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LEARNING OBJECTIVES

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LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

  1. Differentiate types of headache syndromes based on clinical features.

  2. Recommend nonpharmacologic measures for headache treatment and prevention.

  3. Determine when the pharmacologic treatment of headache is indicated.

  4. Construct individualized treatment regimens for the acute and chronic management of headache syndromes.

  5. Monitor headache treatment to ensure its safety, tolerability, and efficacy.

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KEY CONCEPTS

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  • Image not available. Headache may be a primary condition or a secondary one arising from an underlying medical disorder.

  • Image not available. Most primary headache syndromes are benign and can be classified as migraine, tension-type, or cluster.

  • Image not available. Tension-type headache is the most prevalent and can be episodic or chronic.

  • Image not available. Migraine headache can be further classified as with or without aura.

  • Image not available. The short-term goal of headache treatment is pain relief; the long-term goal is preventing recurrence.

  • Image not available. The pharmacologic treatment of headache should be provided promptly to improve response to therapy.

  • Image not available. Several clinical markers, so-called red flags, have been identified that warrant urgent physician referral and further diagnostic evaluation.

  • Image not available. Prophylactic treatment is indicated if headaches are frequent, severe, or require the use of pain relievers two or more times per week.

  • Image not available. Treatment regimens should be individualized: based on the pattern of occurrence, response to therapy, medication tolerability, and comorbid medical conditions.

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INTRODUCTION

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Headache is a common medical complaint associated with significant quality of life and economic issues. Image not available. Even when persistent or recurrent, headaches are usually a benign primary condition; secondary headaches are caused by an underlying medical disorder and may be medical emergencies. Primary headache syndromes are the focus of this chapter. Patients may seek headache care from multiple providers. All clinicians should be familiar with the various types of headache, clinical indicators suggesting the need for urgent medical attention or specialist referral, and nonpharmacologic and pharmacologic options for treatment. Image not available. The International Headache Society (IHS) classifies primary headaches as migraine, tension-type, or cluster and other trigeminal autonomic cephalalgias.1 Tension-type headaches (TTHs) are more common than migraine, and both are more common in women than men. Cluster headache is a much less common chronic headache syndrome that affects predominantly men.

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EPIDEMIOLOGY OF HEADACHE DISORDERS

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Migraine Headache

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Migraine is a primary headache disorder that is estimated to affect 10% to 15% of adults in the United States.2 Less than one-half of headaches meeting the diagnostic criteria for migraine are appropriately diagnosed. Migraine runs in families, and its prevalence depends on age and gender. In children younger than 12 years of age, migraines are more prevalent in males. At puberty, this prevalence shifts markedly to women. This change in gender distribution is thought to be due to the hormonal changes of menarche.3 Onset typically occurs between the ages of 10 and 30 years, but the prevalence is greatest between the ages of 35 to 45 years.4 Migraines ...

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