tailieunhanh - Chapter 015. Headache (Part 13)

Commonly used preventives are listed with reasonable doses and common side effects. Not all listed medicines are approved by the FDA; local regulations and guidelines should be consulted. b Not available in the United States. The probability of success with any one of the antimigraine drugs is 50– 75%. Many patients are managed adequately with low-dose amitriptyline, propranolol, topiramate, gabapentin, or valproate. If these agents fail or lead to unacceptable side effects, second-line agents such as methysergide or phenelzine can be used. Once effective stabilization is achieved, the drug is continued for 5–6 months and then slowly tapered to assess the continued need | Chapter 015. Headache Part 13 Commonly used preventives are listed with reasonable doses and common side effects. Not all listed medicines are approved by the FDA local regulations and guidelines should be consulted. Not available in the United States. The probability of success with any one of the antimigraine drugs is 5075 . Many patients are managed adequately with low-dose amitriptyline propranolol topiramate gabapentin or valproate. If these agents fail or lead to unacceptable side effects second-line agents such as methysergide or phenelzine can be used. Once effective stabilization is achieved the drug is continued for 5-6 months and then slowly tapered to assess the continued need. Many patients are able to discontinue medication and experience fewer and milder attacks for long periods suggesting that these drugs may alter the natural history of migraine. newpage Tension-Type Headache Clinical Features The term tension-type headache TTH is commonly used to describe a chronic head-pain syndrome characterized by bilateral tight bandlike discomfort. The pain typically builds slowly fluctuates in severity and may persist more or less continuously for many days. The headache may be episodic or chronic present 15 days per month . A useful clinical approach is to diagnose TTH in patients whose headaches are completely without accompanying features such as nausea vomiting photophobia phonophobia osmophobia throbbing and aggravation with movement. Such an approach neatly separates migraine which has one or more of these features and is the main differential diagnosis from TTH. However the International Headache Society s definition of TTH allows an admixture of nausea photophobia or phonophobia in various combinations illustrating the difficulties in distinguishing these two clinical entities. Patients whose headaches fit the TTH phenotype and who have migraine at other times along with a family history of migraine migrainous illnesses of childhood or typical .