tailieunhanh - Chapter 015. Headache (Part 18)

Secondary (Symptomatic) SUNCT SUNCT can be seen with posterior fossa or pituitary lesions. All patients with SUNCT/SUNA should be evaluated with pituitary function tests and a brain MRI with pituitary views. SUNCT/SUNA: Treatment Abortive Therapy Therapy of acute attacks is not a useful concept in SUNCT/SUNA since the attacks are of such short duration. However, intravenous lidocaine, which arrests the symptoms, can be used in hospitalized patients. Preventive Therapy Long-term prevention to minimize disability and hospitalization is the goal of treatment. The most effective treatment for prevention is lamotrigine, 200–400 mg/d. Topiramate and gabapentin may also be effective. Carbamazepine, 400–500 mg/d, has been reported by. | Chapter 015. Headache Part 18 Secondary Symptomatic SUNCT SUNCT can be seen with posterior fossa or pituitary lesions. All patients with SUNCT SUNA should be evaluated with pituitary function tests and a brain MRI with pituitary views. SUNCT SUNA Treatment Abortive Therapy Therapy of acute attacks is not a useful concept in SUNCT SUNA since the attacks are of such short duration. However intravenous lidocaine which arrests the symptoms can be used in hospitalized patients. Preventive Therapy Long-term prevention to minimize disability and hospitalization is the goal of treatment. The most effective treatment for prevention is lamotrigine 200-400 mg d. Topiramate and gabapentin may also be effective. Carbamazepine 400-500 mg d has been reported by patients to offer modest benefit. Surgical approaches such as microvascular decompression or destructive trigeminal procedures are seldom useful and often produce long-term complications. Greater occipital nerve injection has produced limited benefit in some patients. Mixed success with occipital nerve stimulation has been observed. Complete control with deep-brain stimulation of the posterior hypothalamic region was reported in a single patient. For intractable cases short-term prevention with intravenous lidocaine can be effective. Chronic Daily Headache The broad diagnosis of chronic daily headache CDH can be applied when a patient experiences headache on 15 days or more per month. CDH is not a single entity it encompasses a number of different headache syndromes including chronic TTH as well as headache secondary to trauma inflammation infection medication overuse and other causes Table 15-10 . Population-based estimates suggest that about 4 of adults have daily or near-daily headache. Daily headache may be primary or secondary an important consideration in guiding management of this complaint. Table 15-10 Classification of Chronic Daily Headache Primary 4 h Daily 4 h Daily Secondary Chronic migraine Chronic cluster .