Céphalées

Céphalées primaires

Migraine

Caractéristiques

• Unilatérale, pulsatile
• (Assez) sévère
• Symptômes végétatifs ++
  • Anorexie, vomissements

  • Photo/phonophobie
  • 
 Augmentation des douleurs avec mouvements de la tête
• Patient veut se retirer dans l’isolement
• Formes épisodiques vs chronique
• 20% avec «aura»: symptômes neurologiques focaux progressifs sur 5-20 min.

Prophylaxie

• Metoprolol, propranolol, timolol, divalproex sodium, and topiramate all have Level A evidence for prevention of episodic migraine and should be considered for migraine occurring at a frequency of at least 5 days per month.

Traitement de la crise aiguë

• AINS

Céphalées secondaires

Red flags

• First or worst headache
• Abrupt-onset or thunderclap attack
• Progression or fundamental change in headache pattern
• Abnormal physical examination findings
• Neurologic symptoms lasting longer than 1 hour
• New headache in persons younger than 5 years or older than 50 years
• New headache in patients with malignancy, coagulopathy, immunosuppression, or pregnancy
• Association with alteration in or loss of consciousness
• Headache triggered by exertion, sexual activity, or Valsalva maneuver

Céphalées en coup de tonnerre

Thrombose d'un sinus intra-crânien

• Treatment with low-molecular-weight heparin results in lower hospital mortality than treatment with unfractionated heparin. Anticoagulation with warfarin is generally continued for a minimum of 3 to 6 months. Extended anticoagulation should be considered in those with severe hypercoagulable states, myeloproliferative disorders, or recurrence and perhaps in those with idiopathic thrombosis.