Céphalées

De Médecine
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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.[1]

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.[2]

Traitement de la crise aiguë

  • AINS
  • For patients with a history of episodic migraine with typical aura that no longer responds to appropriate NSAIDs, guidelines recommend the use of triptans.

Traitement au long cours

Céphalées de tension

Céphalées trigéminales autonomes

Cluster headache

  • Cluster headache, the most common of the trigeminal autonomic cephalalgias, is best prevented with verapamil.

Hémicrânie paroxystique bénigne

SUNCT

Céphalées lancinantes idiopathiques

Synonymes: primary stabbing headache, "ice-pick" headache

  • Indomethacin may be helpful during cycles of repeated occurrences but is rarely necessary.

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

Hémorragie sous-arachnoïdienne

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.

Névralgie du trijumeau

  • Carbamazepine is the treatment of choice for trigeminal neuralgia; management with this agent requires serum monitoring for hyponatremia and agranulocytosis.

Références

  1. Cours médecine Prof Philippe Ryvlin et Patrik Michel, UNIL CHUV
  2. https://mksap18.acponline.org/app/topics/nr/mk18_a_nr_s1/mk18_a_nr_s1_4