Différences entre versions de « Céphalées »

De médecine.top

Ligne 13 : Ligne 13 :
 
==== Prophylaxie ====
 
==== 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.<ref name="MKSAP>https://mksap18.acponline.org/app/topics/nr/mk18_a_nr_s1/mk18_a_nr_s1_4</ref>
 
* 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.<ref name="MKSAP>https://mksap18.acponline.org/app/topics/nr/mk18_a_nr_s1/mk18_a_nr_s1_4</ref>
 +
== Texte du titre ==
 
==== Traitement de la crise aiguë ====
 
==== Traitement de la crise aiguë ====
 
* AINS
 
* 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 ====
 
==== Traitement au long cours ====
  

Version du 12 mai 2020 à 12:13

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]

Texte du titre

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

Cluster headache

Névralgie du trijumeau

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.

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