Différences entre versions de « Céphalées »
De médecine.top
Ligne 16 : | Ligne 16 : | ||
* 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. | * For patients with a history of episodic migraine with typical aura that no longer responds to appropriate NSAIDs, guidelines recommend the use of triptans. | ||
+ | ** Par exemple: [https://compendium.ch/product/62624-imigran-spray-nasal-10-mg Imigran® spray nasal] 1×10/20 mg dans une narine, répéter après 2h, max 40 mg/24h | ||
==== Traitement au long cours ==== | ==== Traitement au long cours ==== |
Version du 21 décembre 2021 à 07:50
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.
- Par exemple: Imigran® spray nasal 1×10/20 mg dans une narine, répéter après 2h, max 40 mg/24h
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
- ↑ Cours médecine Prof Philippe Ryvlin et Patrik Michel, UNIL CHUV
- ↑ https://mksap18.acponline.org/app/topics/nr/mk18_a_nr_s1/mk18_a_nr_s1_4