| April 24, 2006 |
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| The physicians and staff of The Neuroscience Group are providing this physician and provider communication to help you stay abreast of issues and updates in the dynamic field of neurosciences, with the goal of helping you provide better overall healthcare services to your patients |
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Migraine Headaches-Differential Diagnosis Tips
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| The first step in treatment of migraines is the proper diagnosis. Sinus headaches are the most misdiagnosed headache. Migraine headaches frequently have associated sinus symptoms; nasal blockage and discharge and facial pressure. Patients will report that their headaches resolve after antibiotics. However migraines typically only last 4-72 hours without treatment during the time patients are on antibiotics. Headache is only a minor symptom during acute sinusitis. Moderate-severe headaches without purulent sinus drainage are most likely migraines. Many patients compare themselves to family members and coworkers with migraines and believe that a migraine is always disabling requiring dark room and bedrest.
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The second most misdiagnosed headaches are tension headaches. Previously patients were diagnosed with tension headaches if their headaches are bilateral and/or associated with neck pain. We now know that 40% of migraines are bilateral and 60% of migraine patients report associated neck pain. Stress is the number one trigger for migraines.
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| The only headaches associated with the menstrual cycle are migraines. Etiology includes decreased estrogen, increased prostaglandins, opioid disregulation and decreased melatonin. Menstrual migraines generally are more intense, with longer duration then headaches the rest of the month. Menstrual migraines occur the week before, during and after menses. |
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| Cluster headaches are rare and occur in men more than women. These headaches are always one sided, periorbital and associated with rhinorrhea, ptosis, and tearing. Cluster headaches will last only 30-90 minutes without medications. Patients may have several headaches in one day and frequently headaches wake them up at night. Headaches occur in clusters lasting several weeks to months. After the cluster, they may not have another headache for months or years. Patients with migraine headaches also may wake up in the night but their headaches will last 4-72 hours without medications. |
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| Chronic daily headaches are diagnosed when patients report more than 15 headaches a month. Eighty percent of chronic daily headaches are due to overuse of abortive medications. Some patients will discuss their more intense headache with their health care providers but neglect to mention their “regular headaches” which they have been treating with Excedrin migraine on a daily basis. Prophylactic medications are less effective when patients overuse abortive medications at the same time. |
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| The headache clinic at the Neuroscience Group was developed to improve access for evaluation of headache patients and for education. New patient visits are an hour with typically frequent follow up calls to reevaluate plan. All headache patients are given a headache log book to track progress. Follow up visits are a half hour to review their headache log and plan of care. Multidisciplinary meetings are held a couple days a week to review new patients and follow up patients with special needs. |
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