Category: Headache-Pain

AKA Idiopathic Intracranial hypertension (IHH) Pseudo = False False or mimic a tumor in the brain No brain tumor but has increased intracranial pressure Main symptoms: Headache 90% Transient visual obscurations (blurring, lasting seconds) 70% Intracranial noises (pulsatile tinnitus) 60% Photopsia (floaters): 50% Back pain 50% Retrobulbar pain 40%...

IIH is most commonly seen in obese woman of child bearing age. Clinical features Persistent headache Blurred vision papilledema 6th nerve palsy otherwise normal neuro exam IIH without papilledema (IIHWOP) Tests MRI head wo and w contrast MRV to check for venous thormbosis Lumbar puncture: opening pressure over 25...

If migraine frequently recurs during a specific period of the menstrual cycle, or become worse during menopause, then estrogen related migraine needs to be considered. The treatment approach is different from the regular migraine. Hormone related migraine, mechanism and treatment Decline in estrogen Beginning of menstrual cycle Postpartum Scheduled...

Dose over 50 MME/day, greater than 2x risk for overdose MME = Morphine milligram equivalent Over 50 MME means over 50 mg of hydrocodone (Norco) or over 33 mg of oxycodone or over 12 mg of methadone For other drugs, use conversion table to calculate...

Acute migraine treatment options Emergency Setting Sumatriptan 6 mg sq Metoclopramide 10 mg iv Dihydroergotaimne (DHE 45) 1 mg iv Ketorolac 30 mg iv or 60 mg im Dexamethasone: 10-25 mg iv or im to reduce early recurrence NSAID Ketorolac: 30 mg iv or 60 mg im Indomethacin 50...

Beta Blocker: avoid in bradycardia, copd, asthma First trimester exposure did not show increase in major congenital malformations Metoprolol ER: start 50 mg qd available in 50, 100, 200 mg up to 200 mg per day Propronol ER: start 40 mg qd, available in 60, 80, 120, 160 mg...