eMedicine Specialties > Emergency Medicine > Neurology

Headache, Migraine: Follow-up

Author: Michelle Blanda, MD, Chair, Department of Emergency Medicine, Summa Health System; Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine
Coauthor(s): Jeff T Wright, MD, Instructor, Department of Emergency Medicine, Summa Health System; Corporation President and Consulting Staff, Summa Emergency Associates, Inc
Contributor Information and Disclosures

Updated: Sep 28, 2009

Follow-up

Further Outpatient Care

  • Avoid precipitants of attacks, if possible.
  • Follow-up with primary care physician and neurologist after first or subsequent attacks.

Inpatient & Outpatient Medications

  • Multitude of drugs used for migraine prophylaxis
    • Beta-blockers: Atenolol, propranolol, timolol
    • Antidepressants: Amitriptyline (Elavil), nortriptyline (Pamelor)
    • Ergot derivatives: Methysergide (Sansert)
    • Antihistamines: Cyproheptadine (Periactin)
    • Anticonvulsants: Valproic acid (Depakene, Depakote)
  • Abortive therapies
    • Alpha2-adrenergic receptor agonists (Clonidine)
    • Calcium channel blockers: Nimodipine, nifedipine, verapamil
    • NSAIDs

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Must rule out other potentially life-threatening forms of headache (eg, subarachnoid hemorrhage, meningitis).
 


More on Headache, Migraine

Overview: Headache, Migraine
Differential Diagnoses & Workup: Headache, Migraine
Treatment & Medication: Headache, Migraine
Follow-up: Headache, Migraine
References
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References

  1. [Guideline] Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders: 2nd edition. Cephalalgia. 2004;24 Suppl 1:9-160. [Medline].

  2. {Guideline} Matchar DB, Young WB, Rosenberg JA, et al. Evidence-based guidelines for migraine headache in the primary care setting: Pharmacological management of acute attacks. American Academy of Neurology. Available at http://www.aan.com. Accessed October 31, 2007.

  3. [Guideline] Solomon GD, Cady RK, Klapper JA, Ryan RE Jr. Standards of care for treating headache in primary care practice. National Headache Foundation. Cleve Clin J Med. Jul-Aug 1997;64(7):373-83. [Medline].

  4. [Guideline] Ducharme J. Canadian Association of Emergency Physicians Guidelines for the acute management of migraine headache. J Emerg Med. Jan-Feb 1999;17(1):137-44. [Medline].

  5. Cutrer FM, Charles A. The neurogenic basis of migraine. Headache. Oct 2008;48(9):1411-4. [Medline].

  6. [Best Evidence] Brandes JL, Kudrow D, Stark SR, O'Carroll CP, Adelman JU, O'Donnell FJ, et al. Sumatriptan-naproxen for acute treatment of migraine: a randomized trial. JAMA. Apr 4 2007;297(13):1443-54. [Medline].

  7. Bussone G, Grazzi L, D'Amico D, et al. Acute treatment of migraine attacks: efficacy and safety of a nonsteroidal anti-inflammatory drug, diclofenac-potassium, in comparison to oral sumatriptan and placebo. The Diclofenac- K/Sumatriptan Migraine Study Group. Cephalalgia. May 1999;19(4):232-40. [Medline].

  8. Cady R. Migraine. In: Five Minute Clinical Consult. 1997:676-77.

  9. Caesar R. Acute headache management: the challenge of deciphering etiologies to guide assessment and treatment. Emerg Med Rep. 1995;16(13):117-28.

  10. Capobianco DJ, Cheshire WP, Campbell JK. An overview of the diagnosis and pharmacologic treatment of migraine. Mayo Clin Proc. Nov 1996;71(11):1055-66. [Medline].

  11. Diener HC, Kaube H, Limmroth V. A practical guide to the management and prevention of migraine. Drugs. Nov 1998;56(5):811-24. [Medline].

  12. Evans RW. Diagnostic testing for the evaluation of headaches. Neurol Clin. Feb 1996;14(1):1-26. [Medline].

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  15. Lance JW. Current concepts of migraine pathogenesis. Neurology. Jun 1993;43(6 Suppl 3):S11-5. [Medline].

  16. [Guideline] Members of the task force; Evers S, Afra J, Frese A, Goadsby PJ, Linde M. EFNS guideline on the drug treatment of migraine - report of an EFNS task force. Eur J Neurol. Jun 2006;13(6):560-72. [Medline].

  17. Ramirez-Lassepas M, Espinosa CE, Cicero JJ, et al. Predictors of intracranial pathologic findings in patients who seek emergency care because of headache. Arch Neurol. Dec 1997;54(12):1506-9. [Medline].

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  22. Stewart WF, Lipton RB, Celentano DD, et al. Prevalence of migraine headache in the United States. Relation to age, income, race, and other sociodemographic factors. JAMA. Jan 1 1992;267(1):64-9. [Medline].

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  24. Tfelt-Hansen P. Efficacy and adverse events of subcutaneous, oral, and intranasal sumatriptan used for migraine treatment: a systematic review based on number needed to treat. Cephalalgia. Oct 1998;18(8):532-8. [Medline].

  25. Thomas SH, Stone CK. Emergency department treatment of migraine, tension, and mixed-type headache. J Emerg Med. Sep-Oct 1994;12(5):657-64. [Medline].

  26. Thomas SH, Stone CK, Ray VG, et al. Intravenous versus rectal prochlorperazine in the treatment of benign vascular or tension headache: a randomized, prospective, double-blind trial. Ann Emerg Med. Nov 1994;24(5):923-7. [Medline].

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Further Reading

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Keywords

migraine, migraine headache, headache, migraine variant, classic migraine, cluster headache, aura, dizziness, tinnitus, scotomas, photophobia, visual scintillations, bright zigzag lines, migraine with aura, migraine without aura, dopamine receptor hypersensitivity, visual aura, fortification spectra, geometric visual patterns, hemianopsia, blind spots, hallucinations, hemicrania,throbbingheadache, pulsatile headache, lightheadedness, phonophobia, Valsalva maneuvers, hemiplegic migraine, aphasia, third nerve palsy, ophthalmoplegic migraine, ocular muscle paralysis, ptosis, alcohol consumption, fatigue, emotional stress, birth control pills, vasodilators

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Contributor Information and Disclosures

Author

Michelle Blanda, MD, Chair, Department of Emergency Medicine, Summa Health System; Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine
Michelle Blanda, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Jeff T Wright, MD, Instructor, Department of Emergency Medicine, Summa Health System; Corporation President and Consulting Staff, Summa Emergency Associates, Inc
Jeff T Wright, MD is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

Medical Editor

Edward A Michelson, MD, Program Director, Associate Professor, Department of Emergency Medicine, University Hospital Health Systems in Cleveland
Edward A Michelson, MD is a member of the following medical societies: American College of Emergency Physicians, National Association of EMS Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

J Stephen Huff, MD, Associate Professor, Emergency Medicine and Neurology, Department of Emergency Medicine, University of Virginia Health Sciences Center
J Stephen Huff, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Neurology, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Pamela L Dyne, MD, Professor of Clinical Medicine/Emergency Medicine, David Geffen School of Medicine at UCLA; Attending Physician, Department of Emergency Medicine, Olive View-UCLA Medical Center
Pamela L Dyne, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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