Mount Carmel Health Partners Clinical Guidelines Migraine | Página 6

TABLE B: Red Flags Associated with Headaches
Abnormal vital signs including fever and/or elevated WBC New HA under age 5 or over age 50
Altered level of consciousness, decreased cognitive ability,
or personality change Papilledema
Awakens from sleep Worsening of established headache pattern
Carbon monoxide Post-traumatic HA or associated with Valsalva
straining or manipulation
Cerebral venous and sinus thrombosis Pseudotumor cerebri
Drug/toxin-related HA, i.e., sympathomimetic, MAO
inhibitors in combination with tyramine-containing foods Seizure
Exercise or sexual activity or exertion leading to HA Subdural hematoma (warfarin, platelet, or thrombin
inhibitor use)
Focal neurological symptoms, CVA/TIA Sudden onset of “worst headache”
Glaucoma Syncope
Hydrocephalus (N/V, altered vision or level of
consciousness, incontinence) Temporal arteritis (tic douloreaux)
Hypertensive emergency Vertigo
Immunosuppression or associated with HIV Visual disturbance
Lyme disease history Vomiting
Malignancy or tumor Worsening of established headache pattern
TABLE C: Goals of Therapy
Acute Migraine Treatment
Migraine Prophylaxis
Treat attacks quickly and consistently Reduce frequency by 50%
Improve quality of life Reduce intensity and duration of attacks
Optimize self-care for overall treatment Increase efficacy of abortive therapy for acute attacks
Cost-effective drug therapy Eliminate or minimize adverse effects
Eliminate or minimize adverse effects Minimize use of abortive therapy and rescue medications
Diminish impact on activities of daily living
TABLE D: Precipitating and Exacerbating Factors
Precipitating
Exacerbating
Fasting Rapid head motion
Hormones/menstrual cycles Sneezing
Nitrates (cured meats) Straining
Stress, sleep deprivation, or sleep apnea Coughing
Visual stimuli (bright light) Loud noises
Weather/extreme changes in temperature or pressure Strong odors
Wine (especially red)
Migraine - 6
Updated December 2010