engleski

Evidence Based Guidelines for Treatment of Primary Headaches : Report of The Croatian Neurovascular Society

A certain proportion of headache patients should be evaluated by a neurologist. These guidelines are developed to help physicians in making the appropriate choices in work-up and treatment of headache patients. Most migraine sufferers have not been diagnosed by a physician and are not receiving medical guidance to effectively address their migraine attacks. In past 15 years new therapies (acute and preventive) have been introduced. In migraine patients nonresponders to analgesics, especially in patients with moderate to severe migraine, triptans should be introduced. In migraine with frequent attacks or long lasting attacks, preventive treatment according to comorbid diseases should be recommended. In tension type headache, an underlying pathology should be excluded ; management includes pharmacological and non-pharmacological treatment. Although rare, patients with cluster headache experience major pain and disability ; in acute management oxygen inhalation or triptans are recommended, in certain cases prophylaxis is indicated. These guidelines contain classification, diagnostic criteria and principles of management of all primary headaches. These recommendations for headache treatment are based on comprehensive review and meta-analysis of scientific literature with regard to treatment possibilities in Croatia. Key words: migraine, tension headache, cluster headache, headache management, pharmacotherapy Introduction Headache disorders constitute a public-health problem with an impact on both individuals and society. The socio-economic burden includes costs associates with health care utilization and costs with missed work due to sickness absence or reduced productivity. A large proportion of headache sufferers are never diagnosed or regularly treated. A patient may present for care of headaches during an attack or during a headache-free period. If a patient presents during a headache, appropriate evaluation (history, examination, appropriate testing) needs to be undertaken acutely. The primary headache disorders which include migraine and tension-type headache account for the majority of headaches ; those with underlying pathology are far less common (tumor, giant cell arteritis, aneurysm) (1). Once the diagnosis is established, acute treatment should be instituted. If the patient has a history of recurrent headaches, a plan for treatment (acute and/or prophylactic) needs to be established. Guidelines are developed to assist the physician in making the appropriate choices in work-up and treatment of patients. The specific aim of the Evidence based guidelines for treatment of primary headaches is to provide recommendations for diagnostic testing in the group of primary headache patients based on a comprehensive review and meta analysis of scientific evidence.

migraine; tension headache; cluster headache; headache management; pharmacotherapy

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