Neurology
Headache Classification & Management
Neurology

Headache Classification & Management

Type, signs/triggers, and acute + prophylactic treatment.

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TypePresentationAssociatedManagement
MigraineUnilateral, throbbingAura, N/V, photo/phonophobiaAcute: NSAIDs/triptans. Prophylaxis: propranolol, amitriptyline, topiramate/valproate
ClusterBrief, unilateral severe orbital/temporalIpsilateral autonomic (ptosis, miosis, lacrimation), circadianAcute: 100% O₂. Prophylaxis: verapamil
Medication overuse (rebound)≥15 days/month chronic headacheAcute med use ≥10 days/moStop offending acute med + start preventive
Caffeine withdrawalDiffuse + irritabilityWithin 24 hr of last caffeine + fatigueGradual tapering
IIH↑ICP signsObese young women + papilledema + CN VI palsy + pulsatile tinnitus; LP OP >250Weight loss + acetazolamide; ONSF/shunt if vision threatened
SAHThunderclap, 'worst headache'Meningismus, stupor; ruptured berry aneurysmNon-contrast CT → LP for xanthochromia if neg + suspicion
GCANew headache >50Jaw claudication, scalp tenderness, ESR>50High-dose steroids IMMEDIATELY before temporal artery biopsy

High-yield pearls

  • Migraine + pregnancy → acetaminophen first (avoid NSAIDs especially 3rd trimester; avoid triptans/ergots)
  • Triptans contraindicated with CAD, uncontrolled HTN, pregnancy
  • Estrogen contraceptives contraindicated in migraine WITH AURA (stroke risk); copper IUD is safe
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