The Medical clinics of North America
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The treatment of headache disorders in patients with concomitant medical illness constitutes one of the more challenging areas of headache therapy. As new agents are added to our pharmacologic armamentarium, it will become easier to tailor therapy to our patients. The physician who treats the headache patient with concomitant medical illness must be particularly aware of drug side effects and pharmacology in order to prevent a worsening of underlying medical conditions or an exacerbation of headaches.
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Migraine equivalents and complicated migraine are entities in which definition is difficult, presentations are pleomorphic, diagnosis is treacherous, pathophysiology is obscure, and treatment is uncertain. A useful principle is to regard them as diagnoses of exclusion that require aggressive and comprehensive investigation. Rational treatment consists of migraine prophylaxis using agents with minimal vasospastic potential and, in some cases, acetylsalicylic acid for platelet disaggregation. The prognosis for both complicated migraine and migraine equivalents is good; when patients with these diagnoses come to harm, it is often because the diagnosis is incorrect.