Continuum : lifelong learning in neurology
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Continuum (Minneap Minn) · Aug 2015
Emergency Department and Inpatient Management of Status Migrainosus and Intractable Headache.
This article discusses the treatment of status migrainosus in the emergency department and the treatment of intractable migraine in an inpatient setting. ⋯ Treatment of status migrainosus and intractable migraine should focus on adequate fluid hydration and combination IV therapy with multiple nonopioid medications from multiple drug classes. Dopamine receptor antagonists appear to have some of the highest medical evidence for efficacy.
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A thunderclap headache is a very severe headache that reaches its maximum intensity within 1 minute. Patients with thunderclap headache must be evaluated emergently and comprehensively to rule out underlying disorders that can be associated with high mortality and morbidity, determine the cause for the thunderclap headache, and initiate targeted therapy. This review presents an up-to-date summary on the clinical presentation, diagnostic evaluation, and causes of thunderclap headache. ⋯ Patients with thunderclap headache require an emergent and comprehensive evaluation to identify the underlying cause and to initiate appropriate therapy.