Primary care
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This article addresses interesting and enigmatic presentations of headache from a diagnostic and treatment perspective. The emphasis is on migraineurs and other headache patients who represent a significant burden for the primary care provider. In particular, the author focuses on undiagnosed migraine, menstrual migraine, migraine in pregnancy, intractable migraine and status migrainosus,transformed migraine, hemiplegic migraine, basilar migraine, "triptan syndrome," sudden onset of severe headache, post-traumatic headache, and headache in elderly patients.
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Although migraine is a well recognized phenomenon in adults, it is often overlooked or minimized in children and adolescents. Headache is a common complaint in children, and migraine often has its onset in the first two decades of life. Recognition and appropriate treatment can have a significant impact on quality of life for young sufferers and their caregivers and ultimately may affect the course of the illness.
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The authors have a personal philosophy that it is worthwhile for a physician on occasion to be the patient. When this particular physician consults another physician for a medical problem, he is seeking treatment to eradicate that particular problem. ⋯ If we cannot make the proper diagnosis, it is unlikely we will be able to render the appropriate therapy. We need to keep this in mind when we evaluate patients with these headache problems, many of whom have suffered with an incorrect diagnosis for many years.
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Chronic daily headache (CDH) represents one of the most challenging medical conditions that a health care provider is called on to treat. This article outlines the scope of this misunderstood condition,updates the reader on the revised diagnostic criteria for chronic daily headache, and gives practical insight into diagnosis and treatment. Four specific subtypes of CDH are covered: chronic tension-type headache, chronic migraine, new daily persistent headache, and hemicrania continua. Through better recognition and treatment of this all too common condition, this segment of our population can be better helped to lead quality lives.
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Wilderness medicine is not a single entity. It encompasses clinical practice, instruction, and research as they pertain to wilderness settings. Clinical practice often takes place in removed settings far from traditional medical resources and facilities. ⋯ The decision of what treatment should be initiated and if the patient requires evacuation to definitive care often is difficult. There are four phases of an SAR event: location, access, stabilization, and evacuation. Evacuation may require the assistance of organized search and rescue services.