Primary care
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Headache research has been a productive area, and understanding of primary headache pathophysiology has increased greatly. There are many more questions that need to be answered to gain a better understanding of the primary headache process. For the clinician,there is value in understanding the pathophysiology of primary headache, because this understanding can help improve diagnostic acumen and shape treatment plans to provide patients with more effective treatment.
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Medication overuse headache may complicate any type of headache and occurs in young people, adults, and even elderly patients. Overuse of acute medications may change intermittent or self-limited headaches into chronic daily headache. ⋯ Prophylactic therapies are often ineffective in the setting of medication overuse. Recognition of this condition allows appropriate clinical intervention that includes cessation of the offending medications.
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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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Women have more migraine than men. Some secondary headaches are more common in women. Menses, pregnancy, and menopause have an impact on the frequency and treatment of headache. Oral contraceptives can be used in women with migraine with some precautions.
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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.