Understanding the most commonly billed diagnoses in primary care: Headache disorders.

This article, part of a series about the most commonly billed diagnoses in primary care, describes the pathophysiologic processes of the three most common types of headache disorders as well as how the clinical manifestations and treatments are linked to the pathogenesis of the disorders.

A Case Report: The CSF Characteristics of HaNDL Syndrome.

BACKGROUND: Headache and Neurologic Deficits with cerebrospinal fluid Lymphocytosis (HaNDL) is a rare and underdiagnosed syndrome that mimics recurrent stroke, migraine with aura, and encephalitis. OBJECTIVE: Describe the presentation, clinical characteristics, and cerebrospinal fluid (CSF) findings in a patient with HaNDL and provide insight into the importance of the recognition of this syndrome. METHODS: The authors describe a unique case of (HaNDL) during which the patient underwent three lumbar punctures over 26 days. RESULTS: The authors demonstrate the natural course of CSF characteristics of a patient with HaNDL, with rising and falling lymphocyte counts. Additionally, the authors provide an example of the clinical presentation of HaNDL, with episodic attacks over the course of 1 month of migraine headache, hemibody paresthesias, hemibody weakness, and encephalopathy. CONCLUSIONS: HaNDL is a headache syndrome mimicking viral encephalitis, migraine with aura, and recurrent cerebral ischemic events. While HaNDL is a diagnosis of exclusion, the syndrome's association with characteristic clinical and laboratory findings are important to recognize. Furthermore, a monophasic pattern of CSF lymphocytosis in HaNDL may be observed. IMPLICATIONS FOR NURSING: Increased recognition of this syndrome may help prevent unnecessary tests and treatments when patients present with recurrent episodes.

La cefalea y la salud del trabajador de enfermería: análisis de una realidad / No disponible

Este es un estudio transversal que tuvo como objetivo determinar la prevalencia del dolor de cabeza en un equipo de enfermería en un hospital de la comunidad en el interior de Rio Grande do Sul. La recolección de datos se realizó mediante un cuestionario auto-administrado a todos los empleados del equipo, haciendo un total de 168 sujetos. Los datos fueron analizados mediante estadística descriptiva según el análisis de la distribución de frecuencias. La prevalencia de la cefalea en la población estudiada fue de 98%. El estrés fue citado como un factor desencadenante en el 68% de los cuestionarios analizados y el tratamiento farmacológico se utiliza por el 86% de esta población. La migraña y la cefalea tensional son los tipos predominantes. Los datos muestran que la cefalea puede ser considerada como un importante problema de salud pública del trabajador de enfermería y, por tanto, ponen de manifiesto la necesidad de inversiones en un ambiente sano para ellos (AU)

This is a cross-sectional study aimed to determine the prevalence of headaches in a nursing team in a community hospital in inland Rio Grande do Sul/BR. Data collection was made by a self-administered questionnaire to all employees of the team, making a total of 168 subjects. Data were analyzed using descriptive statistics by analyzing frequency distribution. The prevalence of headaches found in the study population was 98%. Stress was cited as a trigger factor in 68% of the questionnaires analyzed and pharmacological treatment is used for 86% of this population. Migraine and tension headache were the prevalent types. The data show that headaches can be considered a major public health problem in nursing and, therefore, reveal the need for investments in healthy nursing environments (AU)

Botox treatment for migraine and chronic daily headache in adolescents.

Children and adolescents experience headaches as do adults and usually present with migraine and chronic daily or tension-type headaches. As some adolescents are unable to achieve headache relief after various treatment strategies, we currently provide botulinum toxin type A (Botox) injections as a clinical treatment (off-label use) in selected cases. Botulinum toxin type A by injection has been found to be effective in the treatment of headache disorders in adults. We treated 12 adolescents (aged 14 to 18 years) with Botox injections for migraine and chronic daily headache. Six patients (all female adolescents) were in long-term treatment and received Botox in the standard "migraine" and "follow-the-pain" patterns every 3 months. Effectiveness was evaluated using pain scales and a standardized quality-of-life survey at baseline and prior to each treatment session. Duration of treatment was 3-29 months. Each patient had 9-63 (average = 42) injections per treatment. All 6 long-term patients reported improvement in headache symptoms, with decreases on pain scales and an average of 33%-75% improvement in quality of life. Two long-term patients had complete relief of headaches between injection series. Four patients had only one series of injections with good results. Two patients had no improvement and refused additional injections. Side effects were mild ptosis (n = 1), blurred vision (n = 1), hematoma at neck injection site with tingling in one arm lasting 24 hours (n = 1), and burning sensations at all injection sites which lasted 1 week (n = 1). Our group findings warrant a controlled trial evaluation of Botox because it may be an effective treatment option for certain adolescents with intractable migraine and chronic daily headaches.

Migraine and chronic daily headache management: implications for primary care practitioners.

AIMS AND OBJECTIVES: The aim of this paper is to outline the classifications of migraine and chronic daily headaches (i.e. headaches occurring at more than 15 days per month) and briefly describe their epidemiology and management. After outlining the patients' management behaviours, this review paper discuss the implications for primary care practitioners, including general practitioners and nurses. Finally the paper sets out current resources for headache education for healthcare practitioners. BACKGROUND: There is a scarcity of recent literature about migraine and chronic daily headache in primary care and of the evidence base for best practice. Patients with migraine and headache may see a variety of healthcare professionals and may not always be accessing the best sources of help. METHODS: Various databases were searched, such as CINAHL, Cochrane, Medline, MedlinePubmed and the BMJ. In addition, manual searches were conducted by following on cited references from papers read. RESULTS: The results of the literature reviews were critically read and evaluated by the team and the results are discussed in the critical review presented in this paper. RELEVANCE TO CLINICAL PRACTICE: The paper proposes multidisciplinary working in relation to migraine and headache management in primary healthcare, using an evidence-based approach that stresses the importance of making the correct diagnosis, patient focused management and appropriate referrals to appropriate agencies to maximize benefits for patients.