Acil serviste akut migren yönetimi

Öz

Baş ağrısı, acil servise en sık başvurulan nörolojik şikâyetlerden biridir. Farklı çalışmalara göre acil servise non-travmatik baş ağrısı şikâyeti ile başvuran hastaların oranı %0.5-4.5 arasındadır. Baş ağrısı ile başvuran hastaların çoğu (%22-55) benign primer baş ağrısıdır. Primer benign baş ağrılarının arasında en sık acil servise başvuru nedeni migren baş ağrısıdır. Migren, en fazla genç yaşlarda olmak üzere tüm yaş gruplarında görülebilmektedir. Erkek/ kadın oranı 1/3 olup prevalansının erkeklerde %5, kadınlarda ise %15-17 olduğu tahmin edilmektedir. Dünya Sağlık Örgütüne göre, sık görülen ve işlevsellik kaybı açısından migren atakları kadınlarda beşinci, erkeklerde ise ilk yirmi hastalık arasında yer almaktadır. Bu nedenle acil serviste migren ataklarının yönetilmesi ve doğru bir şekilde tedavi edilmesi oldukça önemlidir. Bu konu ile ilgili daha önce yapılan derlemeler incelendiğinde, çoğunun oldukça uzun ve detaylı olması nedeniyle acil hekimleri için uygulanabilir olmayabileceği düşünülmüştür.
Bu derlemede acil serviste çalışan hekimlere son bilimsel kılavuzlara dayalı akut migren yönetimi ile ilgili yeterli bilgi verilmesi amaçlanmıştır.

Anahtar Kelimeler

• Migren
• atak tedavisi
• migren tedavisi

Acute migraine management in the emergency department

Abstract

Headache is one of the most common neurological complaints admitted to emergency deprtment (ED). In different studies, the proportion of patients admitted to the emergency room due to nontraumatic headache is around 0.5-4.5%. Most of the patients with headache (22-55%) are benign primary headaches. Among primary headaches, migraine is the most common reason for admission to the emergency department. As can be seen in all ages, it usually occurs at a young age. The male to female ratio is 3: 1 and its prevalence is estimated to be 5% in men and 15-17% in women. According to WHO's list of common diseases, loss of functionality and disability, migraine attacks are in the fifth place in women and among the first twenty diseases in men. Therefore, it is very important to manage migraine attacks in the emergency room. When we look at the previous reviews on this subject, we can deduce that they are not always appropriate for emergency physicians, since most of the articles are quite long and detailed.
Our aim in this review is to give enough information in the light of current information about migraine headache that emergency physicians will need.

Keywords

• Migraine
• attack treatment
• migraine treatments

Kaynakça

1. 1) Bıçakçı Ş, Öztürk M, Üçler S, 2018. current approaches to diagnosis and treatment of headache, Turkish neurology society headache working group practices (10-388), Galenos Publishing, Istanbul. ISBN: 978-605-89294-7-0
2. 2) Cutrer F. M, Wippold II F J, FACR F J. Evaluation of the adult with nontraumatic headache in the emergency department-Uptodate. Literature review current through: Jul 2021. | This topic last updated: Jun 07, 2021.
3. 3) Swadron SP. Pitfalls in the Management of Headache in the Emergency Department. Emergency Medicine Clinics of North America. 2010;28(1):127-147. doi:10.1016/j.emc.2009.09.07
4. 4) Garza I, Schwedt TJ , Overview of chronic daily headache UpToDate. Literature review current through: Jul 2021. | This topic last updated: Jun 01, 2020.
5. 5) The International Classification of Headache Disorders (IHS) CLASSIFICATION ICH-3, https://ichd-3.org/classification-outline/
6. 6) Walls R, Hockberger R, Gausche-Hill M. Headache. In: Rosen's Emergency Medicine: Concepts and Clinical Practice. Saunders WB; 2017:153-159.
7. 7) Stewart WF, Lipton RB, Celentano DD, Reed ML. Prevalence of migraine headache in the United States. Relation to age, income, race and other sociodemographic factors. JAMA 1992;267:64-69.
8. 8) Headache classification of the International Headache Society. The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 2013;33:627-808.

9. 9) Buse DC, Manack AN, Fanning KM, Serrano D, Read ML, Turkel CC, Lipton RB. Chronic migraine prevalence, disability, and sociodemographic factors: Results from the American Migraine Prevalence and Prevention Study. Headache 2012;53:1456-1470.
10. 10) Silberstein S, Loder E, Diamond S, Reed ML, Bigal ME, Lipton RB, with the AMPP Advisory Group. Probable migraine in the United States: Results of the American Migraine Prevalence and Prevention Study. Cephalalgia 2007;27:220-229.
11. 11) Diamond S, Bigal ME, Silberstein S, Loder E, Reed M, Lipton RB. Patterns of diagnosis and acute and preventive treatment for migraine in the United States: Results of the American Migraine Prevalence and Prevention Study. Headache 2007;47:355-363.
12. 12) O. John Ma, Cline D, headache(baş ağrısı) Tintinalli emergency medicine a Comprehensive Study Guide ( Özmen M.) Güneş medical publishing house 2013 (1113-1118).
13. 13) Guidelines HRD. Guidelines of the International Headache Society for controlled trials of acute treatment of migraine attacks in adults: Fourth edition. https://ihs-headache.org/en/resources/guidelines/. Accessed February 1, 2021. https://journals.sagepub.com/doi/full/10.1177/0333102419828967
14. 14) Arsava M, Dericioğlu N, Elibol B, neurology notes (ed. KANSU T) 2013, Hacettepe University publications 26-28
15. 15) Silberstein SD, Holland S, Freitag F, Dodick DW, Argoff C, Ashman E; Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Evidence-based guideline update: Pharmacologic treatment for episodic migraine prevention in adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology 2012;78:1337-1345.
16. 16) Tfelt-Hansen P, Pascual J, Ramadan N; International Headache Society Clinical Trials Subcommittee members: Guidelines for controlled trials of drugs in migraine: Third edition. A guide for investigators. Cephalalgia 2012;32:6-38
17. 17) Henry GL. headache In: Marx JA,Hockberger RS,Walls RM,eds, Rosen's emergency medicine. Concepts and clinical practice. 5th ed. MOSBY. 2002: 149-55
18. 18) Blanda M, Wright JT. Headache, migraine. Updated Sep 3,2008. Http//medicine.medscape.com/article/792267
19. 19) Şerife Örnek, Effectiveness of Intravenous Paracetamol, Dexketoprofen and Ibuprofen in the Treatment of Headache Associated With Acute Migraine Attack, Pamukkale University Emergency Medicine Department, 2020
20. 20) Turkcuer İ, Serinkan M.,Eken C, Intravenous paracetamol versus dexketoprofen in acute migraine attack in the emergency department: a randomised clinical trial. 2014;31(3):182-5.
21. 21) Xu H, Han W, Wang J, Li MJTjoh, pain. Network meta-analysis of migraine disorder treatment by NSAIDs and triptans. 2016;17(1):113.
22. 22) Peck J, Urits I, Zeien J, Hoebee S, Mousa M, Alattar H, et al. A Comprehensive Review of Over-the-counter Treatment for Chronic Migraine Headaches. 2020;24(5):1-9.
23. 23) Mathew N.T. Treatment of Acute Migraine Attacks Headache Handbook. Philadelphia: Lippincott Williams and Wilkins 2005; 60-87
24. 24) Sheridan DC, Spiro DM, Meckler GD. Pediatric migraine: abortive management in the emergency department. 2014; 54(2): 235-45.