Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- cefaleia prolongada
- náuseas e/ou vômitos
- capacidade reduzida de desempenhar atividades
- piora na cefaleia com a prática de atividades
- sensibilidade à luz
- sensibilidade ao ruído
- unilateral
- sensação pulsátil
- aura
Risk factors
- história familiar de enxaqueca
- sexo feminino
- obesidade
- eventos vitais estressantes
- uso excessivo de medicamentos
- distúrbios do sono
- condição socioeconômica baixa
- alergias ou asma
- hipotireoidismo
Diagnostic tests
1st tests to order
- diagnóstico clínico
Tests to consider
- velocidade de hemossedimentação (VHS)
- proteína C-reativa
- punção lombar (PL)
- cultura do líquido cefalorraquidiano (LCR)
- ressonância nuclear magnética (RNM) cranioencefálica
- tomografia computadorizada (TC) do crânio
- angiografia
Treatment algorithm
apresenta-se ao pronto-socorro com enxaqueca persistente
sintomas leves: não gestante
sintomas moderados a graves: não gestante
gestante
sintomas recorrentes frequentes, graves/incapacitantes, não relacionados ao ciclo menstrual: não gestante
sintomas recorrentes frequentes, graves/incapacitantes, relacionados ao ciclo menstrual: não gestante
sintomas graves/incapacitantes recorrentes frequentes: gestante
Contributors
Authors
Timothy A. Collins, MD
Associate Professor of Neurology
Chief
Headache Division
Department of Neurology
Duke University Medical Center
Durham
NC
Disclosures
TAC provides expert testimony for legal cases regarding headache disorders and treatment (approximately one or two cases per year). TAC is an author of several references cited in this topic.
Acknowledgements
Dr Timothy Collins would like to gratefully acknowledge Dr Ann Donnelly, the previous contributor to this topic.
Disclosures
AD declares that she has no competing interests.
Peer reviewers
Anne Walling, MD
Professor
Family and Community Medicine
University of Kansas School of Medicine
Wichita
KS
Disclosures
AW declares that she has no competing interests.
Marc S. Husid, MD
Director
Walton Headache Center
Augusta
GA
Disclosures
MSH declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Ailani J, Burch RC, Robbins MS, et al. The American Headache Society consensus statement: update on integrating new migraine treatments into clinical practice. Headache. 2021 Jul;61(7):1021-39.Full text Abstract
Eigenbrodt AK, Ashina H, Khan S, et al. Diagnosis and management of migraine in ten steps. Nat Rev Neurol. 2021 Aug;17(8):501-14.Full text Abstract
Becker WJ, Findlay T, Moga C, et al. Guideline for primary care management of headache in adults. Can Fam Physician. 2015 Aug;61(8):670-9.Full text Abstract
Worthington I, Pringsheim T, Gawel MJ, et al. Canadian Headache Society Guideline: acute drug therapy for migraine headache. Can J Neurol Sci. 2013 Sep;40(5 suppl 3):S1-S80.Full text Abstract
VanderPluym JH, Halker Singh RB, Urtecho M, et al. Acute treatments for episodic migraine in adults: a systematic review and meta-analysis. JAMA. 2021 Jun 15;325(23):2357-69.Full text Abstract
Orr SL, Friedman BW, Christie SC, et al. Management of adults with acute migraine in the emergency department: the American Headache Society evidence assessment of parenteral pharmacotherapies. Headache. 2016 Jun;56(6):911-40.Full text Abstract
Silberstein SD, Holland S, Freitag F, et al; 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. Neurology. 2012 Apr 24;78(17):1337-45.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Cefaleia tensional
- Cefaleia em salvas
- Cefaleia por uso excessivo de medicamentos
More DifferentialsGuidelines
- Prevention of episodic migraine headache using pharmacologic treatments in outpatient settings: a clinical guideline from the American College of Physicians
- The international classification of headache disorders, 3rd edition
More GuidelinesPatient information
Enxaqueca: perguntas a fazer ao seu médico
Enxaqueca
More Patient informationVideos
Punção lombar diagnóstica em adultos: vídeo de demonstração
Canulação venosa periférica – Vídeo de demonstração
More videos
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer