Migraine headache clinical presentation

Tension-type headache (TTH) is the most common primary headache disorder. It is often underrepresented in clinical practice, as many patients do not present for care.6 The term tension-type headache is used to describe all headache syndromes in which muscle contraction is the most significant factor in the pathogenesis of pain. The 1-year prevalence of TTH in the population ranges from 30% to 90%.6 It is more common in adult females. Environmental factors, as opposed to genetic predisposition, play a more central role in their development. Tension-type headaches can be further divided into episodic or chronic the mean frequency of attacks is 3 days per month in episodic disorders, and chronic TTH is defined as 15 or more attacks in a 1-month period.7 The estimated prevalence of chronic TTH is less than 5%.6 Some researchers believe that chronic TTHs represent a continuum of headache severity with migraine headache.8 When severe headaches are difficult to differentiate clinically, treatment should initially target TTH. 

The source of the ergot strongly influences the type of alkaloids present, as well as the clinical picture of ergotism [171]. The ergot alkaloids have three types of physiological effects they cause contraction of smooth muscle, they block the action of serotonin and adrenaline, and they act on the hypothalamic-pituitary system to inhibit the secretion of prolactin. These properties have led to their being used to induce uterine contractions, to relieve migraine headaches, and to treat prolactin-dependent disorders. 

HPI KO is a 57-year-old man with a history of migraine headaches and MTN who just completed a course of antibiotics for an upper respiratory infection. He had a severe migraine headache for which he took 10 tablets of ergotamine over 6 hours. He is presenting to the ambulatory care clinic with complaints of muscle cramps and numbness in his extremities. Medications Ergotamine 2 mg at onset of headache, then 1 mg every 30 minutes until headache resolution metoprolol and erythromycin for 10 days, KO has NKDA. 

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