All non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, diclofenac, and naproxen, now carry a black box label from the US Food and Drug Administration (FDA) because of their association with increased risk of heart attack. NSAIDs do vary in the amount of risk to the heart, with naproxen

the safest. Other NSAIDs vary in their heart risk, mostly seen in those who use them frequently. Using NSAIDs not more than 2 days a week is generally safe in most individuals who have never had a heart attack. Other acute, as-needed medications that may help CX-4945 dial down the migraine pain without causing blood vessel narrowing include metoclopramide, prochloperazine, diphenhydramine, baclofen, acetaminophen, and gabapentin. Trigger point injections and nerve blocks may also be used. Migraine preventive strategies become very important LY2109761 in individuals with vascular

disease and migraine, as acute treatment options are limited. Topiramate, venlafaxine, and blood pressure medications such as propranolol and candesartan, as well as onabotulinumtoxinA, can be highly effective in decreasing both the intensity and frequency of migraine. In summary, the link of cardiovascular disease and peripheral artery disease with migraine may be present, but it is difficult to separate out from other risk factors often present at the same time such as smoking, diabetes, uncontrolled blood pressure, and other common vascular risks. The presence of coronary artery disease or peripheral vascular disease limits the

use of certain acute and preventive migraine treatments. All medicines that cause artery narrowing should be avoided in the presence of cardiovascular or peripheral vascular disease, but there remain multiple effective treatments to reduce migraine pain and frequency. To find more resources, please visit the American Migraine Foundation (http://kaywa.me/ir2eb) “
“This chapter features an approach to both headache classification and diagnosis. The history of headache classification and the current classification system for headache disorders are first described, Isotretinoin followed by an overview on the approach to the evaluation of a patient with recurrent or daily headache. Then, an outline of a 3 step diagnostic process is presented. First, we emphasize the identification or exclusion of secondary headache disorders by history, physical examination and judicious use of diagnostic tests. Second, 4 groups of primary headache disorders defined based on headache frequency and duration are delineated, and referred to as primary headache syndromes. Finally, the identification of specific disorders within syndromic groups is discussed. “
“A 13-year-old previously healthy female presented at our institution following an acute episode of altered mental status characterized by impairment of speech, urinary incontinence, and emesis.