GUIDELINES FOR TREATMENT OF PRIMARY HEADACHES BY THE CROATIAN SOCIETY FOR NEUROVASCULAR DISORDERS OF THE CROATIAN MEDICAL ASSOCIATION AND CROATIAN SOCIETY FOR PAIN PREVENTION

Abstract

Glavobolja je jedno od najčešćih neuroloških stanja koje iziskuje veliku potrebu za lijekovima i ostalim metodama liječenja same akutne faze glavobolje, a po potrebi i za prevenciju ostalih napada glavobolje. Prema Međunarodnoj klasifi kaciji glavobolja razlikujemo primarne glavobolje (migrena i njeni podtipovi, tenzijska glavobolja i njeni podtipovi, trigeminalne autonomne glavobolje i njeni podtipovi) i sekundarne glavobolje (povezane s infekcijom, traumom glave i vrata, kranijskim ili cervikalnim vaskularnim poremećajima, nevaskularnim intrakranijalnim poremećajima, prestankom uzimanja određenih tvari, psihijatrijskim poremećajima, poremećajima kranija, vrata, očiju, ušiju, nosa, sinusa, ustiju te drugih facijalnih ili kranijskih struktura). Kod samog liječenja glavobolja važno je razlučiti primarnu od sekundarne glavobolje, postaviti dijagnozu primarne glavobolje te odlučiti se za liječenje akutne ili preventivne faze. Od analgetika se najčešće primjenjuju nespecifi čni analgetici koji djeluju na široku paletu boli te specifi čni analgetici koji djeluju samo na određenu vrstu glavobolje (npr. triptani kod migrenoznih napada). Osim navedenog u tekstu su spomenute i ostale metode koje se koriste u liječenju glavobolja, a koje uključuju promjenu životnog stila, izbjegavanje provocirajućih faktora, akupunkturu te primjenu botulinum toksina.Introduction: Headache is one of the most common neurologic conditions, which means that there is a great need for medications and other methods of headache treatment for acute pain relief and chronic prevention of headache. Aim: Knowing that headache is one of the most common conditions, we wanted to summarize its treatment. Methods: We performed MEDLINE search about treatment of primary headaches. We also explored HRČAK, the Croatian scientifi c base. Results: We found articles in both scientifi c bases, but we chose only the most systematized ones. Discussion: According to the International Headache Classifi cation, there are two main types of headaches: primary headaches (migraine ant its subtypes, tension type headache ant its subtypes, trigeminal autonomic cephalgias) and secondary headaches (attributed to infection, head or neck trauma, cranial or cervical vascular disorders, non-vascular intracranial disorders, substance withdrawal, psychiatric conditions, pain attributed to disorders of the cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cervical structures). When managing diagnosis of primary headache, it is important to make a difference between primary and secondary headache, manage the right diagnosis of primary headache, and decide on the right treatment for acute or preventive phase of headache. The most widely used medications in headache treatment are nonspecifi c analgesics, which can treat headache but also other pain disorders. Specifi c headache medications include those that can treat only a specifi c type of headache. Besides these, there are other methods in headache treatment, which include lifestyle modifi cation, avoiding provocative factors, acupuncture, and treatment with botulinum toxin. Conclusion:For primary headache treatment, it is important to establish the accurate diagnosis and act fast in treatment of acute headache attack. For some patients, it is important to start prophylactic treatment but also try to prevent medication overuse headache. When treating a headache of any kind, it is also important to take the whole picture of a patient and his/hercomorbidities and think of the possible side effects. Lifestyle modifi cation and some complementary methods can help us in treating chronic headaches