Update March 22, 2019

Treatment should be directed at the cause of acute headache.

In patients in whom migraine or migraine-like headache has been diagnosed, early treatment with NSAIDs (oral, nasal, or intramuscular ketorolac), metoclopramide, dihydroergotamine, or triptans (oral, nasal, subcutaneous) can often abort or provide significant relief of symptoms (see Chapter 24). There appears to be no benefit of adding intravenous diphenhydramine to intravenous metoclopramideSumatriptan may be less effective as immediate therapy for migraine attacks with aura compared to attacks without aura. In a double-blind, randomized-controlled trial of 100 patients with migraine, ginger powder appeared to be as efficacious as sumatriptan. Injectable morphine and hydromorphone are best avoided as first-line therapy.

Subanesthetic ketamine infusions may be beneficial in individuals with chronic migraine and new daily persistent headache that has not responded to other aggressive treatments. Peripheral nerve blocks may be a safe and effective way to treat headaches in older adults. Noninvasive vagus nerve stimulation has shown promise in the management of migraine and acute cluster headaches.

High-flow oxygen therapy may also provide effective treatment for all headache types in the emergency department setting. Peripheral nerve blocks for treatment-refractory migraine may be an effective therapeutic option in pregnancy. The oral 5-HT1F receptor agonist, lasmiditan, is currently in clinical trials for the treatment of acute migraine. Other causes of acute headache, such as subarachnoid hemorrhage, intracranial mass, or meningitis, require emergent treatment in the hospital.


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Neurofibromatosis is a genetic disorder that causes tumors to form on nerve tissue. These tumors can develop anywhere in your nervous system, including your brain, spinal cord and nerves. Neurofibromatosis is usually diagnosed in childhood or early adulthood.

The tumors are usually noncancerous (benign), but sometimes can become cancerous (malignant).

Complications of neurofibromatosis can include hearing loss, learning impairment, heart and blood vessel (cardiovascular) problems, loss of vision, and severe pain.

Neurofibromatosis treatment aims to maximize healthy growth and development and to manage complications as soon as they arise. When neurofibromatosis causes large tumors or tumors that press on a nerve, surgery can help ease symptoms. Some people may benefit from other therapies, such as stereotactic radiosurgery or medications to control pain.

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