Dawn a Marcus – författare

Migraine is an extremely common condition affecting 28 million Americans. Fully 1 in every 6 adult women suffers from this malady. Patients with migraine are frequently seen in the Emergency Room and Urgent Care Clinic for acute treatment of their headaches. Headache generally accounts for nearly 3 % of all ER visits, resulting in almost 3.5 million visits annually.

There currently are no widely used guidelines for the treatment of patients with headache in the ER or UCC, and reducing the number of CT scans remains a key goal for administrators in many ER or urgent care settings. In one study, 35 drugs, alone or in combination, were used to treat migraine. The most common medication class used was narcotics, which were used in 25% of the visits. The next two most commonly used classes were antiemetics and NSAIDs.  Only 5% of patients seen for headache received headache-specific medications during their visit.

ER and Urgent Care physicians generally have little or no formal training in treating these patients. Consequently, they often feel less comfortable ruling out secondary causes of headaches and using appropriate headache treatment medications and procedures. Since many patients have received narcotics in previous visits, providers may view them as drug seekers. Patients seen in ERs and UCCs for acute treatment of their headaches often report high levels of dissatisfaction. They often end up in the ER or UCC because they don’t have a formal treatment strategy for their severe headaches.

Health plans and insurance agencies are often frustrated by the high cost of fragmented care for patients with headaches. Because of the environment that most ER and UCC providers operate in, many unnecessary scans and tests are done because of uncertainty of the diagnosis and unfamiliarity of the patient.  Primary care physicians are also frustrated by patients with headaches presenting to them after being seen in the ERor UCC, wanting a refill of their narcotics that they were given. Many patients don’t follow up with their PCPs and simply keep returning to the ER/UCC for their treatment.

In short, all involved in the care for patients with headache are frustrated by the current system. The care for these patients is clearly not optimal. It doesn’t have to be that way. There are a wide variety of effective treatment options available, but are underutilized in the acute setting. With these treatment options, patients no longer have to be treated only with parenteral narcotics, only to perpetuate the cycle of suboptimal care described above.

This concise handbook covers all aspects of acute headache care, including care of the child and adolescent with acute headaches, treatment of pregnant and breastfeeding women with acute headaches and appropriate evaluation of secondary headaches.  In addition, two other novel chapters are included: one on caring for older patients with acute headaches as well as a chapter describing how to ensure a seamless transition of the patient back to a headache interested provider.

Headache and Chronic Pain Syndromes provides a case-based approach to state-of-the-art evaluation and treatment of patients with common chronically painful conditions.  Offering strategies for rapidly evaluating and treating pain complaints by body region, this innovative title also provides patient educational handouts that explain the diagnosis and treatment in easy-to-understand language for each condition.  Tools for implementing both medication and non-medication therapies, such as exercises and relaxation techniques, are also included.  Each chapter opens with typical presentations of three to five common patient scenarios, including pediatric, adult, and geriatric patients.  A targeted approach for patient assessment is provided and applied to each scenario, showing how to rapidly identify important clues to distinguish among common diagnoses, including both benign and malignant causes of pain.  Standard treatment regimens are then provided for each patient, along with patient-friendly educational flyers for each common pain condition.  Figures and drawings help provide ready identification of these common chronic pain syndromes.  Headache and Chronic Pain Syndromes offers primary care practitioners, neurologists, and orthopedists an optimal approach to the evaluation, treatment, and follow-up of chronically painful conditions.