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      CME: Neuartige Kopfschmerzen bei Erwachsenen: evidenzbasiertes Vorgehen für die Praxis Translated title: New-Onset Headache in Adults: Evidence-Based Assessment in the Primary Care Setting

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          Abstract

          Zusammenfassung. Viele Menschen leiden an Kopfschmerzen. Die häufigsten primären (idiopathischen) Kopfschmerzen, wie Migräne oder der Kopfschmerz vom Spannungstyp, führen zwar oft zu Einschränkungen im beruflichen und privaten Leben, sind aber nicht gefährlich. Dem gegenüber stehen die sekundären (symptomatischen) Kopfschmerzen, die Symptome einer unter Umständen lebensbedrohlichen Erkrankung sein können. Hier kann neben der hausärztlich organisierten erweiterten Diagnostik (Bildgebung, Blutentnahme, Lumbalpunktion) auch eine notfallmässige Krankenhauseinweisung erforderlich sein. In diesem Artikel fassen wir die empfohlenen Schritte zur Abklärung neuartiger Kopfschmerzen in der hausärztlichen Praxis zusammen.

          New-Onset Headache in Adults: Evidence-Based Assessment in the Primary Care Setting

          Abstract. Many people suffer from headaches. Primary (idiopathic) headaches such as migraine and tension type headaches are most common. They may significantly affect occupational and social aspects of daily life, but are usually not dangerous. On the contrary, secondary (symptomatic) headaches may be a symptom for an underlying life-threatening disorder. In these cases, the primary care physician may need to organize certain diagnostic measures such as brain imaging, blood work or lumbar puncture. Sometimes, emergency hospital admission may be required. In this article we summarize the recommended steps for the assessment of new-onset headaches in patients visiting the primary care practice.

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          [Headache in the emergency department].

          Headache is one of the most frequent symptoms leading to visits at the emergency department. Here, we aim at presenting a pragmatic algorithm for headache patients at the emergency department. The basic principle is taking a detailed history of the current headache with a focus on dynamics, phenotype and trigger factors as well as a possible preexisting headache. "Red flags" should be interrogated specifically. Hypotheses of the etiology of the headache should be generated in combination with the clinical examination (vital signs, neurological exam, otorhinolaryngological and ophthalmological exams) and should be tested appropriately with imaging, laboratory, cerebral spinal fluid studies and ultrasound. Secondary headache have to be treated with a causal approach, if necessary also symptomatically. When a secondary headache can be excluded, we recommend aiming for a primary headache diagnosis with subsequent specific therapy. When a headache patient can be discharged, we recommend scheduling a follow-up appointment to understand the development of a secondary headache and its cause. In case of a primary headache, optimizing prophylaxis and acute therapy is important to prevent future emergency department visits.
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            Guidelines of the International Headache Society for controlled trials of acute treatment of migraine attacks in adults: Fourth edition

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              The International Classification of Headache Disorders

              (2018)
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                Author and article information

                Contributors
                Journal
                prx
                Praxis
                Hogrefe AG, Bern
                1661-8157
                1661-8165
                May 2021
                : 110
                : 7
                : 355-361
                Affiliations
                [ 1 ]Klinik für Neurologie, Universitätsspital Zürich und Universität Zürich
                Author notes
                Prof. Dr. med. Susanne Wegener, Klinik für Neurologie, Universitätsspital Zürich (USZ), Frauenklinikstrasse 26, 8091 Zürich, susanne.wegener@ 123456usz.ch
                Article
                prx_110_7_355
                10.1024/1661-8157/a003688
                727d75ae-6dff-49dd-b26d-0fd7f77ac7ae
                Veröffentlicht unter der Hogrefe OpenMind-Lizenz (https://doi.org/10.1026/a000002)

                Veröffentlicht unter der Hogrefe OpenMind-Lizenz ( https://doi.org/10.1026/a000002

                History
                : 24. März 2021
                Categories
                Continuing Medical Education

                General medicine,Medicine,Cardiovascular Medicine,Radiology & Imaging,Respiratory medicine,Pharmacology & Pharmaceutical medicine
                Abklärung von Kopfschmerzen,Primäre und sekundäre Kopfschmerzen,assessment of headaches,Primary and secondary headaches,migraine,Migräne

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