Migraine treatment: a chain of adverse effects.
This clinical vignette presents a 14 years old female, with a past medical history relevant only for migraine with typical aura of less than monthly frequency, complaining of a severe unilateral headache with rising intensity for the previous 4 h, associated with nausea, vomiting, photophobia and phonophobia. This episode of migraine with aura in a patient with recurrent migraine was complicated by side effects of medical diagnostic and therapeutic procedures (extrapyramidal symptoms, delirium, post-lumbar puncture headache, hospital admission) all of which could have been prevented-quaternary prevention. This case illustrates several important messages in migraine management: (1) use of acetaminophen is not based in high-quality evidence and better options exist; (2) among youngsters, domperidone should be preferred over metoclopramide because it does not cross the blood-brain barrier; (3) moderate to severe migraine crisis can be managed with triptans in teenagers over 12 years old; (4) it is important to recognize adverse drug effects; (5) harmful consequences of medical interventions do occur; (6) the school community must be informed about chronic diseases of the young.
Family Medicine Resident, Garcia de Orta Family Health Unit, West Porto Group of Health Centres, Porto, Portugal ; Neurosciences and Mental Health Department, Medical Psychology Unit, Faculty of Medicine of the University of Porto, Porto, Portugal.
Tiago Sousa
TS
Veloso
Family Medicine Resident, Ramalde Family Health Unit, West Porto Group of Health Centres, Porto, Portugal.
Mariana Seixas
MS
Cambão
Diskinesia, drug-induced (MeSH term); Drug-related side effects and adverse reactions (MeSH term); Inappropriate prescribing (MeSH term); Migraine disorders (MeSH term); Prescribing cascade; Quaternary prevention