Doporu\u010den\u00fd postup pro praktick\u00e9 l\u00e9ka\u0159e<\/p>\n
Doporu\u010den\u00fd postup u migr\u00e9ny pro praktick\u00e9 l\u00e9ka\u0159e I. \uf0a7 Charakteristika p\u0159edm\u011btu doporu\u010den\u00e9ho postupu (definice a vymezen\u00ed chorobn\u00e9ho stavu) Migr\u00e9na je chronick\u00e9, rekurentn\u00ed, benign\u00ed a\u00a0paroxysm\u00e1ln\u00ed\u00a0onemocn\u011bn\u00ed, \u010dasto\u00a0famili-\u00e1rn\u00edho\u00a0v\u00fdskytu. Charakteristick\u00fdm klinick\u00fdm projevem jsou akutn\u00ed ataky v\u011bt\u0161inou jed-nostrann\u00fdch\u00a0bolest\u00ed hlavy st\u0159edn\u00ed a\u017e velk\u00e9 intenzity, variabiln\u00ed frekvence (pr\u016fm\u011brn\u011b 1-6 atak za jeden m\u011bs\u00edc) a r\u016fzn\u00e9ho trv\u00e1n\u00ed (4 a\u017e 72 hodin). Ataky migr\u00e9ny jsou\u00a0zpravi-dla\u00a0doprov\u00e1zeny foto- a\u00a0fonofobi\u00ed, nevolnost\u00ed a zvracen\u00edm. N\u011bkdy p\u0159edch\u00e1zej\u00ed boles-tem hlavy p\u0159echodn\u00e9 neurologick\u00e9 fok\u00e1ln\u00ed poruchy, trvaj\u00edc\u00ed n\u011bkolik minut a\u017e jednu hodinu (aura \u2013 viz klinick\u00fd obraz). \uf0a7 Hlavn\u00ed epidemiologick\u00e9 charakteristiky (frekvence) dle aktu\u00e1ln\u00edho stavu Epidemiologick\u00e9 \u00fadaje z\u00a0\u010cesk\u00e9\u00a0republiky nejsou k dispozici. P\u0159i pou\u017eit\u00ed kriteri\u00ed\u00a0klasifi-kace\u00a0migr\u00e9ny podle IHS (1988) je celosv\u011btov\u00e1 jednoro\u010dn\u00ed prevalence migr\u00e9ny mezi 6% do 12% u mu\u017e\u016f a 15% do 25% u \u017een. Nejv\u011bt\u0161\u00ed prevalence migr\u00e9ny je u mu\u017e\u016f i \u017een ve v\u011bku 30-49 let. Migr\u00e9na je v \u010cR zna\u010dn\u011b\u00a0poddiagnostikovan\u00e1\u00a0a nedostate\u010dn\u011b l\u00e9\u010dena. \uf0a7 Podstata struktur\u00e1ln\u00edch a funk\u010dn\u00edch zm\u011bn (patofyziologie) Patofyziologie migr\u00e9ny nen\u00ed do v\u0161ech detail\u016f zn\u00e1ma. P\u0159edpokl\u00e1d\u00e1 se, \u017ee bolesti\u00a0hla-vy\u00a0migren\u00f3zn\u00edho\u00a0z\u00e1chvatu jsou spu\u0161t\u011bny aktivac\u00ed \u201egener\u00e1toru migr\u00e9ny\u201c v mozkov\u00e9m kmeni r\u016fzn\u00fdmi spou\u0161t\u011bc\u00edmi\u00a0fakotory.\u00a0Antidromn\u00edm\u00a0podr\u00e1\u017ed\u011bn\u00edm vl\u00e1ken\u00a0trigemino-vaskul\u00e1rn\u00edho\u00a0syst\u00e9m doch\u00e1z\u00ed k\u00a0vasodilataci,\u00a0extravazaci\u00a0proteinu, v\u00fdvoji\u00a0neurogenn\u00ed-ho\u00a0vaskul\u00e1rn\u00edho\u00a0z\u00e1n\u011btu s vylu\u010dov\u00e1n\u00edm\u00a0neuropeptid\u016f.\u00a0Algick\u00e9\u00a0podn\u011bty vstupuj\u00ed p\u0159es vl\u00e1kna\u00a0trigeminu\u00a0zp\u011bt do mozkov\u00e9ho kmene a\u00a0projikuj\u00ed\u00a0se do\u00a0talamu\u00a0a mozkov\u00e9 k\u016fry. D\u016fle\u017eit\u00e1 je i nedostate\u010dn\u00e1 \u010dinnost syst\u00e9mu endogenn\u00ed kontroly bolest\u00ed. II. \uf0a7 Klinick\u00fd obraz onemocn\u011bn\u00ed Migr\u00e9na bez aury Z\u00e1chvat migr\u00e9ny se vyskytuje v\u011bt\u0161inou po probuzen\u00ed, kolem 80 % nemocn\u00fdch\u00a0pozo-ruje\u00a0nevolnost a zvracen\u00ed, asi 50 % nemocn\u00fdch m\u00e1 nechutenstv\u00ed a netoleruje p\u0159\u00edjem j\u00eddla.\u00a0Fotofobie\u00a0a\u00a0fonofobie\u00a0pat\u0159\u00ed do klinick\u00e9ho obrazu migr\u00e9ny. Jednotliv\u00e1\u00a0ataka\u00a0trv\u00e1 bez l\u00e9\u010dby n\u011bkolik minut a\u017e hodin, maxim\u00e1ln\u011b pak 3 dny. Intenzita je st\u0159edn\u00ed a\u017e velk\u00e1 a omezuje b\u011b\u017enou ka\u017edodenn\u00ed \u010dinnost. V\u011bt\u0161inou jsou bolesti jednostrann\u00e9 (60-70%), n\u011bkdy oboustrann\u00e9. Jde o bolesti\u00a0pulzujc\u00ed,\u00a0akcentovan\u00e9\u00a0fyzickou aktivitou. Migr\u00e9na s aurou Bolestem hlavy a doprovodn\u00fdm p\u0159\u00edznak\u016fm migr\u00e9ny p\u0159edch\u00e1z\u00ed aura,\u00a0trvaj\u00edc\u00a0\u00edm\u00e9n\u011b\u00a0ne\u017e 60 minut. Bolesti hlavy pak za\u010d\u00ednaj\u00ed b\u011bhem aury, ihned po skon\u010den\u00ed aury nebo po intervalu krat\u0161\u00edm ne\u017e 60 minut. U n\u011bkter\u00fdch nemocn\u00fdch p\u0159edch\u00e1zej\u00ed z\u00e1chvatu mi-gr\u00e9ny\u00a0prodromy\u00a0(a\u017e 24 hodin p\u0159ed z\u00e1chvatem): \u00fanava, chu\u0165 na n\u011bkter\u00e1 j\u00eddla,\u00a0depre-se, rozlady, retence vody. Po skon\u010den\u00ed z\u00e1chvatu maj\u00ed\u00a0migreniky\u00a0euforii nebo depresi, v\u011bt\u0161\u00ed\u00a0diur\u00e9zu, \u00fanavu. Aura m\u016f\u017ee b\u00fdt vizu\u00e1ln\u00ed, senzitivn\u00ed,\u00a0sensorick\u00e1, motorick\u00e1\u00a0ane-bo sm\u00ed\u0161en\u00e1. Typick\u00e1 je vizu\u00e1ln\u00ed aura:\u00a0fosf\u00e9ny, barevn\u00e9 z\u00e1blesky,\u00a0hemianopsie,\u00a0scinti-la\u010dn\u00ed\u00a0skotomy, \u0161\u00ed\u0159\u00edc\u00ed se\u00a0skotomy, blik\u00e1n\u00ed a vln\u011bn\u00ed v zorn\u00e9m poli, deformace p\u0159edm\u011bt\u016f. M\u00e9n\u011b \u010dast\u00e9 jsou\u00a0parest\u00e9zie\u00a0a\u00a0hemiparest\u00e9zie\u00a0(40 %), motorick\u00e9 poruchy (18 %), po-ruchy \u0159e\u010di (17-20 %). V p\u0159\u00edpadech, \u017ee p\u0159\u00edznaky aury trvaj\u00ed v\u00edce ne\u017e 60 minut (kompli-kovan\u00e1 migr\u00e9na), provedeme CT \u010di\u00a0MRI. P\u0159i trv\u00e1n\u00ed z\u00e1chvatu del\u0161\u00edm ne\u017e 72 hodin hovo\u0159\u00edme o status\u00a0migrenosus. Vz\u00e1cn\u011bj\u0161\u00ed jsou n\u011bkter\u00e9 varianty migr\u00e9ny:\u00a0oftalmoplegick\u00e1\u00a0migr\u00e9na,\u00a0retin\u00e1ln\u00ed\u00a0migren\u00e1,\u00a0bazil\u00e1rn\u00ed\u00a0migr\u00e9na. \uf0a7 Postup p\u0159i p\u00e9\u010di poskytovan\u00e9 na po\u010d\u00e1tku a v pr\u016fb\u011bhu onemocn\u011bn\u00ed Nemocn\u00fd s bolestmi hlavy v\u011bt\u0161inou hled\u00e1 prim\u00e1rn\u011b pomoc u praktick\u00e9ho l\u00e9ka\u0159e, jeho\u017e hlavn\u00edm \u00fakolem je rozpoznat, zda se jedn\u00e1 o prim\u00e1rn\u00ed nebo o sekund\u00e1rn\u00ed typ bolesti hlavy. Nemocn\u00fd s typickou nekomplikovanou migr\u00e9nou nebo\u00a0tenzn\u00edm\u00a0typem bolesti hlavy m\u016f\u017ee z\u016fstat v p\u00e9\u010di praktick\u00e9ho l\u00e9ka\u0159e. P\u0159i ne\u00fasp\u011bchu l\u00e9\u010dby nebo\u00a0zhor-\u0161en\u00ed\u00a0\u010di zm\u011bn\u011b stavu (v\u011bt\u0161\u00ed po\u010det z\u00e1chvat\u016f, atypick\u00e9 projevy aury, v\u00fdskyt lo\u017eiskov\u00fdch p\u0159\u00edznak\u016f) mus\u00ed b\u00fdt nemocn\u00fd odesl\u00e1n k neurologovi pop\u0159. do poradny (centra) pro diagnostiku a l\u00e9\u010dbu bolest\u00ed hlavy. P\u0159i podez\u0159en\u00ed na \u201ecluster headache\u201c nebo jin\u00e9 bo-lestzi\u00a0hlavy bez struktur\u00e1ln\u00ed l\u00e9ze je nemocn\u00fd v\u017edy odesl\u00e1n k neurologovi. Po po-drobn\u00e9m neurologick\u00e9m vy\u0161et\u0159en\u00ed a vylou\u010den\u00ed\u00a0sekundarity\u00a0mohou b\u00fdt nemocn\u00ed d\u00e1le v p\u00e9\u010di praktick\u00e9ho l\u00e9ka\u0159e. Nemocn\u00ed s t\u011b\u017ekou,\u00a0resistentn\u00ed\u00a0\u010di komplikovanou migr\u00e9nou a pacienti s diagn\u00f3zou \u201ecluster headache\u201c jsou nad\u00e1le l\u00e9\u010deni na neurologick\u00e9m pra-covi\u0161ti\u00a0pop\u0159. v centru (poradn\u011b) pro diagnostiku a l\u00e9\u010dbu bolest\u00ed hlavy. P\u0159i podez\u0159en\u00ed na sekund\u00e1rn\u00ed typ bolesti hlavy je nemocn\u00fd odesl\u00e1n k\u00a0p\u0159islu\u0161n\u00e9mu\u00a0odborn\u00edkovi. \uf0a7 Diagnostika, diferenci\u00e1ln\u011b diagnostick\u00fd postup Neexistuje \u017e\u00e1dn\u00fd objektivn\u00ed diagnostick\u00fd test, kter\u00fd by byl pou\u017eiteln\u00fd k diagnostice migr\u00e9ny. Rozhoduj\u00edc\u00ed je pe\u010dliv\u00e1 anamn\u00e9za pop\u0159. s pou\u017eit\u00edm standardizovan\u00e9ho do-tazn\u00edku. Diferenci\u00e1ln\u00ed diagn\u00f3za migr\u00e9ny mus\u00ed b\u00fdt zam\u011b\u0159ena k ostatn\u00edm prim\u00e1rn\u00edm bolestem hlavy a k sekund\u00e1rn\u00edm (organicky podm\u00edn\u011bn\u00fdm) typ\u016fm bolesti hlavy. A. Ostatn\u00ed prim\u00e1rn\u00ed bolesti hlavy Nej\u010dast\u011bj\u0161\u00edm typem prim\u00e1rn\u00edch bolest\u00ed hlavy jsou tenzn\u00ed bolesti hlavy (prevalence 69 % u mu\u017e\u016f a 88 % u \u017een). Bolesti hlavy jsou oboustrann\u00e9, v\u011bt\u0161inou tlakov\u00e9 a tup\u00e9, m\u00edrn\u00e9 \u010di st\u0159edn\u00ed intenzity. Chyb\u00ed nausea a zvracen\u00ed, vz\u00e1cn\u011b jsou\u00a0fotofobie\u00a0\u010di\u00a0fonofo-bie. Velmi \u010dasto se tento typ\u00a0vykytuje\u00a0sou\u010dasn\u011b s migr\u00e9nou (\u201emixed headache\u201c). Mezi chronick\u00e9 ka\u017edodenn\u00ed bolesti hlavy pat\u0159\u00ed transformovan\u00e9 migr\u00e9ny, chronick\u00e9 tenzn\u00ed bolest\u00ed hlavy, nov\u00e9\u00a0persistentn\u00ed\u00a0denn\u00ed bolesti hlavy a\u00a0hemikrania\u00a0continua. Bolesti hlavy se vyskytuj\u00ed denn\u011b a trvaj\u00ed d\u00e9le ne\u017e 4 hodiny. Velmi \u010dasto je p\u0159\u00ed\u010dinou t\u011bchto bolest\u00ed hlavy\u00a0nadu\u017eiv\u00e1n\u00ed\u00a0analgetik a ergotaminu. V\u00fdznamn\u00e9 pro praxi jsou chronick\u00e9 sekund\u00e1rn\u00ed bolesti hlavy po traumatech lebky a mozku, p\u0159i\u00a0cerebrovaskul\u00e1rn\u00edch\u00a0onemocn\u011bn\u00edch, chronick\u00e9 bolesti hlavy v r\u00e1mci\u00a0tro-lebn\u00ed\u00a0hypertenze (n\u00e1dory, infekce),\u00a0sinusit\u00edd,\u00a0odontogenn\u00edch\u00a0afekc\u00ed\u00a0aj. Cluster headache je pom\u011brn\u011b vz\u00e1cn\u00fdm typem prim\u00e1rn\u00edch bolest\u00ed hlavy (O,5%). Vy-skytuje\u00a0se p\u0159ev\u00e1\u017en\u011b u mu\u017e\u016f (pom\u011br mu\u017ei:\u017eeny 8:1), jedn\u00e1\u00a0ataka\u00a0a\u017e maxim\u00e1ln\u011b 8 atak denn\u011b v period\u00e1ch trvaj\u00edc\u00edch t\u00fddny a\u017e m\u011bs\u00edce. Mezi periodami jsou\u00a0remise\u00a0trva-j\u00edc\u00ed m\u011bs\u00edce a\u017e roky. Jde o bolesti velmi intenzivn\u00ed, striktn\u011b jednostrann\u00e9 s\u00a0periorbit\u00e1ln\u00edm\u00a0maximem a \u0161\u00ed\u0159en\u00edm do \u0161ir\u0161\u00edho okol\u00ed. Bolesti jsou nej\u010dast\u011bji no\u010dn\u00ed, nemocn\u00fd je neklidn\u00fd a \u010dasto chod\u00ed po m\u00edstnosti. Jeden z\u00e1chvat trv\u00e1 maxim\u00e1ln\u011b 3 hodiny. Charakteristick\u00e9 jsou vegetativn\u00ed doprovodn\u00ed p\u0159\u00edznaky jako\u00a0stejnostrann\u00e1\u00a0lakrimace,\u00a0hyperemie\u00a0spojivek, otok nosn\u00ed sliznice, parci\u00e1ln\u00ed\u00a0Horner\u016fv\u00a0syndrom, p\u0159e-krven\u00ed\u00a0k\u016f\u017ee. B. Sekund\u00e1rn\u00ed bolesti hlavy Sekund\u00e1rn\u00ed bolesti hlavy vid\u00edme \u010dasto u v\u00e1\u017en\u011bj\u0161\u00edch onemocn\u011bn\u00ed. Kdy m\u00e1me myslet na tento typ bolesti hlavy? Kdy\u017e se intenzivn\u00ed bolest\u00ed hlavy objevuj\u00ed poprv\u00e9 v \u017eivot\u011b ve v\u011bku nad 55 let, p\u0159edch\u00e1z\u00ed t\u011blesn\u00e1 n\u00e1maha, intenzita progresivn\u011b\u00a0n\u00e1r\u016fst\u00e1\u00a0a boles-ti hlavy jsou spojeny s ment\u00e1ln\u00edmi poruchami,\u00a0hemipar\u00e9zou\u00a0\u010di nitrolebn\u00ed hypertenz\u00ed. Kter\u00e9 jsou hlavn\u00ed p\u0159\u00ed\u010diny? U\u00a0intrakrani\u00e1ln\u00edch\u00a0n\u00e1dor\u016f jsou bolesti hlavy\u00a0progreduj\u00edc\u00edho\u00a0typu a velmi \u010dasto zjist\u00edme lo\u017eiskov\u00e9 p\u0159\u00edznaky (hemipar\u00e9zy, af\u00e1zie, epileptick\u00e9 z\u00e1chvaty).\u00a0Meningitidy\u00a0jsou do-prov\u00e1zeny\u00a0meninge\u00e1ln\u00edm\u00a0dr\u00e1\u017ed\u011bn\u00edm a vzestupem t\u011blesn\u00e9 teploty, bolesti hlavy jsou dif\u00fazn\u00ed a doprov\u00e1zeny nevolnost\u00ed a poruchami v\u011bdom\u00ed. Rozhoduj\u00edc\u00ed je n\u00e1lez\u00a0likvoru. U absces\u016f mozku se vyskytuj\u00ed progresivn\u00ed, velmi siln\u00e9 a\u00a0resistentn\u00ed\u00a0bolesti hlavy u 70-90 % nemocn\u00fdch. Velmi d\u016fle\u017eitou diagn\u00f3zou u star\u0161\u00edch nemocn\u00fdch s bolestmi hlavy (nad 50 let) je tempor\u00e1ln\u00ed\u00a0ateriit\u00edda. Tempor\u00e1ln\u00ed arterie jsou\u00a0palpa\u010dn\u011b\u00a0bolestiv\u00e1 a pravideln\u011b pozorujeme vy\u0161\u0161\u00ed hodnoty sedimentace \u010derven\u00fdch krvinek. Rozhoduj\u00edc\u00ed je biopsie tempor\u00e1ln\u00ed arterie. Velmi d\u016fle\u017eit\u00e9 v diferenci\u00e1ln\u00ed diagnostice migr\u00e9ny jsou funk\u010dn\u00ed poruchy p\u00e1te\u0159e, zvl. kr\u010dn\u00ed p\u00e1te\u0159e, onemocn\u011bn\u00ed vedlej\u0161\u00edch dutin nosn\u00edch,\u00a0odontogenn\u00ed\u00a0poruchy, glaukom, poruchy\u00a0temporomandibul\u00e1rn\u00edho\u00a0sklouben\u00ed a neural-gie\u00a0mozkov\u00fdch nerv\u016f. \uf0a7 L\u00e9\u010debn\u00fd postup\u00a0Nemedikament\u00f3zn\u00ed\u00a0intervence Prvn\u00edm krokem by m\u011bla b\u00fdt snaha ovlivnit spou\u0161t\u011bc\u00ed faktory\u00a0migren\u00f3zn\u00edch\u00a0bo-lest\u00ed\u00a0hlavy. V ur\u010dit\u00fdch situac\u00edch je u\u017eite\u010dn\u00e1 psychoterapie, relaxa\u010dn\u00ed cvi\u010den\u00ed, redukce stresu, fyzioterapie (zvl\u00e1\u0161t\u011b u nemocn\u00fdch s funk\u010dn\u00edmi poruchami hybn\u00e9ho syst\u00e9mu). Efekt akupunktury je nejist\u00fd a nekonstatntn\u00ed, chyb\u00ed dosud klinicky kontrolovan\u00e9 studie. Homeopatick\u00e9 metody nedoporu\u010dujeme. Medikament\u00f3zn\u00ed l\u00e9\u010dba \uf0a7 Akutn\u00ed l\u00e9\u010dba U lehk\u00e9 migr\u00e9ny pod\u00e1v\u00e1me jednoduch\u00e1 analgetika v dostate\u010dn\u00e9 d\u00e1vce a v\u010das, nejl\u00e9pe v dob\u0159e rozpustn\u00e9 form\u011b (nap\u0159. kys. acetylsalicylov\u00e1 0,75 – 1 g, para-cetamol 0.75 – 1g) nebo nesteroidn\u00ed antiflogistika (ibuprofen 800 mg, Indome-tacin 100mg supp., naproxen 500 mg, diclofenac 50 – 100 mg). Vhodn\u00e1 je kombinace s metoclopramidem (Migpriv, Migr\u00e4nerton). Kombinova-n\u00e9 formy analgetik s kofeinem, kodeinem atd. (Ataralgin, Algifen, Quarelin, Di-nyl, Talvosilen forte, Spasmoveralgin aj.) pod\u00e1v\u00e1me jen opatrn\u011b a kontrolova-n\u011b. U st\u0159edn\u00ed migr\u00e9ny pod\u00e1v\u00e1me analgetika a antiflogistika parenter\u00e1ln\u011b, pop\u0159. v kombinaci s metoclopramidem. P\u0159i ne\u00fasp\u011bchu jsou na m\u00edst\u011b specifick\u00e1 anti-migrenika (triptany), kter\u00e1 jsou l\u00e9ky volby u v\u0161ech t\u011b\u017ek\u00fdch migr\u00e9n. V \u010cR jsou k dispozici: Sumatriptan (Imigran 50 mg, 100 mg tbl., Imigran na-z\u00e1ln\u00ed spray, Imigran 6 mg.inj. sc.), Zolmitriptan (Zomig tbl. 2,5 mg), Eletriptan (Relpax tabl. 40mg a 80 mg), Naratriptan (Naramig tbl. 2,5 mg), Rizatriptan (Maxalt tbl. 5 a 10 mg, Maxalt rapid 5 a10 mg) \uf0a7 Profylaxe Dobr\u00e1 odezva profylaxe je takov\u00e1, kter\u00e1 redukuje frekvenci i intenzitu bolesti hlavy o 50 %. L\u00e9ky prvn\u00ed volby profylaxe migr\u00e9ny jsou: kyselina valproov\u00e1 a valpro\u00e1ty (Convulex, Depakine Chrono, Orfiril). \u00da\u010dinn\u00fd jsou gabapentin (Neurontin) a topiram\u00e1t (Topamax). D\u00e1le jsou dobr\u00e9 zku\u0161enosti s beta-blok\u00e1tory (metoprolol, atenolol), blok\u00e1tory kalciov\u00e9ho p\u0159et\u00ed\u017een\u00ed (Flunarizin, Cinarizin, Verapamil). L\u00e9ky druh\u00e9 volby jsou tricyklick\u00e1 antidepresiva (Amitriptylin, Prothiaden), SSRI (Deprex, Seropra, Citalec, Zoloft aj.). Osv\u011bd\u010duj\u00ed se magn\u00e9zium. III. \uf0a7 Progn\u00f3za Progn\u00f3za migr\u00e9ny je zpravidla p\u0159i adekv\u00e1tn\u00ed, modern\u00ed profylaktick\u00e9 a akutn\u00ed l\u00e9\u010db\u011b dobr\u00e1. Je v\u0161ak nutno po\u010d\u00edtat s t\u00edm, \u017ee jde v\u011bt\u0161inou o celo\u017eivotn\u00ed chronic-k\u00e9 onemocn\u011bn\u00ed, v\u00fdznamn\u011b sni\u017euj\u00edc\u00ed \u017eivotn\u00ed pohodu. \uf0a7 Prevence V prevenci migr\u00e9ny se sna\u017e\u00edme ovlivnit \u010di odstranit n\u011bkter\u00e9 spou\u0161t\u011bc\u00ed faktory\u00a0migren\u00f3zn\u00edch\u00a0z\u00e1chvat\u016f: abusus alkoholu, kou\u0159en\u00ed, nedostatek sp\u00e1nku, p\u0159\u00edjem n\u011bkter\u00fdch potravin (aromatick\u00fd s\u00fdr, citrusy, glutam\u00e1t aj.), stres, deprese aj., funk\u010dn\u00ed poruchy hybn\u00e9ho syst\u00e9mu. Nej\u00fasp\u011b\u0161n\u011bj\u0161\u00ed b\u00fdv\u00e1 razantn\u00ed zm\u011bna \u017eivot-n\u00edho stylu. \uf0a7 Posudkov\u00e1 hlediska Velmi t\u011b\u017ek\u00fd z\u00e1chvat migr\u00e9ny je v\u017edy p\u0159\u00ed\u010dinou kr\u00e1tkodob\u00e9 pracovn\u00ed neschop-nosti (1 \u2013 3 dny). Pracovn\u00ed neschopnost jue nutn\u00e1 v\u017edy po dobvu trv\u00e1n\u00ed z\u00e1-chvatu. Velmi frekventn\u00ed a t\u011b\u017ek\u00e1 migr\u00e9na, resdistentn\u00ed k l\u00e9\u010db\u011b, m\u016f\u017ee b\u00fdt p\u0159\u00ed\u010di-nou \u010d\u00e1ste\u010dn\u00e9ho \u010di \u00fapln\u00e9ho invalidn\u00edho d\u016fchodu. \uf0a7 Literatura 1. Lance JW, Goadsby PJ: Mechanism and Management of Headache. 6. v\u00fdd., Butterworth Heinemann Oxford, 1998 2. Medov\u00e1 E, Kalvach P: Migr\u00e9na, minimum pro praxi. Triton, Praha, 1998 3. Prusinski A: Migr\u00e9na. Avicenum, Praha, 1988 4. Waber\u017einek G.: Bolesti hlavy. Triton, Praha. 2000 5. Waber\u017einek G, Markov\u00e1 J: Bolesti hlavy – diagnostick\u00fd a l\u00e9\u010debn\u00fd stan-dard. \u010cesk\u00e1 a Slov. Neurol. Neurochir. 1998; 61\/94, 90-91. 6. Waber\u017einek G., Keller, O., Markov\u00e1, J.: Bolesti hlavy. Sou\u010dasn\u00e1\u00a0klasifi-kace, diagn\u00f3za a l\u00e9\u010dba. T\u00e9matick\u00e1 p\u0159\u00edloha. \u010cesk\u00e1 a Slov. Neurol. a Neurochir. 1988; 62\/95, 5. Autor: Doc. MUDr. Gerhard Waber\u017einek, CSc. Neurologick\u00e1 klinika LF UK Hradec Kr\u00e1lov\u00e9 a FN Hradec Kr\u00e1lov\u00e9 Diagnostika migr\u00e9ny Anamn\u00e9za: bolesti hlavy u dosp\u011bl\u00fdch z\u00e1chvatovit\u00e9 siln\u00e9 a\u017e velmi siln\u00e9 bolesti hlavy, chronick\u00e9, tup\u00e9 bolesti hlavy, p\u0159ev\u00e1\u017en\u011b jednostrann\u00e9, zhor\u0161uj\u00edc\u00ed se n\u00e1mahou, pulzuj\u00edc\u00ed, \u010dasto se zvracen\u00edm a nevolnost\u00ed, postupn\u011b se zhor\u0161uj\u00edc\u00ed n\u011bkdy s fotofobi\u00ed a\u00a0fonofobi\u00ed, projevy lo\u017eiskov\u00e9 l\u00e9ze CNS, trv\u00e1n\u00ed n\u011bkolik hodin a\u017e n\u011bkolik dn\u00ed ne\u00fa\u010dinnost analgetik bez dal\u0161\u00edch p\u0159\u00edznak\u016f organick\u00e9ho onemocn\u011bn\u00ed CNS prim\u00e1rn\u00ed bolesti hlavy sekund\u00e1rn\u00ed bolesti hlavy 1. Migr\u00e9na CT,\u00a0MRI, likvor, EEG: 2. Tenzn\u00ed bolesti hlavy vylou\u010den\u00ed\u00a0sekundarity\u00a03. Cluster headache 4. Jin\u00e9 bolesti hlavy l\u00e9\u010dba dle p\u0159\u00ed\u010diny bez organick\u00e9 l\u00e9ze CNS P\u0159i zm\u011bn\u011b typu bolesti hlavy, vzniku bolesti po n\u00e1maze zvl. ve v\u011bku nad 50 let, p\u0159i projevech lo\u017eiskov\u00e9 l\u00e9ze CNS jin\u00fdch ne\u017e b\u011b\u017en\u00e1 aura a podez\u0159en\u00ed na sekundaritu CT,\u00a0MRI, angiografie, EEG, likvor a l\u00e9\u010dba dle v\u00fdsledku<\/p>\n","protected":false},"excerpt":{"rendered":"
Doporu\u010den\u00fd postup pro praktick\u00e9 l\u00e9ka\u0159e Doporu\u010den\u00fd postup u migr\u00e9ny pro praktick\u00e9 l\u00e9ka\u0159e I. \uf0a7 Charakteristika p\u0159edm\u011btu doporu\u010den\u00e9ho postupu (definice a vymezen\u00ed chorobn\u00e9ho…<\/p>\n","protected":false},"author":23,"featured_media":0,"parent":3047,"menu_order":171,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"_searchwp_excluded":"","kia_subtitle":"","footnotes":""},"class_list":["post-3118","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"\n