364 Ch 363. Headache

Headache = #2 most common cause of ED visit + leading cause of disability worldwide (migraine alone ~ 12% prevalence)；primary (migraine, tension, cluster + other TACs) vs secondary (SAH, meningitis, tumor, GCA, IIH, sinus, etc.)；red flags (SNOOP10): Systemic (fever, weight loss, immunocompromised, cancer), Neurologic deficit/altered LOC, Onset sudden (thunderclap → SAH), Older onset > 50 (GCA), Pattern change/Progressive, Positional, Precipitated by Valsalva, Papilledema, Pregnancy/Postpartum, Posttraumatic, Painful eye with autonomic, Painkillers overuse；migraine: episodic vs chronic (≥ 15 days/mo); with/without aura；CGRP revolution 2018-2024: anti-CGRP mAbs (erenumab Aimovig, fremanezumab Ajovy, galcanezumab Emgality, eptinezumab Vyepti) for prevention; gepants (atogepant Qulipta, rimegepant Nurtec, ubrogepant Ubrelvy, zavegepant Zavzpret nasal 2023) for acute or prevention; lasmiditan Reyvow (ditan, 5HT-1F)；triptans still SOC for moderate-severe acute；cluster headache circadian + circannual + alcohol trigger → high-flow O2 + SC sumatriptan; verapamil + galcanezumab (FDA approved cluster prevention)。