Archive for the ‘.headache’ Category

  emergency clinicians do not rule in migraine or other benign causes of headache. unless the headache is congruent to an established pattern for that patient, the history and physical specifically targets these 13 conditions. subarachnoid hemorrhage: family history, PCKD, known berry aneurysm, sudden and maximal intensity at onset, posterior location intracerebral hemorrhage: trauma, coagulopathy, decreased level of consciousness, hypertension CNS infection: fever, immunocompromise, CNS instrumentation, recent head/face infection, meningismus increased intracranial pressure: slowly progressive, cancer history, worse in morning, worse with head in dependent position, papilledema carbon monoxide toxicity: contacts with similar illness, locationality (worse at home or at work) acute angle closure glaucoma: unilateral anterior location, precipitated by darkness, change in vision, red eye temporal (giant cell) arteritis: elderly, temporal location, jaw claudication, shoulder girdle symptoms cervical artery dissection: unilateral pain involving neck/face, trauma history cerebral venous sinus thrombosis: thrombophilia, neurologic signs/symptoms in non-arterial distribution, eyelid edema, proptosis hypertensive encephalopathy: altered mentation, marked hypertension, improves with antihypertensive therapy ENT/dental infection: ear, sinus, dental findings idiopathic intracranial hypertension: young overweight female, hormone use, vision changes preeclampsia: late pregnancy or postpartum

Cephalgia in ED responds to oxygen – High-flow oxygen is commonly used for cluster headache. Might it work for all-comers with headache? – This was a tiny randomized trial with three groups: 17 to high-flow oxygen for 15 minutes, 14 to high-flow air for 15 minutes, and 17 to nothing for 15 minutes prior to standard medical therapy. The oxygen group did far better with regard to time to relief, 40 vs. 110 or 120 minutes; length of stay was 57 vs. 210 or 180 minutes; CT was less; less pharmacotherapy was needed, 29% (oxygen group) vs. mid-80s% in the other groups; and headache intensity was much less using visual analog scale. – Assuming no contraindications to high-flow oxygen, this small trial, if confirmed, could change the way we treat all headaches. – Put high-flow oxygen on your next headache patient, and see if it works. Veysman BD et al. Annals of Emergency Medicine, Volume 54, Issue 3, Pages S71-S71 Antimigraine efficacy has been well demonstrated in multiple high-quality clinical trials for chlorpromazine, metoclopramide, and prochlorperazine, and droperidol. In general, these medications are inexpensive, well tolerated, and at least as efficacious, if not more so, than any agent to which they have been compared. These medications should therefore be considered first-line therapy for acute migraine in the ED setting. Of the four agents mentioned above, chlorpromazine has fallen out of favor because of profound orthostasis that may accompany administration of this medication. Of the remaining three agents, droperidol is probably the most effective, with 2-hour…

Migraine criteria for diagnosis

November 23rd, 2009
by reuben in .headache

Careful with a migraine diagnosis in the ED.

post LP headache tables from J Emerg Med 35:2 p 153

pseudotumor IIH