Headache

With this complaint, it’s ALL about doing a good history and exam.











Step 1: Write Out Your Differential Diagnosis











* The KING* Subarachnoid hemorrhage* The QUEEN* Meningitis* 3 Killers in the BRAIN* Stroke* Hematomas* Elevated ICP/Tumors* 3 Killers in the VESSELS* Arterial dissection* Brain DVT (Dural Venous Sinus Thrombosis)* Giant cell/temporal arteritis* 3 MISCELLANEOUS killers* Preeclampsia* Carbon monoxide toxicity* Glaucoma











Step 2: How Does This Compare to Previous Headaches?











* Finding the answer to this question is not always easy!











Step 3: Do a FULL Neuro Exam











* Mental status* Neck stiffness* Extra-ocular movements* Visual fields* Cranial nerves* Speech* Motor* Sensation* Finger to Nose* Gait











Step 4: Order Tests As Necessary











* CT head without contrast* MRI brain* Lumbar puncture* ESR* Carbon monoxide level











Step 5: Give “Headache Cocktail”











* Mix and match based on personal and patient preferences* IV Dopamine antagonist* IV Antihistamine* IV Steroid* IV NSAIDS* IV Fluids* Tylenol* Triptans and opiates rarely indicated











Additional Reading











* Round 7 – Headache (EM Clerkship)* Round 11 – Headache (EM Clerkship)* Approach to Headache (SAEM)