Headache
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Resources
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Headache is a common presenting complaint in Australian Emergency departments. The vast majority of presentations are benign however lurking in this sea of well patients are a few with life threatening illnesses. The key challenge as an emergency physician is differentiating these benign and serious presentations. A thorough and precise history is the cornerstone of good decision making here .
The 'red flag' approach to headache that most of us learn in medical school is a good foundation to build upon. DDX Serious / do not miss SAH / ICH Meningitis / Encephalitis / Cerebral Abscess Giant cell arteritis / Tempral arteritis SOL (Hypertensive encephalopathy / pre-eclampsia) Common Tension Headache Migraine Trigeminal neuralgia Other facial pain - toothache, sinusitis etc. Unusual Idiopathic intracranial hypertension Other less common headache syndromes (eg: Cluster) Asessment History - Very important! Red flags that may warrant further investigation -Sudden Onset (Ie 'felt like someone hit me in the back of the head;') +Careful how you ask this question -First headache or most severe headache -Fevers -Bleeding risk (eg anticoagulant) -Hx malignancy -Infection risk (eg immunosupression) -Age > 50 -Pregnant Examination - Focus on Vitals, Temperature,, signs of meningism and neurological examination - Rarely abnormal but abnormal neurological examination makes sinister pathology likely. Don't forget the temporal arteries in the > 50's. Investigation: Not routine! but targeted to exclude life threatening Dx Bedside: HCG if pregnancy possible Blood: Rarely contributory - ESR useful when considering temporal arteritis (>50) CT and LP -Approach to excluding meningitis -Approach to excluding SAH CT within 6 hours for SAH |
Emergency Medicine - Cadogan & Brown
Rosen's - Chapter on headache |