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)