6- headache

Question 1

main HA in ER

Answer 1

tension - 50%
migraine -10%
benign non-specific - 30%
potentially serious 8%
life threatening -1%

Question 2

Sx of migraine

Answer 2

• gradual onset that may wake from sleep - may have aura
• mod- severe
• typically unilateral
• pounding or throbbing
• N/V, photo/phono phobia
• may last 1-2 days

Question 3

migraine triggers

Answer 3

• foods
• stress
• sleep changes
• OCP
• menstrual

Question 4

3 main classes of migraine Tx

Answer 4

1. neuroleptics - haloperidol, chlorpromazine
2. Dopa antag. - metoclopramide, prochlrperazine
3. vasoactives
   + non specific pain mgmt

Question 5

common migraine approach

Answer 5

5-10mg prochloroperazine again in 30 minutes if needed and IV ketrolac (NSAID)

Question 6

ways to diff. tension from migraine

Answer 6

• never occur during sleep
• gradually over the day
• may occur daily
• posterior often
• less bad then mingraine
• associated with stressors
• no N/V photophobia

Question 7

11 serious causes of non-trauma HA

Answer 7

1. subarachnoid
2. temporal arteritis
3. HT encephalopathy
4. pseuodtumor cerebri
5. CO poisoning
6. tumoir
7. meningitis
8. pre-eclampsia
9. cervical artery dissection
10. central venous thrombosis
11. acute angle closure

Question 8

Sx of subarachnoid

Answer 8

• sudden
• occurs with exertion (excercise, sex)
• worst headache of life
• worst at onset
• N/V
• look for: pupil changes, meningismus, alter LOC, focal deficit

Question 9

how helpful is CT in subarachnoid

Answer 9

great if done quickly

Question 10

what to do if suspect and CT normal

Answer 10

LP - may find red cells, xanthochromia

Question 11

causes of raised ICP

Answer 11

mostly tumors, but also

• abscess
• hemmorage
• subdural hematoma

Question 12

Sx of ICP

Answer 12

gradual onset - days-months

• worse when lying/bending
• neuro and focal Sx
• sublte changes in cog., mood, memory
• no N/V photophobia

Question 13

what to do for suspected ICP

Answer 13

CT, maybe MRI

Question 14

5 Sx of meningitis

Answer 14

1. gradual HA
2. fever
3. altered LOC
4. focus of infection
5. meningisus

Question 15

how to Dx meningitis

Answer 15

LP

Question 16

how to manage meningitis

Answer 16

ABx before getting back CT or LP results

- possible dexa

Question 17

4 patient profile of temporal arteritis

Answer 17

1. middle or elderly aged
2. gradual onset over days
3. may have visual changes
4. tenderness

Question 18

tests for GCA

Answer 18

ESP/CRP

- biopsy