Headache

Question 1

Are opioids effective in the treatment of migraine?

Answer 1

Opioids are of limited benefit in the treatment of migraine.
Morphine may be ineffective and impede recovery.
Fentanyl should be used only in severe headache where other measures have failed and transport is prolonged.

Question 2

When are paracetamol and prochlorperazine indicated?

Answer 2

Severe headache suspected or previously diagnosed as migraine, irrespective of nausea/vomiting.

Question 3

When should Stemetil be omitted?

Answer 3

It is unlikely to be of benefit in SAH/ICH and these patients will likely be CNS depressed.

Question 4

What should prompt a paramedic to consider a serious intracranial pathology?

List the 5 other warning signs.

Answer 4

Sudden onset severe headache, described as “worst in life” or “thunderclap”.
Especially so if intensity increases with seconds to minutes of onset.

1. Abnormal neuro findings or atypical aura
2. New onset headache in >50’s or pts w/ Hx of CA
3. ALOC or collapse
4. Seizure activity
5. Fever and/or neck stiffness

Question 5

What other management may assist in severe headache?

Answer 5

Fluids in severe dehydration may assist headache.

Question 6

What note is made about cluster headaches?

Answer 6

May not benefit from analgesia. Diagnosed cluster headaches may benefit from high flow O2.

Question 7

What are the 2 Assess points under this guideline?

Answer 7

DDx for suspected ICH and meningococcal septicaemia

Question 8

What are the 5 STOP points under this guideline?

Answer 8

1. If uncertain, treat as ICH under Stroke/TIA
2. Treat Seizures as per Seizures guideline
3. Treat Meningococcal as per Meningococcal guideline
4. If pt presenting with severe headache and suspect ICH, treat pain as per severe headache
5. Stemetil is not indicated for SAH/ICH

Question 9

For a “Headache of Any Severity” management is…?

Answer 9

1. Paracetamol 500mg/1000mg
   with or without
2. Stemetil 12.5mg IM if 21 or older

Question 10

At what point is a headache managed as per Severe Headache?

Answer 10

If after 15 mins of initial therapy headache still severe and hospital remains >15 mins away.

Question 11

What is the management for a Severe Headache?

Answer 11

IV or IN Fentanyl, aim for pain reduction to <7.