Headache is a common presenting complaint for patients in ED, and it is important to be able to differentiate between a 'primary headaches' and 'secondary headaches'. Primary headaches are the 'BIG THREE' and are not caused by an underlying medical condition: - Migraine -Tension type headache - Cluster headache Secondary headaches - Are due to an underlying condition and can be much more serious. Most headaches you'll see in ED will be in the first category of a 'primary headache' and of these, the majority will be migraines. In this lunchtime learning session we'll focus on how to diagnose and treat migraine, and also cover some 'red flags' to look out for which should make you think about the possibility of a 'secondary' cause of headache. HOW TO DIAGNOSE MIGRAINE? HISTORY: Migraine is a clinical diagnosis - meaning that it's a diagnosis made by history and examination. Always ask about RED FLAGS in a headache history (covered at the end of this teach). Consider a gross neurological examination in patients presenting with headache. A useful mnemonic to remember the key features of migraine is POUND Think if I had a 'pound' for everytime I saw a patient with a migraine I'd be rich!
The more of these criteria your patient has the more likely it is to be migraine. Patients with 4 or more of these symptoms have a likelyhood ratio of 24 or a sensitivity of 92% in primary care. Other symptoms that may be present:
Same old symptoms? Or NEW?: Its important to establish if the patient previously suffers from headaches or has a known diagnosis of migraine. If they do, it's important to establish if the symptoms they are having are the same or different to their normal headaches. If the symptoms are new or different this should raise the possibility of an alternative diagnosis and prompt you to consider senior review of the patient/further investigations. TREATMENT OF MIGRAINE: Environment:
Analgesia: Remember the pain ladder:
Antiemetics:
Specific drugs for migraine:
To admit or not?:
WHAt DO WE MEAN BY RED FLAGS?Red flags are symptoms that you should ask about in your headache history that raise the possibility of a secondary cause of headache. If these are present consider a senior review of the patient +/- further investigations/admission. RED FLAGS:
What conditions can these red flags be signs/symptoms of? The diagram below is not a comprehensive list but gives you an idea of other things to consider if red flags are present: References:
Dr Alice Hunter
0 Comments
|
This will be an archive of learning blogs and lunchtime learnings bites!
Archives
February 2023
Categories
All
|