Case 18 - 24 yo with headaches Flashcards
Migraine history
5 episodes of moderate to severe pulsating headache with n/v photophobia, phonophobia, usually unilateral, with aura lasts 4-72 hours
Tension headache history
10 episodes of mild to moderate pressing pain, bilateral, occipital, 30 mins to 7 days, no aura, not aggravated by physical activity
Cluster headache history
5 episodes of severe pain with rhinorrhea, lacrimation, facial sweating, eyelid edema, ptosis, often unilateral, orbital, no aura, 15-180 minutes
Medication overuse (analgesic rebound) headache
rebound of a primary headache from chronic use of analgesics, rx: stop meds
Headache differential: Life threatening diagnoses
- Bacterial meningitis - acute headache, fever, chills, stiff neck, new rash, abnl mental status
- Intracranial hemorrhage - first or worst headache, HTN, abnl neuro exam, recent trauma
- Brain tumor - weight loss, abnl neuro exam
Headache physical exam
- mental status
- musculoskeletal
- neurological - cranial nerves, gait, coordination, look for papilledema
Studies for headache
- imaging not usually recommend, only with headache with atypical patterns or high risk (ex. increasing frequency, marked change in pattern, awakens from sleep)
- LP for possible meningitis
Management of headache
- Non-pharm - headache diary, identify and alleviate triggers
- Acute medications (abortive) - triptans, ergot alkaloids, aspirin, acetominophen, excedrin
- Prophylactic medications: Propanolol, timolol, divalproex, topiramate, amitriptyline, calcium channel blockers,
Appropriate use of narcotics for chronic pain
- understand underlying cause of pain
- use non-pharm remedies first, and then use non-opioids first
- try not to use short acting opioids that have increased tolerance
- have patient sign a narcotic contract, check urine drug screens, check state reporting systems
