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Reading Clin Med Fall 2023 > Headache 2-11: Acute Headache > Flashcards

Headache 2-11: Acute Headache Flashcards

1
Q

What is the most common reason that adults seek medical care

A

Headache
*accounts for 13 million visits each year
*5th most common reason for ED visit is
*2nd most common reason for neurologic consultation in the ED

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2
Q

What is the challenge to the initial evaluation of an acute headache?

A

To identify which patients are presenting with an uncommon but life-threatening condition
*1% of patients fall into this category

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3
Q

If a headache lessens in severity while on typical migraine therapies does that rule out critical conditions?

A

No
*critical conditions such as subarachnoid hemorrhage or meningitis

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4
Q

What is a sentinel headache

A

Happens before a subarachnoid hemorrhage (days or weeks)
1. Sudden
2. Intense
3. Persistent headache

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5
Q

How can an acute headache be classified as?

A
  1. Vascular events
  2. Infections
  3. Intracranial masses
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6
Q

What will aid in the diagnosis of a certain type of HA

A

Having the patient carefully describe the onset of headache

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7
Q

What is the typically description of a thunderclap headache

A
  1. Sudden onset headache
  2. Reaches maximal and severe intensity within seconds or a few minutes
    *subarachnoid hemorrhage
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8
Q

What is the estimated prevalence of subarachnoid hemorrhage in patients with a thunderclap HA

A

45%

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9
Q

If there is a thunderclap Ha during the postpartum period that is precipitated by the valsalva maneuver or recumbent positioning what can that indicate

A
  1. Reversible cerebral vasoconstriction syndrome
  2. Irreversible cerebral venous sinus thrombosis
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10
Q

What warrants immediate neuro imaging/

A

A new HA in a patient older than 50 years or with HIV infection

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11
Q

If the patient has a history of HTN what should be done

A

Search for other features of malignant HTN
*appropriate to determine the urgency of control of HTN

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12
Q

What is HA and HTN associated with pregnancy due to?

A

Preeclampsia

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13
Q

What is a suggestive of phenochromocytoma

A

Episodic HA
1. HTN
2. Palpitations
3. Sweats

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14
Q

What is associated with an increased risk of cerebral venous thrombosis

A
  1. A history consistent with hypercoagulabitiy
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15
Q

What is the classic migraine patterns

A

1 scintillating scotoma followed by
2. Unilateral HA
3. Photophobia
4. N/V
* 3+ AND exacerbation by physical activity = migraine
* 1 or 2 = not migraine

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16
Q

Someone comes in with a HA what parts of the PE are you going to do?

A
  1. Vitals
  2. Neuro
  3. Vision (fundoscopic exam)
    *if fever do Kernig and Brudzinksi
17
Q

If the patient is older than 60 and they come in with a HA what should they be evaluated for?

A

Temporal artery tenderness

18
Q

What can diminished visual acuity be suggestive of

A
  1. Glaucoma
  2. Temporal arteritis
  3. Optic neuritis
19
Q

What can visual field defects be sings of

A
  1. Venous sinus thrombosis
  2. Tumor
  3. Aneurysm
20
Q

What is Afferent pupillary defects due to

A

Intracranial masses or optic neuritis

21
Q

What is ipsilateral ptosis and miosis suggestive of

A

Horner syndrome

22
Q

What type of imaging study is sufficient to exclude intracranial HTN

A

Non contrast head CT

23
Q

Does a normal neuro imaging study exclude subarachnoid hemorrhage

A

No
*follow with a LP

24
Q

If a pateint has a high level of suspicion for subarachnoid hemorrhage what should a normal CT and lumbar puncture be followed by

A

CTA

25
Q

When would a LP be used

A

To exclude infectious causes of acute HA in patients with fever or meningeal signs

26
Q

When should a patient that comes in complaining in of an acute non traumatic HA should be evaluated for a subarachnoid hemorrhage

A
  1. Age 40 or older
  2. Neck pain or stiffness
  3. loss of consciousness
  4. Onset during exertion
  5. Thunderclap HA
  6. Limited neck flexion on examination
27
Q

What is the treatment for people who experience migraine of migraine like HA

A
  1. Ketorolac
  2. Dihydroergotamine
  3. Lasmiditan
  4. Ubrogepant
    *can provide relief of symptoms
28
Q

What is superior to ketamine for treatment of benign HA

A

Prochlorperazine

29
Q

When could oral corticosteroids be used for HA

A

Prevent rebound HA after ED discharge

30
Q

what should be avoided for first line therapy

A
  1. Parenteral morphine and hydromorphone
31
Q

What might be beneficial to individuals with chronic migraine and new daily persistent HA that has not responded to other aggressive treatments

A

Subanesthetic ketamine infusions

32
Q

What can provide effective treatment for all HA types in the ED department

A

High-flow oxygen therapy

33
Q

When to admit a patient with a HA

A
  1. Need for repeated doses of parenteral pain medication
  2. To facilitate and expedited work up requiring a sequence of neuro imaging and procedures
  3. Pain severe enough to impair ADLs
  4. Patients with subarachnoid hemorrhage, intracranial mass, or meningitis

Reading Clin Med Fall 2023 (4 decks)

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