Headache

Question 1

What group is at increased risk for venous sinus thrombosis?

Answer 1

PTs that are hypercoaguable (post-partum is a large group)

Question 2

If a patient presents with a headache and multiple people in the house have similar headaches, what must you always consider?

Answer 2

1. CO

2. Infectious cause

Question 3

What funduscopic exam finding might you see with SAH?

Answer 3

Subhyaloid hemorrhage

Question 4

What is a quick way to figure out the prognosis of a patient with SAH?

Answer 4

Their mental status directly correlates

Question 5

How sensitive is CT for diagnosing SAH?

Answer 5

98% in the first 12 hours but then it starts to drop off quickly

Question 6

In SAH, what will an LP show?

Answer 6

1. Hours 0-12: RBCs

2. Hours 12+: xanthochromia

Question 7

What is a good first line treatment for a patient that presents with migraine?

Answer 7

Compazine (Prochlorperazine)

This also helps with their N/V

Question 8

Why do you often give benadryl with compazine?

Answer 8

To avoid askisthesia

Question 9

What are good second line treatments for migraines in the ED?

Answer 9

1. Metoclopramide (Reglan)
2. Promethazine (Phenergan)
3. Ketorlac (Toradol)
4. Droperidol (can cause QT prolongation)

All are less effective than Compazine (Prochlorperazine)

Question 10

Why are triptans less widely used in the ED?

Answer 10

1. They are more narrow spectrum (better just for headaches)

Question 11

What is the most commonly used triptan used in the ED?

Answer 11

Sumitriptan SubQ

Question 12

Besides supplemental O2, how do you treat cluster headaches?

Answer 12

Same way that you treat migraines. Start with compazine.