Headaches quiz - Ch 140 (billie) Flashcards
what onset type and symptoms may be considered “red flags” for headache
Onset:
- sudden
- traumatic
- with exertion
symptoms:
- AMS
- Seizure
- Fever
- Neuro symptoms
- visual changes
what medications are considered a red flag for patients w CC of HA
- anticoags/antiplatelet
- recent abx use
- Immunosuppressent
what past history is considered a red flag for patients w CC of HA
- no prior HA’s
- change in HA quality
- progressive HA worsening over weeks/months
what associated conditions are considered a red flag for patients w CC of HA
- pregnancy/post partum
- SLE
- Behcets disease (?)
- vasculitis
- sarcoidosis
- cancer
what PE findings are considered a red flag for patients w CC of HA
- AMS
- Fever
- Neck stiffness
- papilledema
- focal neuro s/s
what laboratory studies are useful when temporal arteritis is suspected as the cause of HA
- ESR
- CRP
what is the go-to imaging if imaging is indicated in a patient with headache?
what types of etiologies would we be looking for in this imaging?
NONcontrast CT head
etiologies:
- intracranial hemorrhage
- subdural hematoma
- space-occupying lesion
- signs of potentially elevated ICP
- SAH
If initial imaging is negative, however there is high clinical suspicion for SAH, what is the next step in patient care?
CT angiography or lumbar puncture
(Im not sure if this is right, the whole next chapter covers SAH so maybe dont lock this in)
If initial imaging is negative, however there is high clinical suspicion for cerebral venous thrombosis what is the next step in patient care?
MRI
If initial imaging is negative, however there is high clinical suspicion for meningitis or encephalitis, what is the next step in patient care?
lumbar puncture
what patients should you consider subdural hematomas and intracerebral hemorrhages as etiologies
- elderly
- alcoholics
- substance abusers
- antiplatelet/anticoag users
when should you consider cerebellar hemorrhage with a CC of HA? what is needed for this diagnosis?
with associated vestibular symptoms!
surgical consultation would be needed
How do HA’s present when they are associated with brain tumors
- bilateral or unilateral
- constant or intermittent
- worse upon awakening
- worse w valsalva
- positional (made better/worse w position changes)
- associated w nausea/vomiting
when should you consider the possibility of metastatic brain lesions in HA patients
- known cancer diagnosis
- seizures
- mental status changes
what are risk factors for cerebral venous thrombosis
- hypercoagulable states d/t OCP
- postpartum
- perioperative status
- clotting factor deficiencies
- polycythemia
what will the physical exam show in a patient with cerebral venous thrombosis?
- papilledema may be present
- neuro s/s wax and wane
what lab findings will be present in a patient with cerebral venous thrombosis
- lumbar puncture may demonstrate increased opening pressure
what is the most useful test for the diagnosis of cerebral venous thrombosis
MR venography
who is temporal arteritis MC in? what are the associated symptoms of this diagnosis
- MC in pts over 50. risk increases w age
- fatigue
- fever
- jaw claudication
- vision changes
- tender/nonpulsatile or normal temporal arteries.
what labs and diagnostics are used in the diagnosis of temporal arteritis
- CRP and ESR
- temporal artery biopsy (definitive)
what is the MC benign cause of HA in the ED
migraine headaches
what is the clinical presentation of a migraine headache
- gradual onset
- unilateral
- pulsating
- worse w activity
- N/V
- photophobia
- phonophobia
- w or w/o aura.
who is idiopathic intracranial HTN MC in?
obese women ages 20-44
what is the clinical presentation of Idiopathic intracranial HTN
- transient vision disturbances
- back pain
- pulsatile tinnitus
- papilledema
what diagnostic study can be used in the diagnosis of idiopathic inracranial HTN?
elevated opening pressure on lumbar puncture
what can idiopathic intracranial HTN lead to?
permanent vision loss if left untreated.
when does intracranial hypotension typically occur
after a procedure that violates the dura such as a lumbar puncture or epidural anesthesia.
what is the clinical presentation of intracranial hypotension
- worse with upright posture
- better w laying down
- alternation in hearing/vision
- vomiting
what is the criteria for diagnosis of temporal arteritis
what is the clinical presentation of a cluster HA
- severe unilateral pain in orbital/supraorbital/ or temporal area
- associated w lacrimation, nasal congestion, rhinorrhea, conjunctival injection, and pacing in the exam room.
- s/s occur daily for weeks w periods of remission that last for weeks to years.
If temporal arteritis without vision loss is suspected in a patient what is the treatment?
- oral prednisone 60mg QD
- consult ophthalmology for temporal artery biopsy
what is the treatment for migraine patients in the ED
- symptom relief with - dihydroergotamine or sumatriptan
- nausea relief w dopamine antagonists such as metoclopramide, chlorpromazine, prochlorperazine
- consider dexamethasone 6-10mg IV for reduced recurrence.
what is the treatment for patients with idiopathic intracranial hypertension
- starting dose of oral acetazolamide 250mg-500mg BID
- recommend weight loss to obese patients
- remove excess CSF during diagnostic lumbar puncture to 15-20cm H2O
- consult neuro and opthalmology
what is the treatment for patients with intracranial hypotension d/t lumbar puncture or epidural
- symptomatic treatment
- epidural blood patch. typically performed by anesthesiology
what is the treatment for cluster headaches
- high flow oxygen delivered at 12 L/min for 15 min via nonrebreather.
- consider sumatriptan 6mg subcutaneous injection for pain that is unresolved after oxygen
