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Emergency Medicine > Headaches quiz - Ch 140 (billie) > Flashcards

Headaches quiz - Ch 140 (billie) Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

what onset type and symptoms may be considered “red flags” for headache

A

Onset:
- sudden
- traumatic
- with exertion

symptoms:
- AMS
- Seizure
- Fever
- Neuro symptoms
- visual changes

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2
Q

what medications are considered a red flag for patients w CC of HA

A
  • anticoags/antiplatelet
  • recent abx use
  • Immunosuppressent
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3
Q

what past history is considered a red flag for patients w CC of HA

A
  • no prior HA’s
  • change in HA quality
  • progressive HA worsening over weeks/months
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4
Q

what associated conditions are considered a red flag for patients w CC of HA

A
  • pregnancy/post partum
  • SLE
  • Behcets disease (?)
  • vasculitis
  • sarcoidosis
  • cancer
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5
Q

what PE findings are considered a red flag for patients w CC of HA

A
  • AMS
  • Fever
  • Neck stiffness
  • papilledema
  • focal neuro s/s
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6
Q

what laboratory studies are useful when temporal arteritis is suspected as the cause of HA

A
  • ESR
  • CRP
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7
Q

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?

A

NONcontrast CT head

etiologies:

  • intracranial hemorrhage
  • subdural hematoma
  • space-occupying lesion
  • signs of potentially elevated ICP
  • SAH
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8
Q

If initial imaging is negative, however there is high clinical suspicion for SAH, what is the next step in patient care?

A

CT angiography or lumbar puncture

(Im not sure if this is right, the whole next chapter covers SAH so maybe dont lock this in)

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9
Q

If initial imaging is negative, however there is high clinical suspicion for cerebral venous thrombosis what is the next step in patient care?

A

MRI

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10
Q

If initial imaging is negative, however there is high clinical suspicion for meningitis or encephalitis, what is the next step in patient care?

A

lumbar puncture

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11
Q

what patients should you consider subdural hematomas and intracerebral hemorrhages as etiologies

A
  • elderly
  • alcoholics
  • substance abusers
  • antiplatelet/anticoag users
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12
Q

when should you consider cerebellar hemorrhage with a CC of HA? what is needed for this diagnosis?

A

with associated vestibular symptoms!

surgical consultation would be needed

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13
Q

How do HA’s present when they are associated with brain tumors

A
  • bilateral or unilateral
  • constant or intermittent
  • worse upon awakening
  • worse w valsalva
  • positional (made better/worse w position changes)
  • associated w nausea/vomiting
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14
Q

when should you consider the possibility of metastatic brain lesions in HA patients

A
  • known cancer diagnosis
  • seizures
  • mental status changes
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15
Q

what are risk factors for cerebral venous thrombosis

A
  • hypercoagulable states d/t OCP
  • postpartum
  • perioperative status
  • clotting factor deficiencies
  • polycythemia
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16
Q

what will the physical exam show in a patient with cerebral venous thrombosis?

A
  • papilledema may be present
  • neuro s/s wax and wane
17
Q

what lab findings will be present in a patient with cerebral venous thrombosis

A
  • lumbar puncture may demonstrate increased opening pressure
18
Q

what is the most useful test for the diagnosis of cerebral venous thrombosis

A

MR venography

19
Q

who is temporal arteritis MC in? what are the associated symptoms of this diagnosis

A
  • MC in pts over 50. risk increases w age
  • fatigue
  • fever
  • jaw claudication
  • vision changes
  • tender/nonpulsatile or normal temporal arteries.
20
Q

what labs and diagnostics are used in the diagnosis of temporal arteritis

A
  • CRP and ESR
  • temporal artery biopsy (definitive)
21
Q

what is the MC benign cause of HA in the ED

A

migraine headaches

22
Q

what is the clinical presentation of a migraine headache

A
  • gradual onset
  • unilateral
  • pulsating
  • worse w activity
  • N/V
  • photophobia
  • phonophobia
  • w or w/o aura.
23
Q

who is idiopathic intracranial HTN MC in?

A

obese women ages 20-44

24
Q

what is the clinical presentation of Idiopathic intracranial HTN

A
  • transient vision disturbances
  • back pain
  • pulsatile tinnitus
  • papilledema
25
Q

what diagnostic study can be used in the diagnosis of idiopathic inracranial HTN?

A

elevated opening pressure on lumbar puncture

26
Q

what can idiopathic intracranial HTN lead to?

A

permanent vision loss if left untreated.

27
Q

when does intracranial hypotension typically occur

A

after a procedure that violates the dura such as a lumbar puncture or epidural anesthesia.

28
Q

what is the clinical presentation of intracranial hypotension

A
  • worse with upright posture
  • better w laying down
  • alternation in hearing/vision
  • vomiting
29
Q

what is the criteria for diagnosis of temporal arteritis

A
30
Q

what is the clinical presentation of a cluster HA

A
  • 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.
31
Q

If temporal arteritis without vision loss is suspected in a patient what is the treatment?

A
  • oral prednisone 60mg QD
  • consult ophthalmology for temporal artery biopsy
32
Q

what is the treatment for migraine patients in the ED

A
  • symptom relief with - dihydroergotamine or sumatriptan
  • nausea relief w dopamine antagonists such as metoclopramide, chlorpromazine, prochlorperazine
  • consider dexamethasone 6-10mg IV for reduced recurrence.
33
Q

what is the treatment for patients with idiopathic intracranial hypertension

A
  • 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
34
Q

what is the treatment for patients with intracranial hypotension d/t lumbar puncture or epidural

A
  • symptomatic treatment
  • epidural blood patch. typically performed by anesthesiology
35
Q

what is the treatment for cluster headaches

A
  • 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
36
Q
A

Emergency Medicine (29 decks)

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