Severe Headache Flashcards
Severe Headache
ASAP:
ABCs, IVs, O2 prn, monitor, VS, EKG
Severe Headache
Hx:
Pain OPQRST, vision changes, n/v, prev HAs. H/o CVA, TIA, aneurysm, HTN, DM, glaucoma, trauma, HIV. SAMPLE hx. HA red flags: worse ,new onset, different, worse over days-weeks, sudden, fever, stiff neck, neuro sx, AMS, immunosuppressed, young/old,
peri/retro-orbital pain, neurological finding, multiple patients with HA, pregnancy or post-pregnancy, clotting disorder, cervical manipulation with facial pain or HA, dizziness with HA
Severe Headache
Exam:
Detailed HEENT, fundo & neuro
Severe Headache
Life threats:
CVA
ICH
Aneurysm
Cavernous Sinus Thrombosis
AVM
Mening/encephalitis
Abscess
Tumor
Severe Headache
Other Important Diagnoses:
Temporal Arteritis
Trigeminal Neuralgia
CO tox
Glaucoma
HTN emergency
Severe Headache
Labs:
CBC, BMP LP: cell count, GS & Cx, protein/gluc, opening pres. ABG (CO tox), ESR (TA), IOP (AACG)
Severe Headache
Rads:
CT (non-con for ICH, mass, tumor; con for abscess)
Severe Headache
Tx if suspected meningitis…
If suspecting meningitis…
Rocephin 2 gm IV (peds: 100 mg/kg IV) immediately, Dex 10 mg/kgI V, + Ampicillin 2gm IV if > 50 or
comorbidities
Severe Headache
Tx if suspected encephalitis…
Acyclovir 10 mg/kg IV
Severe Headache
Treatment:
If Temporal Arteritis
Solumedrol 125mg IV, then Prednisone 1mg/kg PO qd and NSAIDs
Severe Headache
Treatment if CO tox:
100% O2, HBOT
Severe Headache
Treatment if acute angle glaucoma:
Diamox, Mannitol, Timolol, Pilocarpine
Severe Headache
Treatment if migrane:
NSAID, APAP, Triptans, Compazine/ Reglan, Benadryl, Phenergan, Fioricet, DHE
Severe Headache
Treatment if tension HA:
If tension HA…
NSAIDs, APAP
Severe Headache
Treatment if cluster HA:
Triptans, high flow O2, intranasal Lidocaine
