Headache resident survival guide: Difference between revisions
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{{Family tree | | | | A01 |-| A02 |-|-|.| |A01= '''Red flags''' <br>•Headache beginning after 50 years old <br>•Increased severity and frequency of headaches <br>•Sudden onset of headache <br>•New onset of headache in cancer and HIV patients <br>•Headache with sign of systemic illness(fever,rash,neck stiffness) <br>•Focal neurological symptoms <br>•Papilledema | {{Family tree | | | | A01 |-| A02 |-|-|.| |A01= '''Red flags''' <br>•Headache beginning after 50 years old <br>•Increased severity and frequency of headaches <br>•Sudden onset of headache <br>•New onset of headache in cancer and HIV patients <br>•Headache with sign of systemic illness(fever,rash,neck stiffness) <br>•Focal neurological symptoms <br>•Papilledema <br>•Headache subsequent to head trauma | A02= Yes }} | ||
{{Family tree | | | | |!| | | | | | | A01 | | |A01=Refer and investigate }} | {{Family tree | | | | |!| | | | | | | A01 | | |A01=Refer and investigate }} | ||
{{Family tree | | | | A01 |-| A02 |-|-|'| | A01= '''Possible indicators of secondary [[headache]]''' <br>•Unexplained focal signs <br>•Atypical [[headaches]] <br>•Unusual [[headache]] precipitatnts <br>•Unusual aura [[symptoms]] <br>•Onset after after age 50 <br>•Agravatting by [[neck]] movement: abnormal [[neck]] examination findings (consider cervicogenic [[headache]]) <br>•[[Jaw]] [[symptoms]] (consider [[temporomandibular joint]] dysfunction) | A02= Yes }} | {{Family tree | | | | A01 |-| A02 |-|-|'| | A01= '''Possible indicators of secondary [[headache]]''' <br>•Unexplained focal signs <br>•Atypical [[headaches]] <br>•Unusual [[headache]] precipitatnts <br>•Unusual aura [[symptoms]] <br>•Onset after after age 50 <br>•Agravatting by [[neck]] movement: abnormal [[neck]] examination findings (consider cervicogenic [[headache]]) <br>•[[Jaw]] [[symptoms]] (consider [[temporomandibular joint]] dysfunction) | A02= Yes }} |
Revision as of 00:13, 7 November 2020
For Headache resident survival guide click here.
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];
Headache Resident Survival Guide Microchapters |
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Overview |
Causes |
FIRE |
Diagnosis |
Treatment |
Do's |
Don'ts |
Overview
First step in headache diagnosis is to determine what kind of headache patient has, primary or secondary headache disorder. Primary headaches such as migraine,tension-type,cluster are not caused by another underlying disease,despite secondary headaches are caused by another underlying disorders such as trauma,tumors.For differentiating these two types of headache,history and physical examination is necessary,although neuroimaging and other tests maybe needed as well.
Causes
Primary | Migraine | |
---|---|---|
Tension- type headache | ||
Cluster headache | ||
Secondary | Extracranial disorders | Carotid or vertebral artery dissection |
Temporomandibular joint dysfunction | ||
Glaucoma | ||
Sinusitis | ||
Intracranial disorders | Brain space occupying lesion | |
Chiari Type 1 malformation | ||
CSF leak with low pressure headache | ||
Hemorrhage | ||
Meningitis | ||
Vascular malformations | ||
Venous sinus thrombosis | ||
Systemic disorders | Acute severe hypertension | |
Pheochromocytoma | ||
Fever | ||
Vasculitis | ||
Viral infections | ||
Hypercapnia | ||
Drugs | Analgesic overdose | |
Proton pump inhibitors | ||
Caffeine withdrawl | ||
Hormones (estrogen) | ||
Toxins | Carbonmonoxide | |
Nitrates |
Life-threatening causes: Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
- Brain abscess
- Cerebral aneurysm
- Encephalitis
- Hydrocephalus
- Hypertensive encephalopathy
- Increased intracranial pressure
- Intracerebral hemorrhage
- Meningitis
- Subarachnoid hemorrhage
- Subdural hemorrhage
FIRE
Diagnosis
Red flags •Headache beginning after 50 years old •Increased severity and frequency of headaches •Sudden onset of headache •New onset of headache in cancer and HIV patients •Headache with sign of systemic illness(fever,rash,neck stiffness) •Focal neurological symptoms •Papilledema •Headache subsequent to head trauma | Yes | ||||||||||||||||||||||||||||||||||||||||
Refer and investigate | |||||||||||||||||||||||||||||||||||||||||
Possible indicators of secondary headache •Unexplained focal signs •Atypical headaches •Unusual headache precipitatnts •Unusual aura symptoms •Onset after after age 50 •Agravatting by neck movement: abnormal neck examination findings (consider cervicogenic headache) •Jaw symptoms (consider temporomandibular joint dysfunction) | Yes | ||||||||||||||||||||||||||||||||||||||||
No | Migraine •Acute medications •Monitor for medication overuse •Prophylactic medication if: -Headache >3 d/mo and acute medications are not effective OR -Headache >8 d/mo (risk of overuse) OR -Disability despite acute medication | ||||||||||||||||||||||||||||||||||||||||
Headache with >2 of the following: •Nausea •Light sensitivity •Interference with activities Practice points: •Migraine has been historically underdiagnosed •Considere migraine diagnosis for recurring "sinus" headaches | Yes Migraine | Medication overuse Assess •Ergots, triptans, combination analgesics, or codeine or other opioids >10 d/mo OR •Acetaminophen or NSAIDs >15 d/mo Manage •Educate patient •Considere prophylactic medication •Provide an effective acute medication for severe attacks with limitations on frequency of use •Gradual withdrawal of opioids if used, or combination analgesic with opioid or barbiturate •Abrupt (or gradual) withdrawal of acetaminophen, NSAIDs or triptans | Behavioral management •Keep headache diary: intensity, triggers, frequency, medications •Adjust lifestyle factors: reduce caffeine, ensure regular exercise, avoid irregular or inadecuate sleep or meals •Develope stress management strategies: relaxation training, CBI, pacing activity, biofeedback | ||||||||||||||||||||||||||||||||||||||
No | Tension type headache •Acute medications •Monitor for medication overuse •Prophylactic medication disability despite medication | ||||||||||||||||||||||||||||||||||||||||
Headache with no nausea but >2 of the following: •Bilateral headache •Nonpulsating pain •Not worsened by activity | Yes Tension type headache | ||||||||||||||||||||||||||||||||||||||||
No | |||||||||||||||||||||||||||||||||||||||||
Uncommon headache syndromes | |||||||||||||||||||||||||||||||||||||||||
All of the following: •Frequent headache •Severe •Brief <3 h per attack) •Unilateral (always same side) •Ipsilateral eye redness, tearing or restleness during attacks | All of the following: •Unilateral (always same side) •Continuous •Dramatically responsive to indomethacin | Headache continuous side onset | |||||||||||||||||||||||||||||||||||||||
Yes | Yes | Yes | |||||||||||||||||||||||||||||||||||||||
Cluster headache or another trigeminal autonomic cephalalgia •Management primarly pharmacologic •Acute medication •Prophylactic medication •Early specialist referral recommended | Hemicrania continua •Specialist referral | New daily persistent headache •Specialist referral | |||||||||||||||||||||||||||||||||||||||