Identifying atypical headaches, treatment of primary headaches, and how to approach complicated and atypical headaches. Adapted from Sigrid Nasser's Grand Rounds lecture, January 25th, 2015 Identifying Atypical HeadachesMigraines are seen frequently in the ER, and typically present similar to the POUND Mnemonic;
Atypical headaches can be identified using the SNOOP mnemonic
Treatment of primary headachesPatients presenting with typical headaches without red flags, and intact neurologic exams can be treated without imaging. Primarily, the goals of care are to block inflammation, hydrate, and utilization of dopamine or histamine antagonists or GABA agonists to treat headaches. Simple Analgesics: Tylenol and other NSAIDs can be used with antiepetics to treat mild-moderate primary headaches including migraines. Triptans: Although effective against placebos in studies, triptans have many limitations and contraindications, and is less frequently utilized in the emergency department. Dopamine Antagonists: Evidence shows that DA such as metoclopramide or prochlorperazine is better than toradol for primary recurrent tension headaches and migraine. Magnesium: Studies show magnesium is more effective than placebo or IVF alone. Anticholinergics: There is minimal data showing that benadryl helps with akasthisia or headaches, however patients tend to have shorter length of stay when given benadryl in addition to DAs Steroids: Dexamethasone has previously been used as an acute headache treatment and recurrence prevention. A recently American Headache society review recommends for a single dose, however, currently, a 2015 Canadian Headache Society review recommends against steroids. Fluids: There is little data to suggest that IVF are effective, however anecdotally, IVF tend to help with headaches and should be offered unless there are any contraindications. ![]()
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Secondary HeadachesCommon causes of secondary headaches include masses, bleeds, pseudotumor, hydrocephalus, hissection, carbon monoxide, and temporal arteritis. Concerns for secondary headaches includes any neurologic deficits, acute onset, new headaches in patients > 40 years old, or any signs of systemic illness or cancers.
Secondary headaches require further evaluation including imaging and potentially lumbar puncture to evaluate opening pressure and fluid evaluation. Negative CT imaging does not fully rule out masses, as well as potential central venous thrombosis. CTV can come close to the sensitivity of MRV in diagnosing venous thrombosis.
13 Comments
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5/31/2024 02:20:38 am
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3/26/2025 10:18:42 pm
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3/27/2025 10:40:28 pm
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3/31/2025 10:56:08 pm
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oiler James
4/8/2025 11:54:15 am
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DAVID SUTTER
4/13/2025 07:53:00 pm
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4/13/2025 09:05:32 pm
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DAVID SUTTER
4/15/2025 08:21:39 pm
I already gave up on ever getting cured of HSV2 because i have try many treatment none of them work out for me i have gone to different hospital they always tell me the same thing there is no cure for herpes, when i came across a post about Dr UMA in the net from a lady called Angela i contacted her and she reassured me with his herbal medicine which i took according to the way he instructed, that how i was cured. I doubted at first because i have been to a whole lot of reputable doctors, tried a lot of medicines but none was able to cure me. so i decided to listen to him and he commenced treatment, and under two weeks i was totally free from Herpes. i want to say a very big thank you to DR UMA for what he has done in my life. feel free to leave him a message on email [email protected] or also Whats-app him +2347035619585.. he also cure all this 1.HIV 2.HIV HPV 3 .ALS 4. BED WETTING DIABETES.
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frances tony
4/16/2025 04:26:51 am
I thought the physicians says there is no cure for HSV 2!!! I am telling you today that DR.UMA cure HSV 2 with his herbal medicine and once you get cured you are cured forever it is never reversible, I have been suffering for this deadly disease called HSV 2 for more than 2years and I lost all hope because my doctor says there is no cure for HSV 2. Brethren I saw a testimony on the internet on how DR.UMA cure HSV, Hapatitis etc with his herbal medication and an email and watsapp to contact him was also displayed, I thought this was a joke but I decided to contact him and he replied telling me not to worry that my problem is over . DR.UMA sent me a herbal medication to drink for one month but only 2weeks I feel strange and I went to my doctor and he confirmed me negative. He can help you too. Contact him via [email protected] WhatsApp +2347035619585. He is capable of curing AUTISM, HERPES, HPV, HSV1&2, HEPATITIS A B C, and DIABETES.
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Liam Noah
4/17/2025 02:04:35 pm
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