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Primary & Secondary Headaches

1/25/2017

23 Comments

 
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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 Headaches

Migraines are seen frequently in the ER, and typically present similar to the POUND Mnemonic;
  • Pulsatile Quality
  • Over four to 72 hours
  • Unilateral location
  • Nausea or vomiting
  • Disabling intensity

Atypical headaches can be identified using the SNOOP mnemonic
  • Systemic: signs of concerns of autoimmune disorder, systemic illness, or cancer
  • Neurologic Deficits
  • Onset: Abrupt onset
  • Onset: new headaches after >40 years old
  • Progressive ​

Treatment of primary headaches

Patients 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. 
trial_toradol_vs_metcloparmide.pdf
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management_of_headache.pdf
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canadian_headache.pdf
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Secondary Headaches

Common 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. 
23 Comments
Karen
5/31/2024 02:20:38 am

I recommend this herbal syrup.............

Get rid of the Herpes totally,.

Opportunity of a lifetime,

You can win back Ex with his help..

Thanks (( robinsonbuckler11@)) gmail.com

Reply
Kathleen Dunham
5/13/2025 07:00:53 am

It is so unfortunate that the FDA and Big Pharma ban a lot of natural cures for CANCER just to make money.
I am a very private person, especially when it pertains to my health! I decided to share my story to give others hope and inspiration.
2 years ago, my now 21-year-old daughter was diagnosed with stage 4 cancer that metastasized to her bones. She had one round of oral chemo, which resulted in chemo toxicity. Her heart and kidneys were severely damaged. She couldn’t walk or talk without coughing and was rushed to the hospital numerous times with dangerously low blood pressure. I gave up on the doctors; I decided to stop all medical treatment and look for alternatives. I ended up researching natural herbs, which led me to contact a herbalist, Dr.Water. He offered me some herbal products, which I gave to my daughter, and her health rapidly improved. A few days after she finished the treatment, we did a scan, and it confirmed that she was cancer-free and her bones were healing. I was overjoyed; it was like a miracle. It’s been over a year now, and she is perfectly healthy. No antibiotics, no probiotics; she only takes a few natural supplements that Dr. Water directed us to buy.
Natural herbs can be a perfect alternative to so many health conditions out there, but we seem to neglect them. Feel free to share my story, and here is Dr.Water's contact: +2349050205019 and [email protected].
Extra thanks to Dr. Hamza Shazam and Dr. Terry Marcelino for their guidance throughout my journey!
Thank you to Jimmy Philip Sacchetti for reaching out to me!
Thank you to my family and friends for their love and support, and many thanks to Dr. Water, who saved my daughter's life!!! I love you all.

Reply
Sarah Vaughn
11/11/2024 12:59:40 pm

Dr. Oosa herbal medicine is a good remedy for Herpes, I was a carrier of Herpes and I saw a testimony on how Dr. Oosa cured Herpes, I decided to contact him and he guided me. I asked him for solutions and he started the remedies for my health. Doctor Oosa natural herbal medicine is 100% guarantee sure and safe with zero side effect. Thank God, now everything is fine, I'm cured by Dr. Oosa herbal medicine, I'm very thankful to Dr. Oosa, because he is the best online natural herbal doctor to eradicate your viral infections or diseases, reach him on [email protected] call or whatsapp him on +2348101793937
Doctor Oosa can also cure the following:

CANCER ALL KINDS
LUNGS AND LIVER DISEASES
HIV
FIBRIOD
DIABETES
ERICTILE DISFUNCTION
INFERTILITY IN MEN
INFERTILITY IN WOMEN
HUMAN PAPPILLOMA VIRUS (HPV)
GENITAL WARTS
HERPES ALL KINDS
PREGNANCY ISSUES
LOW SPERM COUNT
WEIGHT LOSS
HAIR LOSS
Arthritis
Epilepsy

Reply
monica
3/7/2025 07:24:30 am

I was diagnosed of herpes 3 years, and ever since then i have been taking treatment to prevent outbreaks, burning and blisters, but there was no improvement until i came across testimonies of Dr. Aba on how he has been curing different people from different diseases all over the world, then i contacted him. After our conversation he sent me the medicine which I took according to his instructions for up to 2 weeks. After completing the medication I went back to my doctor for another test and the virus was all gone and I was completely cured, since then I have not had any signs of outbreak. I'm so filled with joy. With herbal medication Herpes Virus is 100% curable. I refer Dr. Aba to everyone out there with the virus. His email address is [email protected] you can also Add Dr.Aba on whatsApp number on +2348107155060

Reply
magriet dennis
3/26/2025 10:18:42 pm

Get rid of all kinds of Herpes and virus infections, Diabetes, Hepatitis A B C, Menopause and HIV with Natural Roots and Herbs, i was once infected with HERPES and after using Dr UMA Herbal Medicine for couple of weeks i couldn't trace it anymore, i even went for checkup and my test came out Negative. Get your cure today from this wonderful herbalist, Dr. UMA.
You can also reach doctor UMA on WhatsApp
+2347035619585 or Email [email protected].

Reply
NELS KATE
3/27/2025 10:40:28 pm

I have been suffering from Herpes for the past 1 years and 8 months, and ever since then i have been taking series of treatment but there was no improvement until i came across testimonies of Dr. UMA on how he has been curing different people from different diseases all over the world, then i contacted him as well. After our conversation he sent me the medicine which i  took according .to his instructions. When i was done taking the herbal medicine i went for a medical checkup and to my greatest surprise i was cured from Herpes. My heart is so filled with joy. If you are suffering from Herpes or any other disease you can contact Dr. UMA today on this Email address: [email protected] or whatsapp +2347035619585.

Reply
jefferson dinhnguyen
3/31/2025 10:56:08 pm

I got cure from HPV within 2 weeks of applying the natural herbs from Dr Onokun the great herbal healer kindly contact him and get healed via http://onokunherbs.com or Facebook.com/naturaltreatmentcenter1

Reply
oiler James
4/8/2025 11:54:15 am

I am from New Jersey. My herpes virus turned to war after 2 years of living with it. I have tried different medical procedures to cure my herpes but to no avail. Most people think herpes is only a minor skin irritation of which herpes has long term effects on health and passes through the bloodstream and can be easily contracted through sexual intercourse. I knew I had herpes from the first day I started feeling itchy in my pubic area and the pain was very unbearable. I couldn't stand it anymore. After 2 years of trying other means to get rid of it, I had to contact Doctor Guba to help me with a permanent cure. I saw his email and whats-app number from a testimony I read online from a lady who was also helped by him in curing infertility problems, I had faith and contacted him. He assured me of his work and I ordered his herbal medicine. Within 5 days, I didn't feel any pain anymore and within 2 weeks, my skin was all cleared and smooth. I am very grateful to you sir and I write this testimony as others have done to bring those having faith to you sir. If you have herpes or other similar disease and you want it cured, kindly contact Doctor Guba, WhatsApp (+2348162388034) Email [email protected] OR website: https://drgubahealingherbs.wixsite.com/guba-healing-herbs

Reply
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4/13/2025 09:54:23 am

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DAVID SUTTER
4/13/2025 07:53:00 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.

Reply
frances tony
4/13/2025 09:05:32 pm

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.

Reply
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.

Reply
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.

Reply
Liam Noah
4/17/2025 02:04:35 pm

Good day viewers am here to recommend a herbal doctor that is really amazing, shearing this testimony of how i got cured completely from herpes is the best news to provide on social media. am so excited the herbal medicine works perfectly for me and am now totally cured from herpes with the medication he sent to me. Please contact Dr Guba for quick help if you are suffering from any disease ? WhatsApp him via + 234 816 238 8034  and also on Email;  [email protected]  Or website: https://drgubahealingherbs.wixsite.com/guba-healing-herbs

Reply
nelly tyson
4/22/2025 06:31:28 am

I was once diagnosed with herpes but after drinking Dr Osalu herbal Medicine for a couple of weeks I couldn't trace it anymore because all the symptoms disappeared totally so I went to several labs for tests and they all came out Negative. Order and get Your herbal cure today from him.
WhatApp: +2348078668950
Email: [email protected]
Website: https://drosaluherbalhome.wixsite.com/drosaluherbshome

Reply
frances tony
5/3/2025 06:49:08 pm

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.

Reply
Vanessa Craig
5/5/2025 02:24:24 am

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Reply
DAVID SUTTER
5/5/2025 01:56:55 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.,

Reply
frances tony
5/6/2025 02:25:30 pm

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.

Reply
Diana M Eklund
5/10/2025 09:32:34 am

MY HERPES SIMPLEX CURE BY HERBAL MEDICINE..
It's Good for herpes patient to please read my testimony,my name is Diana i am from California USA, I caught genital herpes from my ex girlfriend who never had any symptoms. I have had it for 1 year now, and it has affected my life. I have told my boyfriends who I trusted about it and I have never had a bad reaction, it has affected my new relationships with Damon People think herpes is really a minor skin irritation,herpes has a long term effects on health.The stigma attached to this virus by ignorant people is ridiculous. Most people have herpes in one form or another. I would like to advise people on how i got rid of my herpes.i was reading a comment on the internet,and i saw a testimony posted by a woman from island that she got rid of her herpes with the help of dr. sikies .so i was so happy when i saw that post,that his herbal medication is free.i quickly collected the herbal doctor email: [email protected]
call or whatsapp him on his mobile number +2348163430143
Place order via website https://drsikiesherbalcuremedicine.weebly.com/
He also have the herb to cure
(1) CANCER,
(2) DIABETES,
(3) HIV&AIDS,
(4) URINARY TRACT INFECTION,
(5) CANCER,
(6) HERPES,
(7) BARENESS/INFERTILITY
(8) DIARRHEA
(9) ASTHMA...

Reply
susan
5/11/2025 12:02:02 am

I never believe there is a cure to this herpes 1&2 because all the hospitals have told me there is no cure to it, a few months ago I came across this EMAIL [email protected] on the internet from a message shared by someone who he helped with his herbal cure. I contacted him through the email and asked for the cure and he informed me about the process and this man sent me a herbal medicine from africa which I took according to the way he instructed for weeks. I can’t believe when I go for a test my result comes out negative after all the symptoms have gone. I am so happy to share this to the world there is real cure to this herpes you can also contact DR ABA through his email address on [email protected]

Reply
Dorothy
5/12/2025 03:00:57 am

Using herbal natural remedy was what got me tested negative to HSV 2 after been diagnosed for years. I have spend so much funds on medications like acyclovir (Zovirax), Famciclovir (Famvir), and Valacyclovir (Valtrex). But it was all a waste of time and my symptoms got worse. To me It is very bad what Big pharma are doing, why keep making humans suffer greatly just to get profits annually for medications that don't work. I'm glad that herbal remedies are gaining so much awareness and many people are getting off medications and activating their entire body system with natural herbal remedies and they have become holistically healed totally. Quickly contact Dr Riaria herbal home now on his email. [email protected] or WhatsApp him on:+234 701 0627-760

You can visit his website for more info: https://drriaria.wixsite.com/website

Reply
williams
5/13/2025 03:23:06 pm

I was diagnosed with HPV which they said there is no cure for this virus. but I'm surprised that after taking Dr Ogedegbe herbs i got cured out of it. and also I have referred a lot of people to this herbal medical doctor for a cure and he has never failed. Here is Dr Ogedegbe email address [email protected] or call/whatsapp him +2349121737553

Reply



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