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.
23 Comments
Karen
5/31/2024 02:20:38 am
I recommend this herbal syrup.............
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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.
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Sarah Vaughn
11/11/2024 12:59:40 pm
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monica
3/7/2025 07:24:30 am
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magriet dennis
3/26/2025 10:18:42 pm
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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.
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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
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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
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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.
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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.
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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
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
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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.
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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.
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Vanessa Craig
5/5/2025 02:24:24 am
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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..
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]
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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
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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
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