Headache resident survival guide: Difference between revisions
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{{Family tree | | | | A01 |-| A02 |-|-|.| |A01= '''Red flags''' <br>''Emergent''(address immediately) <br> | {{Family tree | | | | A01 |-| A02 |-|-|.| |A01= '''Red flags''' <br>''[[Emergency|Emergent]]''(address immediately) <br>•[[Thunderclap headache|Thunderclap]] onset <br>•[[Fever]] and [[meningismus]] <br>•[[Papilledema]] with focal signs of reduced LOC <br>•[[Acute glaucoma]] <br>''[[Urgency|Urgent]]'' (address with hours to days) <br>•[[Temporal arteritis]] <br>•[[Papilledema]] without focal signs of LOC <br>•Relevant systemic illness <br>•Elderly patient with new headache and cognitive change | 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> | {{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 | | | | |!| | }} | {{Family tree | | | | |!| | }} | ||
{{Family tree | | | | A01 | | | | | | |, | {{Family tree | | | | A01 | | | | | | | | | |,|-| A02 | | A01= No | A02= '''[[Migraine]]''' <br>•Acute medications <br>•Monitor for [[medication]] overuse <br>•[[Prophylactic]] [[medication]] if: <br>-[[Headache]] >3 d/mo and acute [[medications]] are not effective <br>OR <br>-[[Headache]] >8 d/mo (risk of overuse) <br>OR <br>-[[Disability]] despite acute [[medication]] }} | ||
{{Family tree | | | | |!| | | | | | | | | | |!| }} | |||
{{Family tree | | | | B01 |-| B02 |-| B03 |-|+|-| B04 | B01= [[Headache]] with >2 of the following: <br>•[[Nausea]] <br>•[[Light sensitivity]] <br>•Interference with activities <br>Practice points: <br>•[[Migraine]] has been historically underdiagnosed <br>•Considere [[migraine]] diagnosis for recurring "[[sinus]]" [[headaches]] | B02= Yes <br>[[Migraine]] | B03= '''[[Medication]] overuse''' <br>Assess <br>•[[Ergot|Ergots]], [[triptans]], combination [[analgesics]], or [[codeine]] or other [[opioids]] >10 d/mo <br>OR <br>•[[Acetaminophen]] or [[NSAIDs]] >15 d/mo <br>Manage <br>•Educate patient <br>•Considere [[prophylactic]] [[medication]] <br>•Provide an effective acute [[medication]] for severe attacks with limitations on frequency of use <br>•Gradual withdrawal of [[opioids]] if used, or combination [[analgesic]] with [[opioid]] or [[barbiturate]] <br>•Abrupt (or gradual) withdrawal of [[acetaminophen]], [[NSAIDs]] or [[triptans]]| B04= '''[[Behavioral therapy|Behavioral management]]''' <br>•Keep [[Headache|headache diary]]: intensity, triggers, frequency, [[medications]] <br>•Adjust lifestyle factors: reduce [[caffeine]], ensure regular [[exercise]], avoid irregular or inadecuate [[sleep]] or meals <br>•Develope [[stress]] management strategies: relaxation training, [[CBT|CBI]], pacing activity, biofeedback}} | |||
{{Family tree | | | | |!| | | | | | | |!| | |!|}} | |||
{{Family tree | | | | B01 | | | | | | |!| | |`|-| B02 | | B01= No | B02= '''[[Tension headache|Tension type headache]]''' <br>•Acute [[medications]] <br>•Monitor for [[medication]] overuse <br>•[[Prophylactic]] [[medication]] disability despite medication}} | |||
{{Family tree | | | | |!| | | | | | | |!| }} | {{Family tree | | | | |!| | | | | | | |!| }} | ||
{{Family tree | | | | |`|-|-| B01 |-| B02 | B01= [[Headache]] with no [[nausea]] but >2 of the following: <br>•[[Bilateral]] [[headache]] <br>•Nonpulsating pain <br>•Not worsened by activity | B02= Yes <br>[[Tension headache|Tension type headache]] }} | |||
{{Family tree | | | | |`|-|-| B01 |-| B02 | B01= Headache with no nausea but >2 of the following: <br> | |||
{{Family tree | | | | | | | | |!| | | | | | | | }} | {{Family tree | | | | | | | | |!| | | | | | | | }} | ||
{{Family tree | | | | | | | | B01 | | | | | | | B01= No }} | {{Family tree | | | | | | | | B01 | | | | | | | B01= No }} | ||
{{Family tree | | | | | | | | |!| | | }} | {{Family tree | | | | | | | | |!| | | }} | ||
{{Family tree | | | | | | | | B01 | | B01= '''Uncommon headache syndromes''' }} | {{Family tree | | | | | | | | B01 | | B01= '''Uncommon [[headache]] [[syndromes]]''' }} | ||
{{Family tree | | |,|-|-|-|-|-|+|-|-|-|-|-|.| }} | {{Family tree | | |,|-|-|-|-|-|+|-|-|-|-|-|.| }} | ||
{{Family tree | | C01 | | | | C02 | | | | C03 | C01= All of the following: <br>•Frequent headache <br>•Severe <br>•Brief <3 h per attack) <br>•Unilateral (always same side)<br> | {{Family tree | | C01 | | | | C02 | | | | C03 | C01= All of the following: <br>•Frequent [[headache]] <br>•Severe <br>•Brief <3 h per attack) <br>•Unilateral (always same side)<br>•[[Ipsilateral]] [[eye redness]], tearing or restleness during attacks | C02= All of the following: <br>•Unilateral (always same side) <br>•Continuous <br>•Dramatically responsive to [[indomethacin]]| C03= [[Headache]] continuous side onset}} | ||
{{Family tree | | |!| | | | | |!| | | | | |!| }} | {{Family tree | | |!| | | | | |!| | | | | |!| }} | ||
{{Family tree | | C01 | | | | C02 | | | | C03 | C01= Yes | C02= Yes | C03=Yes }} | {{Family tree | | C01 | | | | C02 | | | | C03 | C01= Yes | C02= Yes | C03=Yes }} | ||
{{Family tree | | |!| | | | | |!| | | | | |!| }} | {{Family tree | | |!| | | | | |!| | | | | |!| }} | ||
{{Family tree | | C01 | | | | C02 | | | | C03 | C01= '''Cluster headache or another trigeminal autonomic cephalalgia''' <br>•Management primarly pharmacologic <br>•Acute medication <br> | {{Family tree | | C01 | | | | C02 | | | | C03 | C01= '''[[Cluster headache]] or another [[Trigeminal Neuralgia|trigeminal autonomic cephalalgia]]''' <br>•Management primarly [[pharmacologic]] <br>•Acute medication <br>•[[Prophylactic medication]] <br>•Early specialist referral recommended | C02= '''[[Hemicrania continua]]''' <br>•Specialist referral | C03= '''New daily persistent [[headache]]''' <br>•Specialist referral }} | ||
{{Family tree/end}} | {{Family tree/end}} | ||
Revision as of 04:49, 17 September 2020
For Headache resident survival guide click here.
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];
Headache Resident Survival Guide Microchapters |
---|
Overview |
Causes |
FIRE |
Diagnosis |
Treatment |
Do's |
Don'ts |
Overview
A headache is pain or discomfort in the head, scalp, or neck.
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 Emergent(address immediately) •Thunderclap onset •Fever and meningismus •Papilledema with focal signs of reduced LOC •Acute glaucoma Urgent (address with hours to days) •Temporal arteritis •Papilledema without focal signs of LOC •Relevant systemic illness •Elderly patient with new headache and cognitive change | 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 | |||||||||||||||||||||||||||||||||||||||