EM Fundamentals

APPROACH TO HEADACHES

Goals and Objectives Goals Resident will be comfortable with initial evaluation and basic management of patients with headaches Learning Objectives Resident will be able to list life- and vision-threatening causes of headaches Intracranial hemorrhage CNS infection Cervical artery dissection Venous thrombosis Temporal arteritis Idiopathic Intracranial Hypertension (Pseudotumor cerebri) Resident will be able to list essential exam steps for all patients with headaches HEENT exam (including fundoscopic) Neurologic exam (full) Resident will be able to describe indications for CNS imaging and lumbar puncture Resident will be able to describe initial interventions for patients presenting with potentially life- and vision-threatening causes of headaches, including: Blood pressure management Coagulopathy reversal Anticoagulation Antibiotics Steroids Oxygen therapy

Recommended Resources Prior to Conference Pitfalls in the Management of Headache in the Emergency Department (Emerg Med Clin N Am 2010) (pdf) Additional Resources Overview Critical Issues in Evaluation and Management of Acute Headache (ACEP Clinical Policy) Approach to Headache (CDEM) Intracranial Hemorrhage Intracranial Hemorrhage (CDEM) The rational clinical examination. Does this patient have a hemorrhagic stroke? (JAMA) Aneurysmal SAH Management (Crit Care Med 2009) (pdf / pdf) Critical Care of Poor-Grade SAH (Curr Opin Cit Care 2011) (pdf) Subarachnoid Hemorrhage (EMCrit) See also: Stroke CNS Infections Severe CNS Infections (EMCrit) Cervical Artery Dissection When to Suspect Cervical Artery Dissection (ACEP Focus On) Spontaneous CAD (NEJM 2001) Venous Thrombosis Cerebral Venous Thrombosis (Circ 2012) (pdf) Temporal Arteritis Does this patient have temporal arteritis? (JAMA 2002) Treatment of Giant Cell Arteritis (Rev Neurol Dis 2008) (pdf) Giant Cell Arteritis and Polymyalgia Rheumatica (NEJM 2014) Idiopathic Intracranial Hypertension Idiopathic Intracranial Hypertension (Neurol Clin 2010) (pdf) Lumbar Puncture Lumbar Puncture (LITFL) CSF Analysis (LITFL) Lumbar Puncture Video (NEJM)

Original Post by Eric Shappell on 12/02/2014
Reviewed by James Ahn on 12/02/2014
Last Updated by Eric Shappell on 12/09/2014 Contact / Feedback