Top 10 Workups
6 1
HEADACHE
•
How severe is the headache? Has there been a change in conscious-
ness? Are there any new focal CNS symptoms? Has the patient had
similar headaches in the past? If so, what precipitates or relieves
them?
•
If the headache is severe and acute or associated with N/V,
changes in vision, other focal CNS findings, fever, or decreased
consciousness, the patient should be seen immediately.
However,
you may very well have a headache too, hopefully without any of
these findings.
Major Causes and Types of Headache
•
Subarachnoid hemorrhage
•
Tension
•
Migraine
•
Cluster
•
Medication side effect
•
Temporal arteritis
•
Infectious (meningitis, sinusitis, fever, in general)
•
Trauma
•
CVA
•
Severe hypertension (HTN)
•
Mass lesions
Things You Don’t Want to Miss (Call Your Resident)
•
Meningitis
•
CVA
•
Subarachnoid hemorrhage or subdural hematoma
•
Mass lesion associated with herniation
Key History
•
Check vitals: BP, pulse, respirations, O
2
saturations, and
temperature.
•
Quickly look at the patient and review the chart.
•
A detailed, well-focused history is the best method for evaluating
a headache. Most are tension or migraine type, but more serious
conditions need to be ruled out.