{"id":595,"date":"2016-08-16T13:30:46","date_gmt":"2016-08-16T13:30:46","guid":{"rendered":"http:\/\/emedsa.org.au\/CoreMed\/?p=595"},"modified":"2016-08-17T01:16:43","modified_gmt":"2016-08-17T01:16:43","slug":"headache-assessment","status":"publish","type":"post","link":"http:\/\/emedsa.org.au\/CoreMed\/2016\/08\/16\/headache-assessment\/","title":{"rendered":"Headache &#8211; Assessment"},"content":{"rendered":"<p><a href=\"http:\/\/twitter.com\/share?url=http%3A%2F%2Femedsa.org.au%2FCoreMed%2F2016%2F08%2F16%2Fheadache-assessment%2F&amp;count=none&amp;text=Headache - Assessment - CoreMed\" class=\"twitter-share-button\">Tweet<\/a><\/p><h1 align=\"left\"><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-602 aligncenter\" src=\"http:\/\/emedsa.org.au\/CoreMed\/wp-content\/uploads\/2016\/08\/Headache.jpg\" alt=\"Headache\" width=\"960\" height=\"646\" srcset=\"http:\/\/emedsa.org.au\/CoreMed\/wp-content\/uploads\/2016\/08\/Headache.jpg 960w, http:\/\/emedsa.org.au\/CoreMed\/wp-content\/uploads\/2016\/08\/Headache-300x202.jpg 300w, http:\/\/emedsa.org.au\/CoreMed\/wp-content\/uploads\/2016\/08\/Headache-768x517.jpg 768w, http:\/\/emedsa.org.au\/CoreMed\/wp-content\/uploads\/2016\/08\/Headache-624x420.jpg 624w\" sizes=\"auto, (max-width: 960px) 100vw, 960px\" \/><\/h1>\n<h1 align=\"left\">ACUTE HEADACHE<\/h1>\n<p>(this section does not consider traumatic causes of headache)<\/p>\n<ul>\n<li>Consider early CT brain if rapid onset of headache to rule out expanding space-occupying lesion particularly if there is <a href=\"http:\/\/emedsa.org.au\/CoreMed\/2016\/07\/23\/altered-mental-state\/\">altered mental state<\/a> or focal neurological deficit<\/li>\n<li>In severely depressed conscious state then early <a href=\"http:\/\/emedsa.org.au\/CoreMed\/2016\/07\/24\/tracheal-intubation\/\">airway protection<\/a> is required<\/li>\n<li>Abrupt onset of severe (&#8216;thunderclap&#8217;) should be considered a sub-arachnoid haemorrhage until proven otherwise<\/li>\n<li>Do not send a patient with rapidly deteriorating conscious state unescorted for imaging<\/li>\n<li>Note that a <a href=\"http:\/\/emedsa.org.au\/CoreMed\/2016\/08\/16\/headache-plain-ct-brain-accuracy\/\">normal plain CT brain<\/a> does not rule out a number of important causes of acute headache<\/li>\n<li>Consider important <a href=\"http:\/\/emedsa.org.au\/CoreMed\/2016\/08\/13\/headache-clinical-anatomy\/\">non-intracranial sources<\/a> of headache<\/li>\n<\/ul>\n<p><strong>Red flags<\/strong><\/p>\n<ul>\n<li>Rapid onset<\/li>\n<li>Altered mental state<\/li>\n<li>Focal deficit<\/li>\n<li>Meningism<\/li>\n<li>Severe hypertension<\/li>\n<li>Anticoagulation<\/li>\n<li>Signs of <a href=\"http:\/\/emedsa.org.au\/CoreMed\/2016\/07\/23\/raised-intracranial-pressure\/\">Raised Intracranial Pressure<\/a><\/li>\n<\/ul>\n<h2>ASSESSMENT<\/h2>\n<ul>\n<li>There are many causes for acute headache\u00a0so it important to follow the\u00a0<a href=\"http:\/\/emedsa.org.au\/CoreMed\/2016\/08\/01\/the-patient-consultation\/\">Principles of a Systematic Assessment<\/a><\/li>\n<li>Focus on the\u00a0<a href=\"http:\/\/emedsa.org.au\/CoreMed\/2016\/07\/24\/chronology-of-disease-illustrated\/\">chronology<\/a>\u00a0which gives an indication of\u00a0<a href=\"http:\/\/emedsa.org.au\/CoreMed\/2016\/07\/23\/emergency-presentations-common-causes\/\">urgency<\/a>\u00a0alongside\u00a0<a href=\"http:\/\/emedsa.org.au\/CoreMed\/2016\/08\/13\/headache-clinical-anatomy\/\">location<\/a>\u00a0of pain. \u00a0This and the\u00a0<a href=\"http:\/\/emedsa.org.au\/CoreMed\/2016\/08\/13\/headache-clinical-anatomy\/\">associated symptoms<\/a>\u00a0greatly assists at narrowing down the possibilities to the likely culprit organ, the pathological process and best investigative strategy<\/li>\n<li>Consider\u00a0<a href=\"http:\/\/emedsa.org.au\/CoreMed\/2016\/08\/13\/headache-clinical-anatomy\/\">non intra-cranial causes<\/a>\u00a0of headache<\/li>\n<li>Consider pre-eclampsia in late pregnancy as a cause<\/li>\n<\/ul>\n<p>See\u00a0<a href=\"http:\/\/emedsa.org.au\/DocumentationForms\/HeadacheChecklist.htm\">Acute Headache\u00a0Assessment Form<\/a>\u00a0(printable form)<\/p>\n<p><strong>Examination<\/strong><\/p>\n<ul>\n<li>Vital signs especially fever or <a href=\"http:\/\/emedsa.org.au\/CoreMed\/2016\/07\/23\/raised-intracranial-pressure\/\">Cushing&#8217;s reflex<\/a><\/li>\n<li>GCS<\/li>\n<li>A careful neurological examination including gait, coordination and reflexes<\/li>\n<li>A test of higher cortical functions e.g. speech<\/li>\n<li>Evaluate cognition via the mini-mental state examination<\/li>\n<li>Examine the head for\u00a0<a href=\"http:\/\/emedsa.org.au\/CoreMed\/2016\/08\/13\/headache-clinical-anatomy\/\">non-intracranial pathology<\/a><\/li>\n<\/ul>\n<h3>COMMON TRAPS<\/h3>\n<ul>\n<li>Ignoring any headache in an anti-coagulated patient<\/li>\n<li>Considering a normal plain CT brain rules out all serious pathology<\/li>\n<\/ul>\n<h2>INVESTIGATIONS<\/h2>\n<p>Depending on clinical assessment, severity of symptoms and likelihood of acute pathology<\/p>\n<p>Routine blood tests are usually not helpful unless there are specific suspicion<\/p>\n<ul>\n<li>WCC\/CRP (if infective process suspected)<\/li>\n<li>ESR\/CRP (if temporal arteritis suspected)<\/li>\n<\/ul>\n<p>High patient risk groups<\/p>\n<ul>\n<li>Anticoagulated patients<\/li>\n<li><a href=\"http:\/\/emedsa.org.au\/CoreMed\/2016\/07\/23\/immunocompromise\/\">Immuno-compromise<\/a><\/li>\n<\/ul>\n<h3>DISPOSITION<\/h3>\n<p style=\"text-align: left;\"><strong>Immediate\u00a0CT brain<\/strong><\/p>\n<ul style=\"text-align: left;\">\n<li>Rapidly deteriorating conscious state<\/li>\n<li>Focal deficit<\/li>\n<\/ul>\n<p><strong>Early CT brain<\/strong><\/p>\n<ul>\n<li>Rapid onset of acute headache<\/li>\n<li>Headache different or &#8216;worst ever&#8217; from previous episodes<\/li>\n<\/ul>\n<p style=\"text-align: left;\"><strong>Prolonged observation<\/strong><\/p>\n<p style=\"text-align: left;\">Moderate headache with<\/p>\n<ul>\n<li style=\"text-align: left;\">Fever<\/li>\n<li style=\"text-align: left;\"><a href=\"http:\/\/emedsa.org.au\/CoreMed\/2016\/07\/23\/immunocompromise\/\">Immuno-compromise<\/a>\u00a0(e.g. AIDs patients)<\/li>\n<\/ul>\n<p style=\"text-align: left;\"><strong>Discharge Criteria<\/strong><\/p>\n<ul>\n<li style=\"text-align: left;\">Afebrile<\/li>\n<li style=\"text-align: left;\">Normal GCS<\/li>\n<li style=\"text-align: left;\">No focal deficit or other neurological symptoms<\/li>\n<li style=\"text-align: left;\">No signs of\u00a0<a href=\"http:\/\/emedsa.org.au\/CoreMed\/2016\/07\/23\/raised-intracranial-pressure\/\">Raised Intracranial Pressure<\/a><\/li>\n<li style=\"text-align: left;\">Mild symptoms<\/li>\n<li style=\"text-align: left;\">Normal CT brain if high-risk patient<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Tweet ACUTE HEADACHE (this section does not consider traumatic causes of headache) Consider early CT brain if rapid onset of headache to rule out expanding space-occupying lesion particularly if there&#8230; <a href=\"http:\/\/emedsa.org.au\/CoreMed\/2016\/08\/16\/headache-assessment\/\">Read more &raquo;<\/a><\/p>\n","protected":false},"author":1,"featured_media":602,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"episode_type":"","audio_file":"","cover_image":"","cover_image_id":"","duration":"","filesize":"","date_recorded":"","explicit":"","block":"","filesize_raw":"","footnotes":""},"categories":[1],"tags":[],"class_list":["post-595","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized"],"_links":{"self":[{"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/posts\/595","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/comments?post=595"}],"version-history":[{"count":8,"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/posts\/595\/revisions"}],"predecessor-version":[{"id":624,"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/posts\/595\/revisions\/624"}],"wp:featuredmedia":[{"embeddable":true,"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/media\/602"}],"wp:attachment":[{"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/media?parent=595"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/categories?post=595"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/tags?post=595"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}