TEST QUESTION: Severe Headache

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Example Video:

Subdural Hematoma- A True Story (OLD CARTS presentation)

TODAY’S TEST QUESTION:


CORRECT ANSWER:

B) Call the on call provider for a stat (immediate) head CT

MORE INFO:

  • The key words here are “sudden severe headache”. This is a red flag.

  • Generally CT of head is done first before a MRI is done 

  • MRI is usually done after the CT if no acute finds on CT of head

  • The blood pressure is in 150’s– which wouldn’t likely be the cause of a severe headache.

  • Although it is important to note that the higher the blood pressure gets-symptoms of headache, blurred vision, and nausea are more likely to be present.

  • It is important to note that pain may be what is actually causing the blood pressure to increase.

  • Hydralazine is sometimes a PRN (as needed) medication on the chart. It is usually under set parameters to give if SBP >160, >170, >180, >190, etc…

  • Although administering acetomenophen might be something to do at some point for the pain-it’s important to realize the significance and urgency of a sudden severe headache. Think about what needs to come first in this situation? What are the potential causes?

  • See the list of differential diagnosis below-subdural hematomas, stroke, some things to think about

DIFFERENTIAL DIAGNOSIS FOR HEADACHE

Acute angle-closure glaucoma

Acute mountain syndrome/hypoxia

Alcohol withdrawal

Caffeine withdrawal

Carbon monoxide poisoning

Cervical disc disease-bulging discs

Concussion/head trauma

Dehydration

Eclampsia

Elevated blood pressure

Increased intracranial pressure

Influenza

Medication overuse

Medication withdrawal

Meningitis

Migraines-cluster, tension

Neck tension

Sinusitis

Subarachnoid hemorrhage

Subdural hematoma

Stroke

Temporal arteritis

TIA

TMJ

Trigeminal neuralgia

Tumor-brain

These are just some of the potential causes

  This is not an all-inclusive list…..


REFERENCE

  1. Epocrates- (paid version) Differential Dx list headaches
DISCLAIMER: The information posted is not intended to be medical advice. This is for educational purposes only. This information is intended for medical professionals & students. Check with your primary care provider if you have any questions regarding your health. This is not intended to guide in medical decisions or treatment in any way. As always, medical professionals should call the on call provider if any clarifications are needed. This is not intended to guide or direct medical decisions, treatment choices, and or interventions. State and hospital protocols should always be followed accordingly. Med Made Ez (MME) disclaims any liability for the decisions you make based on this information.

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