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Example Video:
TODAY’S TEST QUESTION:
CORRECT ANSWER:
B) Call the on call provider for a stat (immediate) head CT
MORE INFO:
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The key words here are “sudden severe headache”. This is a red flag.
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Generally CT of head is done first before a MRI is done
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MRI is usually done after the CT if no acute finds on CT of head
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The blood pressure is in 150’s– which wouldn’t likely be the cause of a severe headache.
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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.
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It is important to note that pain may be what is actually causing the blood pressure to increase.
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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…
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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?
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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
- Epocrates- (paid version) Differential Dx list headaches