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A Few Random Thoughts About Headaches CCFP (EM) Rounds Dec 17 th, 2009 Ian Walker
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What Will We Be Talking About? Migraine SAH Workup Significant CT negative HA’s Trigeminal Neuralgia Cluster Headache
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Migraine Define It!! Treatment Options?
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STEROIDS, ANYONE?
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Worrisome Features for SAH Thunderclap Exertional or Coital Vascular Risk Factors Family History Meningismus Altered LOC
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The LP Controversies When? What constitutes positive? Checking for Xantho
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Differential?
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A Case This Woman Waxing and waning headache for 4 days Diplopia yesterday, none now Worse supine Nausea No history of same Slight weakness on L
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Dural Sinus Thrombosis Think elevated ICP Think DVT of the brain Think CT Venogram Think LP Think about it
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Intracranial Dissection
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What Should Make You Think About It? Manipulation Trauma (MVC, etc) Neuro findings Horner’s Cerebellar Findings
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Another Case This Patient 1 week of headache Worse in am Worse laying down Intermittent Visual blurring What’s The Best Test?
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Does this 48 year old Man have GCA?
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Cluster Headache Severe, unilateral Rhinorhea and lacrimation Headaches “cluster” temporally O2, lidocaine, verapamil, pre-gabalin Great patient for a neurologist
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PUTTING IT ALL TOGETHER
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