Headache

=Headache= Headache One-Pager

Acute
Headache, while painful, is most often benign. **Accompaning physical findings** are rare (fever, nucal rigidity, high bp, occular signs, ptosis, etc) and if present, more worrisome - and often lead to **more work-up**. (CT, LP, and blood work - ESR, CBC, being the most common "ER" work-up in the initial stages) The presentation of Encephalitis, Meningitis, Abcess, Tumor are usually not subtle - Past History may be helpful. No PMHx of headaches, or the "worst HA of my life" suggest more w/up is necessary.

In the absence of these "red flags", **Viral etiologies, dehydration, stress, and tension HA's** are the most common causes, and symptomatic treatment (NSAIDs, fluid, rest) are reasonable.

Chronic
Chronic may include **recurring Headache**, or Ongoing/unremmiting HA's have a higher overlap with Depression, Stress, and Disability. Migrane, Cluster, and other "chronic headaches" tend to recurr in somewhat typical patterns, some with prodromes.


 * Cresendo** (increasing) headache is usually more worrisome, and if associated with N/V/neuro deficets, fever, or other "red flags" warrants an urgent/emergent work up (CT, LP, etc)

=Work up= Recurrent work-ups are rarely productive (eg serial CT's) in the absence of warning signs and may expose patients to later sequelae (eg orbit irradiation from CT's causing cataracts) and anxiety.
 * Tx** for Migranes - Choose based on side effects and co-morbidities - B-Blockers, TCA's, anti-convulsants or CaChB's may be tried - (eg Tricyclics if smoker, over 60 yo, or depressed) Accupressure, stress reduction and lifestyle modification may be helpful.



DDx
Depression, stress, and of course addiction should always be investigated if suspected. These are addressed as other "top 30" Dx's a work in progress.

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