MIGRAINE, DEMENTIA, DELIRIUM, POST-CONCUSSION SYNDROME,
TRAUMATIC BRAIN INJURY ASSESSMENT WELL RATED
DOWNLOAD TO SCORE A
Migraine
Assessme
nt
✓ It is important that the patient characterize the headache by describing the duration,
quality, and location of the pain. The presence or absence of any precipitating factors, or
triggers, and the age at onset should be established. The presence of associated
symptoms, such as nausea, vomiting, and photophobia, should be explored
✓ A medication profile is essential and should include medications that have been tried in
the past for headache control. If OTC medications are taken, the number used per
month should be identified because patients may not view OTC drugs as medications.
✓ A targeted physical examination is important in ruling out harmful secondary headache
pathologies and confirms any information given in the history. 12 The examination
findings in primary headache disorders are usually within normal limits.
o Key aspects of the physical examination include a cardiopulmonary and
complete neurologic assessment with a major focus on the following:
▪ • Funduscopic and pupillary assessment •
▪ Auscultation of the carotid and vertebral arteries •
▪ Mental status examination •
▪ Palpation of the head, neck, and temporal arteries •
▪ Evaluation for any neck stiffness, focal weakness, sensory loss and gait •
▪ Vital signs
✓ Problem findings include:
Onset of headache after the age of 50 years
▪ • Asymmetry of pupillary responses
▪ • Decreased deep tendon reflexes
▪ • Headache described as “the worst ever experienced”
▪ • Personality change
▪ • Onset of a new or different headache
▪ • Onset of a headache that progressively worsens
, MIGRAINE, DEMENTIA, DELIRIUM, POST-CONCUSSION SYNDROME,
TRAUMATIC BRAIN INJURY ASSESSMENT WELL RATED
DOWNLOAD TO SCORE A
▪ • Papilledema
▪ • Painful temporal arteries
Diagnosis
✓ The use of diagnostic studies depends on the results of the history and physical
examination.
✓ If the diagnosis is not clear or the history or physical findings are cause for concern,
diagnostic studies should be used to distinguish primary headache from a secondary
condition.
Treatment
✓ Nonpharmacologic measures attempt to control the headache without medication.
These methods include behavior modification, biofeedback, acupressure, management
of headache triggers, and a wellness program.
✓ Preventive therapy is appropriate for patients if they are unable to deal with their
attacks, they experience more than four headaches a month, or the attacks are prolonged
and refractory to medicine. Preventive therapy is given daily and, if successful, will
decrease headache intensity and frequency
✓ For example, a connection has been shown between epilepsy and migraine; therefore
anticonvulsants, such
as divalproex sodium (Depakote), gabapentin (Neurontin), and topiramate (Topamax),
can be used to control migraine
✓ A patient with cold hands, Raynaud phenomenon, or hypertension may do well with
calcium channel blockers, such as diltiazem (Cardizem) and amlodipine (Norvasc),
which cause vasodilation and decrease blood pressure.
o • A beta blocker, such as propranolol (Inderal) or atenolol, may be chosen for
the patient with palpitations caused by mitral valve prolapse or panic
disorders and should be avoided in those with asthma.
TRAUMATIC BRAIN INJURY ASSESSMENT WELL RATED
DOWNLOAD TO SCORE A
Migraine
Assessme
nt
✓ It is important that the patient characterize the headache by describing the duration,
quality, and location of the pain. The presence or absence of any precipitating factors, or
triggers, and the age at onset should be established. The presence of associated
symptoms, such as nausea, vomiting, and photophobia, should be explored
✓ A medication profile is essential and should include medications that have been tried in
the past for headache control. If OTC medications are taken, the number used per
month should be identified because patients may not view OTC drugs as medications.
✓ A targeted physical examination is important in ruling out harmful secondary headache
pathologies and confirms any information given in the history. 12 The examination
findings in primary headache disorders are usually within normal limits.
o Key aspects of the physical examination include a cardiopulmonary and
complete neurologic assessment with a major focus on the following:
▪ • Funduscopic and pupillary assessment •
▪ Auscultation of the carotid and vertebral arteries •
▪ Mental status examination •
▪ Palpation of the head, neck, and temporal arteries •
▪ Evaluation for any neck stiffness, focal weakness, sensory loss and gait •
▪ Vital signs
✓ Problem findings include:
Onset of headache after the age of 50 years
▪ • Asymmetry of pupillary responses
▪ • Decreased deep tendon reflexes
▪ • Headache described as “the worst ever experienced”
▪ • Personality change
▪ • Onset of a new or different headache
▪ • Onset of a headache that progressively worsens
, MIGRAINE, DEMENTIA, DELIRIUM, POST-CONCUSSION SYNDROME,
TRAUMATIC BRAIN INJURY ASSESSMENT WELL RATED
DOWNLOAD TO SCORE A
▪ • Papilledema
▪ • Painful temporal arteries
Diagnosis
✓ The use of diagnostic studies depends on the results of the history and physical
examination.
✓ If the diagnosis is not clear or the history or physical findings are cause for concern,
diagnostic studies should be used to distinguish primary headache from a secondary
condition.
Treatment
✓ Nonpharmacologic measures attempt to control the headache without medication.
These methods include behavior modification, biofeedback, acupressure, management
of headache triggers, and a wellness program.
✓ Preventive therapy is appropriate for patients if they are unable to deal with their
attacks, they experience more than four headaches a month, or the attacks are prolonged
and refractory to medicine. Preventive therapy is given daily and, if successful, will
decrease headache intensity and frequency
✓ For example, a connection has been shown between epilepsy and migraine; therefore
anticonvulsants, such
as divalproex sodium (Depakote), gabapentin (Neurontin), and topiramate (Topamax),
can be used to control migraine
✓ A patient with cold hands, Raynaud phenomenon, or hypertension may do well with
calcium channel blockers, such as diltiazem (Cardizem) and amlodipine (Norvasc),
which cause vasodilation and decrease blood pressure.
o • A beta blocker, such as propranolol (Inderal) or atenolol, may be chosen for
the patient with palpitations caused by mitral valve prolapse or panic
disorders and should be avoided in those with asthma.
