APPROACH TO HEADACHE IN ETD
&
ISCHEMIC VS HEMORRHAGIC STROKE
Presenters:
Grace
Amber
,Introduction to headache
● Headache is a common Emergency Department complaint.
● The causes of headache can range from benign to life threatening.
● Nearly 47% of adults report headaches at some time in their life and there are approx. 2.1 million ED
visits per year in the US (2-4% of ED visits). *no data in Malaysia
● While the differential for headache is large, a systematic approach to history and physical exam will
allow for effective evaluation of these patients and determination of necessary diagnostic testing and
therapeutic interventions.
,Types of headache
•Primary (without underlying medical condition)
•Migraine
•Tension-type headache
•Cluster headache
•Others eg trigeminal autonomic cephalalgias, exercise-
related
•Secondary (caused by underlying medical condition)
•Vascular: SAH, HPT emergency, ischemic/hemorrhagic
stroke
•Infective: meningitis/encephalitis, brain abscess
•Increased ICP: brain tumor, idiopathic
•Trauma-related: post-traumatic headache,
epidural/subdural hematoma
•Ophthalmologic/ENT causes: glaucoma, sinusitis
, Approach to headache in ED
1. Triage
- Primary triage: Rapid assessment of AVPU, RR, CCTVR, pain score
- Secondary triage: obtain vital signs, perform simple examination
- Triage accordingly (green, yellow, or resus)
2. Primary assessment
- ABCDE
- Exclude life threatening condition
3. Focus history taking
4. Physical examination including neuro exams
5. Diagnostic testing
6. Establish differential diagnosis
7. Treatment plan
&
ISCHEMIC VS HEMORRHAGIC STROKE
Presenters:
Grace
Amber
,Introduction to headache
● Headache is a common Emergency Department complaint.
● The causes of headache can range from benign to life threatening.
● Nearly 47% of adults report headaches at some time in their life and there are approx. 2.1 million ED
visits per year in the US (2-4% of ED visits). *no data in Malaysia
● While the differential for headache is large, a systematic approach to history and physical exam will
allow for effective evaluation of these patients and determination of necessary diagnostic testing and
therapeutic interventions.
,Types of headache
•Primary (without underlying medical condition)
•Migraine
•Tension-type headache
•Cluster headache
•Others eg trigeminal autonomic cephalalgias, exercise-
related
•Secondary (caused by underlying medical condition)
•Vascular: SAH, HPT emergency, ischemic/hemorrhagic
stroke
•Infective: meningitis/encephalitis, brain abscess
•Increased ICP: brain tumor, idiopathic
•Trauma-related: post-traumatic headache,
epidural/subdural hematoma
•Ophthalmologic/ENT causes: glaucoma, sinusitis
, Approach to headache in ED
1. Triage
- Primary triage: Rapid assessment of AVPU, RR, CCTVR, pain score
- Secondary triage: obtain vital signs, perform simple examination
- Triage accordingly (green, yellow, or resus)
2. Primary assessment
- ABCDE
- Exclude life threatening condition
3. Focus history taking
4. Physical examination including neuro exams
5. Diagnostic testing
6. Establish differential diagnosis
7. Treatment plan
