# Headache

Checklist
‍-- Chart Check: meds (AC), prior head imaging, h/o cancer, immunosuppression
-- HPI Intake: *onset, timing, location/radiation, quality, severity, triggers, aura, other symptoms, red flags (focal deficit, meningeal signs, fevers, AMS, new >35-50yo, acute and severe, worse with exertion, worse in AM, wakes at night, immunosuppressed, h/o cancer), medications, caffeine
-- Can't Miss: SAH, stroke, meningitis, hypertensive encephalopathy, CNS tumor, temporal arteritis, cerebral venous thrombosis
-- Admission Orders: Labs - CBC, TSH; If red flags - get non-con head CT (thunderclap, trauma, new HA) or brain MRI with contrast (chronic headache but change in severity or pattern)
-- Initial Treatment to Consider: NSAIDs, tylenol, reglan

Intake
-- Onset: ***
-- Timing: *** duration of episodes, frequency
-- Location/Radiation: ***
-- Quality: *** band-like vs pulsing
-- Severity: ***
-- Triggers: *** stress, poor sleep, food, EtOH, menstruation, positional
-- Aura: ***
-- Associated Sxs: *** pounding, photo/phonophobia, N/V
-- Red Flags: *** focal neuro exam, meningeal signs, fevers, AMS, new >35-50 yo, acute and severe, worse with exertion, worse when wake up, wakes up at night, immunosuppressed, h/o cancer
-- Medications: *** analgesics, AC, OCPs
-- Caffeine: ***

Assessment:
-- History: *** timing, triggers, immunosuppressed, h/o cancer
-- Clinical: *** red flags - fevers, AMS, vision change, focal deficits, meningeal signs, worst of life, within minutes
-- Exam: *** focal neuro deficit, meningel signs (nuchal rigidity), tenderness over temporal artery, tenderness over sinuses, dental
-- Data: *** CT Head
-- Etiology/DDx: *** Common - tension, migraine, med overuse; Can’t Miss - meningitis, HTN emergency, SAH, stroke, cerebral sinus thrombosis, tumor; Other - trigeminal neuralgia, cervicogenic

The patient's HPI is notable for ***. Exam showed ***. Labwork and data were notable for ***. Taken together, the patient's presentation is most concerning for ***, with a differential including ***.

Plan:
Workup
-- Imaging: *** if any red flags - focal neuro exam, meningeal signs, fevers, AMS, new >35-50 yo, acute and severe, worse with exertion, worse when waking up, wakes up at night, immunosuppressed, h/o cancer)

Treatment
-- Abortives: *** ibuprofen 400-600mg, tylenol 1000mg, excedrin; sumatriptan 50-100mg; not to be used more than 2-3 times per week or 10 times per month
-- Preventatives: *** amitriptyline 10-50mg, venlafaxine 37.5-150mg, topiramate 25-100mg
-- Supplements: *** Magnesium 400mg-800 BID, riboflavin 400mg, Coenzyme Q10 100mg TID
-- Triggers: avoid known triggers including ***
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