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Headache


we may one day collaborate with neurology to incorporate their rapid headache protocol



Inclusion Criteria

  • Persistent pain in tension or migraine headache
  • Hx of migraine with same aura, onset, location and pattern
  • Drug related headache
  • No focal neurological signs
  • Normal CT scan (if done)
  • If LP is needed, then it must be done and normal (unless failed attempt and IR consult for LP arranged in ED BEFORE transfer to CDU, and low risk patient).

Exclusion Criteria

  • Focal neurologic signs
  • Meningismus
  • Elevated intraocular pressure as cause (i.e. glaucoma)
  • Abnormal CT scan
  • Abnormal LP (if performed)
  • Hypertensive emergency (diastolic BP > 120 with symptoms)
  • Suspected temporal arteritis
  • Blocked VP shunt
  • Frequent ED visits – suspected habitual patient, narcotic seeking behavior

Potential Interventions

  • Serial exams including vital signs,
  • Neuro checks: level of alertness, speech, motor function
  • Analgesics

Discharge Criteria

Home

    • Resolution of pain
    • Other to take patient home
    • No deterioration in clinical course

Admit

    • No resolution in pain
    • Deterioration in clinical course
    • Rule in of exclusionary causes

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