Headache Clincal Update Live Tweet
Check out the summary of the live tweet from the March 6th Emergency Department clinical update on headaches (especially migraines) presented by Marielle A. Kabbouche, MD.
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Live tweet of migraine lecture starts now! #PEMLectures #FOAMed
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#PEMLectures #FOAMed Maternal history is seen more in patients with migraine – take that dad’s
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#PEMLectures #FOAMed triggers vary, there is an internal thalamic clock, afferent stimuli to CNS (flickering light), “stress”
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#PEMLectures #FOAMed 25% of patients hav premonitory Sx yawning, irritable, dressed, hunger/thirst that start DAYS before
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#PEMLectures #FOAMed These premonitory Sx come from dopamine
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#PEMLectures #FOAMed Bille 1962 migraines http://onlinelibrary.wiley.com/doi/10.1111/j.1651-2227.1962.tb06591.x/abstract … need institutional access
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#PEMLectures #FOAMed 10% of kids 5-15y have recurrent headaches http://onlinelibrary.wiley.com/doi/10.1111/j.1651-2227.1962.tb06591.x/abstract …
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#PEMLectures #FOAMed 28% high schoolers with headache have migraines M 120 : F 539
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#PEMLectures #FOAMed location of headache – occipital in a young child – can be worrisome
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#PEMLectures #FOAMed child drawings of headaches can be predictive http://www.ncbi.nlm.nih.gov/pubmed/18263755 pic.twitter.com/BcRIhw9JYf
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Hey, check it out – part 3 of the #osteomyelitis series is up at the #PEMBlog with the focus on labs http://pemblog.com #FOAMed
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#PEMLectures #FOAMed worry for space occupying <1 mo duration, no fam history, abnl neuro exam, gait abnl, seizure http://pediatrics.aappublications.org/content/108/2/255.full.pdf …
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#PEMLectures #FOAMed Those findings could prompt you to get CT and/or MRI if available in next 2-3 days
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#PEMLectures #FOAMed additional worrisome Sx for space occupying are sleep related HA (wakes you up), occipital in school aged
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#PEMLectures #FOAMed AAN guidelines in children with migraines http://tools.aan.com/professionals/practice/pdfs/Headache_Peds_Physicians.pdf …
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#PEMLectures #FOAMed The aura in 15% have typical visual scotoma, this occurs with transient diminished cerebral blood flow, starts occiput
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#PEMLectures #FOAMed AURA should last no longer than 1hr (normally 5—60min) if longer r/o TIA/CVA. if aura is motor (weak, can’t talk)>image
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#PEMLectures#FOAMed Photo/Phonphobia, Unilateral, Nausea, Throbbing – PUNT for migraines
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#PEMLectures #FOAMed 5 attacks, 4-72hrs, 2/4[unilateral, throb, moderate/severe, worse with physical act] & 1 of N/V or photo/phono#PEMLectures #FOAMed aura requires 2 attacks vs the 5 for migraine. so in the ED don’t Dx with migraine unless they have had it previously#PEMLectures #FOAMed You can actually have aura without headache – this is a migraine!#PEMLectures #FOAMed chronic ≥15d/month for 3 months#PEMLectures #FOAMed Tension headaches do NOT have nausea/vomit, photo/phonophobia#PEMLectures #FOAMed Treatment! that’s what you were all waiting for…#PEMLectures #FOAMed Ibuprofen 71% pain free, 62% improved, 18% recur –#PEMLectures #FOAMed Triptans in children – imitrex tabs 22% pain free at 2h, 30% some relief / nasal 76% at 2h#PEMLectures #FOAMed Zomig tastes better than imitrex nasal spray – hard to improve by insurance#PEMLectures #FOAMed Overall for triptans Frova has a longer t1/2 (26 h) may prevent another attack in menstrual migraines#PEMLectures #FOAMed Triptans can be used for ≤6 headaches per month#PEMLectures #FOAMed Also TRIPTANS only work for acute presentation, unlikely to benefit unless taken at onset of headache#PEMLectures #FOAMed It may be reasonable to Rx a triptan for a future migraine – i.e. outside of 72hours from ED visit – e.g. IMITREX 100mg#PEMLectures #FOAMed side effects of triptans “dizzy” tired, jaw tightness, bad taste , chest tightness – may not occur with another triptan#PEMLectures #FOAMed triptans OK in well controlled hypertension#PEMLectures #FOAMed The triptan most likely to be filled varies – Imitrex is the ‘safest bet’ as pill#PEMLectures #FOAMed if previous CVA and/or HTN don’t give triptans#PEMLectures #FOAMed analgesic rebound – misuse of caffeine/meds over 2 weeks – treatment is to withdraw these meds#PEMLectures #FOAMed amitriptyline is first prophylaxis, topamax close behind – need to ask about mental health d/t TCA overdose worry#PEMLectures #FOAMed Depakote as prophylaxis is the ER version given bid#PEMLectures #FOAMed anxiety is the #1 comorbidity#PEMLectures #FOAMed ED treatment portion go… now!#PEMLectures #FOAMed in the ED all kids with serious neurological abnormalities (meningitis, tumor) had an abnormal neuro exam#PEMLectures #FOAMed Compazine 1hr 75% improved 50% headache free 3hrs 95% improvement 60% headache free http://www.ncbi.nlm.nih.gov/pubmed/11335783#PEMLectures #FOAMed I just posted a summary of antiemetic http://www.pemcincinnati.com/blog/wwd2-antiemetics-migraines/ … and depakote in migraines http://www.pemcincinnati.com/blog/briefs-depakote-migraines/ …#PEMLectures #FOAMed Benadryl done before compazine MAY limit the dopaminergic activity – so it might not be good to use beforehand#PEMLectures #FOAMed Decadron – IN adults prevents recurrence w/in 72hrs NNT=9 http://www.pemcincinnati.com/blog/briefs-depakote-migraines/ … no great studies in kids#PEMLectures #FOAMed Magnesium 2g over 2 hrs for post concussive headache – this is if antiemetic/toradol doesn’t work#PEMLectuers #FOAMed DHE is an inpatient med – headaches start to get better initially, but 5th dose is the point where they make a decision#PEMLectures #FOAMed IV proposal for migraines http://www.ncbi.nlm.nih.gov/pubmed/10759925 no good studies on kids – so don’t try it pleasestorify.com
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