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Headache

Low Risk, < 6 Hours Onset

-VS unremarkeable
-Overall well-appearing, does appear uncomfortable. No abnormal cardiopulmonary findings. Absolutely no focal neurologic deficits, sided/crossed findings whatsoever. No visual changes. No numbness/tingling/sensation deficits. No nuchal rigidity.
-Patient presents with slow onset headache which is similar to previous and not the worst headache of their life. There are no clinical symptoms to support a bleed, mass, or infection. Those would be very low probability with the exception of a mass which would be low probability.
-CT head within 6 hours of onset essentially rules out SAH/acute bleed and decreases likelihood of mass further. The limitations of a CT head were discussed with the patient and they understood. Will plan to treat as primary headache. Will re-evaluate for improvement and/or resolution of symptoms. Discussed the possibility of outpatient MRI with patient. 

Re-exam, normal CT, DC

CT negative which essentially rules out sever intracranial injury. Patient states they feel much better after medications and would like to go home. On repeat exam, no abnormal neurologic findings. The patient is ambulatory without difficulty. Return precautions were extensively discussed. They understand to return immediately for any worsening symptoms or failure to improve.

Low Risk, > 6 Hours Onset

-VS unremarkeable
-Overall well-appearing, does appear uncomfortable. No abnormal cardiopulmonary findings. Absolutely no focal neurologic deficits, sided/crossed findings whatsoever. No visual changes. No numbness/tingling/sensation deficits. No nuchal rigidity.
-Patient presents with slow onset headache which is similar to previous and not the worst headache of their life. There are no clinical symptoms to support a bleed, mass, or infection. Those would be very low probability with the exception of a mass which would be low probability.
-CT head negative which decreases likelihood of bleed or mass further. The limitations of a CT head were discussed with the patient and further evaluation with LP was discussed given the risk of serious bleed being around 1 in 625. Will plan to treat as primary headache. Will re-evaluate for improvement and/or resolution of symptoms. Discussed the possibility of outpatient MRI with patient. 

Re-exam, normal CT, DC

CT negative which essentially rules out sever intracranial injury. Patient states they feel much better after medications and would like to go home. On repeat exam, no abnormal neurologic findings. The patient is ambulatory without difficulty. We did discuss the possibility of LP to help completely rule out an acute bleed. Risks and benefits were discussed and through shared decision making, they decided to defer LP. Return precautions were extensively discussed. They understand to return immediately for any worsening symptoms or failure to improve.

  • Last updated January 20, 2023

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