Headaches you should know about.
According to the ACI Stemetil IV is preferred to Chlorpromazine (Largactil) because of hypotension. Also the dose of Chlorpromazine quoted is high.
Occipital nerve block would not be first line treatment in ED.
Narcotics are not recommended.
If above does not work Sumatriptan 6mg sc would be an option.
Ketorolac 30mg IM is OK but we were told that the patient has already had NSAIDs.
Ergots have largely been replaced by Sumatriptan.
I prefer the "Old English" option---but it is unfortunately made up.
Of course they will all have additional symptoms and signs such as a high temp and confusion in meningoencephalitis or vertigo and incoordination in a patient with a cerebellar bleed.
As the name suggest they occur in groups or "clusters". Attacks last 15min to 3hrs and tend to occur 2 to 3 hours into sleep.
The deep fried canary comes from Ancient Rome.
Tape on forehead----Vietnam.
Pickled sheep's eye in tomato juice--Mongolia.
Vertebral artery dissection usually occurs following trauma but there may be a lag in symptoms of days, weeks, months or longer.
Classically you get a partial or complete "Lateral medullary syndrome" also known as "Wallenberg syndrome". For further on this below is a link to the LITFL review.
https://litfl.com/wallenberg-syndrome/
Remember----pain and neuro symptoms/signs = Vascular until proven wrong.
There is a bit of controversy and practice variation.
Generally in ED we see patients on the worse end of the spectrum so Amoxycillin or Augmentin is reasonable.
Steroids do not alter the course and Anti histamines are not useful.
The data is a bit inconsistent with migraine but solid for cluster headaches and occipital neuralgia.
It is pretty easy, quick and safe to try. Below is a "You Tube" link which shows it.
So---I would not LP these patients given the potential complications of an LP. Also remember that most of these patients would have had a plain CT along with a CTa looking at intra and extra cranial vessels.
The exiled Bolshevik leader was attacked in his house just outside Mexico City by a man (Spanish communist) wielding a shortened climbing ice pick. Trotsky blamed Josef Stalin----and he was probably right.