6 - Headache

Summary

The typical evaluations of headache include vital signs, palpation of the sinuses, temporomandibular joint and cervical musculature, and auscultation of the carotids in addition to neurological examinations. Although plain films of the sinuses, temporomandibular joint, or cervical spine are occasionally helpful, brain computerized tomography (CT) or magnetic resonance imaging (MRI) are the imaging studies of choice for headache. Subarachnoid hemorrhage (SAH) afflicts nearly 30,000 Americans each year, the majority suffering a ruptured intracranial aneurysm. The primary headache syndromes include: tension-type headache, cluster headache and migraine headache. Given the wide array of newer treatment options for acute migraine, the role of narcotics has become more limited. However, it is compassionate and necessary to treat occasional patients who have failed all reasonable options with potent narcotic analgesics. Most migraine headaches may be aborted with parenteral sumatriptan, dihydroergotamine, or neuroleptic agents.