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How to diagnose and treat benign headaches

  • Brian H. Rowe (a1) (a2), Cristina Villa-Roel (a1) and Lynette D. Krebs (a1)

Extract

A 19-year-old female, university student with a long-standing history of migraine headaches presented to the emergency department (ED) with a 36-hour history of gradual onset of left-sided headache, preceded by visual aura. She stated that her headache was worse than usual and now associated with nausea, vomiting, and photophobia, despite use of oral ibuprofen. On examination, she was afebrile, her SaO2 = 98% on room air, her pulse was 110 beats/minute, and she was breathing 20 breaths/minute. She received a Canadian Triage and Acuity Scale score of 2 due to her pain score of 8/10 on a Visual Analogue Scale (VAS). Her neurological examination was normal and her neck was supple with full range of motion. She was a non-smoker, infrequent cannabis user, and her last menstrual period was normal.

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Copyright

Corresponding author

Correspondence to: Dr. Brian Rowe, Department of Emergency Medicine, University of Alberta, 1G1.43 WMC, 8440-112 Street NW, Edmonton, AB T6G 2B7; Email: brian.rowe@ualberta.ca

References

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1.Fuller-Thomson, E, Jayanthikumar, J, Agbeyaka, SK. Untangling the association between migraine, pain, and anxiety: examining migraine and generalized anxiety disorders in a Canadian population based study. Headache 2017;57(3):375–90.
2.Perry, JJ, Sivilotti, MLA, Sutherland, J, et al. Validation of the Ottawa Subarachnoid Hemorrhage Rule in patients with acute headache. CMAJ 2017;189(45):E137985.
3.Berdahl, CT, Vermuen, MJ, Larson, DB, Schull, MJ. Emergency department computed tomography utilization in the United States and Canada. Ann Emerg Med 2013;62:486–94.
4.Sumamo Schellenberg, E, Dryden, DM, Pasichnyk, D, et al. Acute Migraine Treatment in Emergency Settings. Report No. 12(13)-EHC142-EF. AHRQ Comparative Effectiveness Reviews. Rockville, MD: Agency for Healthcare Research and Quality, (US); 2012.
5.Colman, I, Friedman, B, Brown, M, et al. Dexamethasone to prevent migraine relapse after discharge from the emergency department: a systematic review. BMJ 2008;336(7657):1359–61.
6.Rowe, BH, Colman, I, Edmonds, ML, et al. Randomized controlled trial of intravenous dexamethasone to prevent relapse in acute migraine headache. Headache 2008;48:333–40.

Keywords

How to diagnose and treat benign headaches

  • Brian H. Rowe (a1) (a2), Cristina Villa-Roel (a1) and Lynette D. Krebs (a1)

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