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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.
SPECIFIC NEUROLOGICAL CONDITIONS
Robert G. Kaniecki, Department of Neurology University of Pittsburgh Pittsburgh, Pennsylvania,
L. R. Searls, Ingham Regional Medical Center Sparrow Hospital/MSU Emergency Medicine Residency Program Lansing, Michigan
Although the most common sources of pain in the neck and upper extremities are musculoskeletal or neurogenic, referred pain from ischemic processes of visceral organs is often confounding. The most common cause of neck pain is cervical strain, characterized by transient cervical pain, stiffness, and posterior cervical muscle spasm. Local application of heat and anti-inflammatory analgesics are generally effective. Lesions of the cervical spinal cord generally result in deep segmental pain that is poorly localized and infrequently influenced by positional changes or Valsalva maneuvers. Tumors of the axial skeleton are commonly metastatic in origin. The thoracic region is the most common spinal location for metastatic disease, and 70% of spinal cord compression cases arise from thoracic cord involvement. Lumbar strain or sprain is the most common source of benign backache. The treatment for spinal stenosis involves analgesics, adjuvant analgesics (antidepressants or antiepileptics), physical therapy, and surgery in appropriate cases.
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