What Will We Be Talking About?
• Migraine• SAH Workup• Significant CT negative HA’s• Trigeminal Neuralgia• Cluster Headache
Worrisome Features for SAH
• Thunderclap• Exertional or Coital• Vascular Risk Factors• Family History• Meningismus• Altered LOC
A Case
• This Woman• Waxing and waning
headache for 4 days• Diplopia yesterday,
none now• Worse supine• Nausea• No history of same• Slight weakness on L
Dural Sinus Thrombosis
• Think elevated ICP• Think DVT of the brain• Think CT Venogram• Think LP• Think about it
What Should Make You Think About It?
• Manipulation• Trauma (MVC, etc)• Neuro findings• Horner’s• Cerebellar Findings
Another Case
• This Patient• 1 week of headache• Worse in am• Worse laying down• Intermittent Visual
blurring
• What’s The Best Test?
Cluster Headache
• Severe, unilateral• Rhinorhea and lacrimation• Headaches “cluster” temporally• O2, lidocaine, verapamil, pre-gabalin• Great patient for a neurologist