Not sure why I always post about pain on Fridays, but here I go again. We’ve had some discussions about headaches in Red Clinic lately (and I don’t mean the VA formulary), and I thought it would be useful to review some diagnostic strategies.
Remember the mnemonic: POUND Pulsatile One day Unilateral Nausea Daily activity (Interferes with daily activity) These are intense, debilitating headaches, often with nausea and photo/phonophobia. Patients will “take to the bed” to get over them. May have an aura: visual or sensory disturbances that are fully reversible.
Milder in intensity, bilateral, throbbing in quality. May have muscle tenderness over the scalp or neck. Patients usually can stay at work, continue activities with these headaches.
Rare Patients have episodes of daily headache, intense, usually unilateral and associated with autonomic symptoms. They will have symptom free periods between “clusters” for months or even years.
Medication Rebound Headache
Common Daily headache associated with regular use of almost any medicine for headache treatment. Most common with opiates, butabital containing meds (Midrin), or caffeine containing meds (fioricet or excedrin). Intermediate risk of triptans. Lowest risk with NSAIDs.
Just a quick post today- sort of a philosophical discussion about ordering tests, medicines, and just providing too much medical care. I tend to espouse the idea that I should mostly educate and get out of the way. I spend a lot of time talking people out of tests and medicines, and pointing out that more medical care leads to more problems.
A blog post from one of my favorite primary care docs points this out, in his typical entertaining fashion. Take a look and see what you think:
Musings of a Distractible Mind- More Trouble
I’ve got a link to his blog in the blog roll to the right- you might think about following him if you are into reading blogs. He’s just started a new practice, more of a concierge/direct pay model, which is really interesting to think about and watch him work through the kinks. Enjoy!