headache

Emergency Department Treatment of Elevated Blood Pressure in the Headache Patient

Original Articles, Volume 23, Issue 2, Pages 53 – 96 (2024)

Headache accounts for 1 – 3% of emergency department (ED) visits globally and is associated with elevated blood pressure (BP). It is unclear if anti-hypertensive therapy provides benefits. This retrospective study assessed effects of anti-hypertensive therapy in ED headache patients on rescue analgesic need, hospital admissions, and length of stay (LOS). 1385 patients were included. 366 received anti-hypertensive therapy. The anti-hypertensive therapy cohort was older (p < 0.001) with increased odds of admission (p < 0.001) and 2.385 hrs longer ED LOS (p < 0.001). No difference in rescue analgesia was found (p < 0.429). Anti-hypertensive therapy in hypertensive ED headache patients is associated with increased hospital admission and ED LOS, but no difference in rescue analgesia utilization.

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HaNDL with care

Case Reports, Volume 14, Issue 3, Pages 97 - 144 (2015)

Abstract

Headache with neurological deficit and cerebrospinal fluid (CSF) lymphocytosis (HaNDL) syndrome is an important diagnosis to consider in patients presenting with the relevant features to acute medicine. Investigations should aim to exclude more serious differential diagnoses such as infectious, inflammatory and neoplastic causes prior to making a formal diagnosis of HaNDL. Increased awareness and early consideration of HaNDL would help to avoid unnecessary prolonged courses of antimicrobial therapy and invasive investigations such as cerebral angiography.

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Presentations to An Acute Medical Unit Due to Headache: A Review of 306 Consecutive Cases

Research Audit and Clinical Practice, Volume 11, Issue 3, Pages 129 - 185 (2012)

Abstract

The United Kingdom National Health Service has recently prioritised the need for ambulatory care pathways for acute headache. The present study sought to better characterise patients referred to an Acute Medical Unit so as to inform pathway development. In 2011, York Hospital received 306 referrals due to acute headache, representing 3% of acute medical admissions. Investigations included CT scan (38%), lumbar puncture (38%), and MRI (18%); there were no specialised investigations in 26%, and 18% of patients were discharged on the day of presentation. Subarachnoid haemorrhage occurred in only 4 patients (1%), meningitis in 10 (3%), and intracranial tumour in 5 (2%). The findings indicate that a significant proportion of patients with acute headache could be managed by ambulatory care.

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Actinomycosis masquerading as malignancy

Case Reports, Volume 11, Issue 2, Pages 57 - 124 (2012)

Abstract

We describe a patient who presented with neurological symptoms and radiological findings consistent with metastatic malignancy in several sites. However, no obvious primary site of tumour was identified and the patient later went on to develop clinical features of sepsis whilst using palliative dexamethasone therapy. A diagnosis of actinomycosis was eventually made on open lung biopsy and the patient recovered completely on penicillin V. This case serves to illustrate the need to obtain a formal tissue diagnosis whenever possible in all cases of suspected malignancy, in addition to exposing the weaknesses inherent in empiric diagnoses.

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Acute Angle closure glaucoma (AACG): an important differential diagnosis for acute severe headache

Case Reports, Volume 10, Issue 2, Pages 65 - 120 (2011)

Abstract

Acute headache is a common presenting symptom in the acute medical unit. We present a case of Acute Angle Closure Glaucoma (AACG) presenting with acute severe headache. It highlights the importance of remembering this ophthalmologic emergency and reminds us of its clinical presentation. The rapid assessment and diagnosis of AACG allowed prompt treatment and likely prevented the patient from losing her vision.

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Posterior Reversible Encephalopathy Syndrome: ‘A headache’ on the AMU

Case Reports, Volume 12, Issue 1, Pages 1 - 64 (2013)

Abstract

Headache and seizures are common presentations to the acute medical unit. We report a case of posterior reversible encephalopathy syndrome (PRES) in a 73 yr old woman with a history of uncontrolled hypertension who had recently discontinued one of her antihypertensive drugs; such cases are rare but pose a diagnostic challenge given the nonspecific nature of the clinical presentation. However, early diagnosis and treatment leads to full recovery in the majority of patients.

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