headache CJ

Pt having «new» headaches
Location: •
Quality: •
Intensity: •
Migraine features: «nausea, vomiting, photophobia, phonophobia»
Duration: •
Frequency: •
Onset: •
Triggers:•
Relief: •

Specific features:
-«NO» aura (scotoma, scintillations)
-«NO» lacrimation or nasal congestion
-«NO» continuous symptoms over weeks and half of head

Secondary causes:
-«NOT» associated with neck movement or scalp tenderness = cervicogenic pain, carotid dissection
-«NOT» Associated with jaw pain = TMJ dysfunction
-«NOT» Associated with temporal pain, jaw claudication, visual loss, PMR = temporal arteritis
-«NOT» Eye-pain = acute angle-closure glaucoma
-«NOT» Rebound headaches from analgesia

Red flags:
-«NO» systemic features: fever, HTN, myalgia, weight loss
-«NO» neurologic features - focal deficits, dec LOC, field defects, seizures, weakness
-«NO» sudden onset, thunderclap, with activity/positional changes
-«NO» first headache in patient >50 or with cognitive change
-«NO» change from known HA pattern
-«NO» immunosuppresion from cancer, chemotherapy, HIV
-«NO» hypercoaguability in females (OCP + smoking, hematologic abN)

O:
Temporal artery: normal pulsatility and nontender
Eye pain: nontender to palpation
TMJ: nontender to palpation, no crepitus
Cervicogenic muscles: nontender
Neck pain: none to palpation or c-spine movement
«CJ_exam_neuro»

A: Headache, likely •
P:
-Trigger research and diary
-Relaxation techniques, stress management, CBT
«-Trial physiotherapy, massage therapy»
«-Acute medication: tylenol 1000 mg + naproxen 500 mg (in abortive fashion), discussed s/e»
«-Triptan: •, discussed usage, only two doses in 24 hours separated by 2 hours, s/e»
«-Prophylaxis: •, discussed s/e»