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HeadacheTeaching
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<<forEachTiddler where 'tiddler.tags.contains(context.inTiddler.title)' sortBy tiddler.title ascending write '"*[["+tiddler.title+"]]\n"'>> <<tiddler AutoRefresh with: force>> poorly managed in primary care but only 1 in 1000 have tumour Mostly cluster, tension, migraine, secondary, other Don't miss ... meningococcal, berry aneursym, tumour, temporal arteritis, carotid dissection, acute closed angle glaucoma, CO poisoning, SAH Red flags >1% chance serious ... abN neurology, papilloedema, new cluster, Hx cancer elsewhere (current) Orange flags 0.1-1% serious ... occurs with valsalva, change in frequency, new onset >50, wake from sleep, unresolved in 6-8/52 Note - cluster headache unilat occurs daily at same time for few days then again few weeks later, associated antonomic Sx (sweating) Key steps 5 questions how many pain killers being taken ? how many types of headache is there ? impact of headache (migraine - lay down, tension - keep going, cluster - bang head) if migraine - FH, age when started (late teens), frequency, nausea, photophobia what does pt think causes this ? 2 examinations BP and fundoscopy (early - hyperaemia, moderate - blurred disc, patton lines, late - no disc) 1 delay tactic keep diary, next time double appt, measure impact with MIDAS (looks at impact on life over 3/12)or HIT score
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