Above is the complete FERNE.org lecture on the optimal management of emergency department patients with life-threatening headaches and the COVID-19 implications.
This lecture was developed with EB Medicine collaborators and was presented in an EB Medicine podcast on June 4, 2020. Questions to help guide your learning and teaching activities are provided below. You can also access a pdf by clicking here.
You may watch portions of this lecture by viewing the YouTube playlist below or by hovering over the three lines in the right upper portion of the video.
Select the lecture portion you wish to view by clicking on the links below.
Video Chapters – Life-Threatening Headache Patients & COVID-19
- Introduction: Life-Threatening Headache Pts and COVID-19
- History & Physical Exam
- Sub-Arachnoid Hemorrhage
- SAH and ACEP Guidelines
- Cervical Artery Dissection
- Central Venous Thrombosis
- Idiopathic Intracranial HTN
- Giant Cell Arteritis
- Reversible Encephalopathy
- Meningitis & Encephalitis
- Angle Closure Glaucoma
- Pregnancy-Induced HTN
- Carbon Monoxide Poisoning
- Head & Neck Infections
- COVID-19 & Headache: Life-Threatening Headache Patients & COVID-19
Study Questions - Life-Threatening Headache
Click the document title below to print the PDF of all of the questions from the headache learning modules.
FERNE Questions for Headache Educational Modules
Click the + buttons below to reveal the questions in each of the individual headache learning modules.
- How do patients with potentially life-threatening headaches present, and will they present differently as a result of Covid-19 infection?
- What is the optimal way in which secondary headache patient should be examined, diagnosed, and treated during the Covid-19 pandemic?
- Is there a significant paradigm shift in the acute management of headache patients when Covid-19 is a likely or confirmed contributor to the patients’ illness?
- Take a look at the video clip that introduces content that is based, in part, on the 2019 monograph: ”Evaluation and Management of Life-Threatening Headaches in the Emergency Department” from the EB Medicine Emergency Medicine Practice Series. History and Physical Exam
- What is the difference between primary and secondary headache etiologies?
- What are the life-threatening secondary headache etiologies that must be excluded in the acute setting?
- What is the OPQRSTU system for obtaining the history from an acute headache patient?
- What are the associated historical findings to be assessed in an acute headache patient?
- What are the red flags in the history obtained from an acute headache patient?
- What general physical findings should be assessed in an acute headache patient?
- What should the head and neck exam include in an acute headache patient?
- What elements of the eye exam should be included in the evaluation of an acute headache patient?
- What secondary headache etiologies are suggested by an observed lid lag or fundus papilledema?
- What elements of the neurological exam must be assessed and documented in patients with an acute headache?
- What are the red flags that must be noted in the physical exam of an acute headache patient?
- What lab tests should be considered to exclude which secondary headache etiologies when evaluating an acute headache patient, and why?
- When should a lumbar puncture be performed in the evaluation of an acute headache patient, and why?
- When should increased intracranial pressure (ICP) be suspected when performing a lumbar puncture, and how, why, and when should ICP be measured when evaluating an acute headache patient?
- What lab tests should be performed on which tubes of cerebrospinal fluid (CSF) from the lumbar puncture of an acute headache patient?
- Which is the optimal first neuroimaging brain study to be performed when evaluating an acute headache patient, and what is the expected yield of this study?
- What significant cranial abnormalities can be reliably excluded with the initial non-contrast brain CT of patients with an acute headache?
- What other neuroimaging studies should be considered when evaluating the many possible secondary headache etiologies in an acute headache patient?
- Take a look at the video clip that discussed the history, physical exam, lab, and neuroimaging studies to be considered when evaluating an acute headache patient. These questions and more lead to the discussion of specific life-threatening headache etiologies that is based, in part, on the 2019 monograph: ” Evaluation and Management of Life-Threatening Headaches in the Emergency Department” from the EB Medicine Emergency Medicine Practice Series.
- What is the one of the most important secondary headache causes to be excluded in patients who present with an acute headache?
- What are the characteristics of a thunderclap headache, since this headache type suggests the need to exclude the diagnosis of sub-arachnoid headache in acute headache patients?
- How should likelihood ratios be utilized when considering the presence of a sub-arachnoid hemorrhage (SAH) in an acute headache patient?
- How do likelihood ratios relate to the a priori risk assessment established prior to stratifying risk based on the history, physical exam, and/or diagnostic evaluation?
- What are the critical elements of the Ottawa SAH Rule, and how can this rule be used to support medical decision making with regards to the diagnostic evaluation of an acute headache patient?
- Based on the Ottawa SAH Rule results, what documentation and clinical statement can be made in the electronic medical record (EMR) that supports the diagnostic evaluation of an acute headache patient?
- What does the American College of Emergency Physicians (ACEP) 2008 clinical policy state regarding the diagnostic evaluation of patients with a sudden, severe (thunderclap) headache?
- According to the ACEP 2008 clinical policy, what additional testing must be performed to exclude SAH if the initial non-contrast brain CT is negative?
- What does the 2019 ACEP headache clinical policy state with regard to risk stratification when considering SAH? Is the Ottawa SAH rule more sensitive or more specific, and which is more important when excluding SAH?
- According to the ACEP 2019 clinical policy, can a non-contrast head CT be utilized alone to exclude SAH in an acute headache patient?
- From this 2019 clinical policy, if additional diagnostic testing must be performed, is lumbar puncture or CT angiography recommended as the preferred method for detecting sub-arachnoid blood, and why?
- What is the optimal acute management of patients diagnosed with an acute SAH?
- What is the one of the most important secondary headache causes to be excluded in patients who present with an acute headache?
- What are the characteristics of a thunderclap headache, since this headache type suggests the need to exclude the diagnosis of sub-arachnoid headache in acute headache patients?
- How should likelihood ratios be utilized when considering the presence of a sub-arachnoid hemorrhage (SAH) in an acute headache patient?
- How do likelihood ratios relate to the a priori risk assessment established prior to stratifying risk based on the history, physical exam, and/or diagnostic evaluation?
- What are the critical elements of the Ottawa SAH Rule, and how can this rule be used to support medical decision making with regards to the diagnostic evaluation of an acute headache patient?
- Based on the Ottawa SAH Rule results, what documentation and clinical statement can be made in the electronic medical record (EMR) that supports the diagnostic evaluation of an acute headache patient?
- What does the American College of Emergency Physicians (ACEP) 2008 clinical policy state regarding the diagnostic evaluation of patients with a sudden, severe (thunderclap) headache?
- According to the ACEP 2008 clinical policy, what additional testing must be performed to exclude SAH if the initial non-contrast brain CT is negative?
- What does the 2019 ACEP headache clinical policy state with regard to risk stratification when considering SAH? Is the Ottawa SAH rule more sensitive or more specific, and which is more important when excluding SAH?
- According to the ACEP 2019 clinical policy, can a non-contrast head CT be utilized alone to exclude SAH in an acute headache patient?
- From this 2019 clinical policy, if additional diagnostic testing must be performed, is lumbar puncture or CT angiography recommended as the preferred method for detecting sub-arachnoid blood, and why?
- What is the optimal acute management of patients diagnosed with an acute SAH?
- What is PRES, and what are the common historical and exam findings in a patient with PRES?
- How is blood pressure lowered in patients with PRES?
- What is a “safe” blood pressure in patients with elevated BP and an urgent or emergency BP situation?
- How much should the mean arterial pressure (MAP) be reduced in patients with elevated BP and PRES? How much will the SBP and DBP change with a therapeutic MAP reduction?
- How is MAP calculated, and what is the MAP when BPs are normal and elevated?
- What are the IV bolus anti-hypertensives that can be used to lower MAP in PRES patients?
- What are the continuous infusion IV anti-hypertensive meds that can lower MAP?
- What are the clinical criteria that define pregnancy-induced hypertension (PIH)?
- What medications can be used to treat hypertension (HTN) in PIH?
- How is magnesium provided to patients with severe PIH?
- What is acute angle closure glaucoma, and what are the common historical and exam findings in a patient with this headache type?
- What is the normal intraocular pressure (IOP), and what is a significant IOP elevation?
- What is the mechanism for the pathological IOP elevation in patients with acute angle closure glaucoma?
- What medications can be used to treat acute angle closure glaucoma?
- What are the common historical and exam findings in a patient with headache related to carbon monoxide poisoning?
- What is the normal carbon monoxide (CO) level, and what is a significant CO elevation?
- How should patients with CO poisoning be treated, and which CO patients need to receive hyperbaric oxygen therapy (HBOT)?
- What are the common historical and exam findings in a patient with headache related to Idiopathic Intracranial Hypertension (HTN)
- What is the treatment of patients with headache related to Idiopathic Intracranial Hypertension (HTN)?
- What are the common head and neck infections that can cause headache?
- What are the common historical and exam findings in patients with headache related to head and neck infection?
- What is the most important therapeutic step in managing patients with headache and a suspected head and neck infection?
- What are the common historical and exam findings in a patient with headache suspected to be related to meningitis or encephalitis?
- What are the most common infectious agents seen in patients with meningitis and encephalitis?
- What is the most important therapeutic step in managing patients with headache and suspected meningitis or encephalitis?
- What are the antibiotic treatments based on age for patients with suspected meningitis or encephalitis?
- What are the common historical and exam findings in a patient with headache suspected to be related to cerebral venous sinus thrombosis?
- What is the optimal neuroimaging study for patients with suspected cerebral venous sinus thrombosis?
- What does a cerebral venous sinus thrombus show on the MR venogram (MRV)?
- How are patients with cerebral venous sinus thrombosis treated?
- What are the common historical and exam findings in a patient with headache related to giant cell arteritis?
- What is the treatment of patients with headache related to giant cell arteritis?
- What are the CNS mechanisms by which the COVID-19 virus causes nerve, neurological dysfunction, and headache?
- What are the common historical and exam findings in patients with headache related to COVID-19 infection?
- How common is headache in patients with COVID-19, both during the acute infection phase and as a long-haul symptom?
- What are common neurological complications related to COVID-19 infection?
- Does the diagnosis and treatment of patients with headache differ in the presence of COVID-19 infection?