HEADACHE
                                ΝΝΝΝΝΝΝΝ
        Cavernous Sinus Thrombosis              <PeriOrbt.TXT -cavernous>
        Cluster Headaches                       <N-Clustr.TXT>
        Dystonic and Akathisia from
         treatment for Migraines                <Dystonic.TXT>
        Migraine Headache                       <N-Migran.TXT>
        Spinal Headache (post-LP Headache)      <SpinalHA.TXT>
        Subarachnoid hemorrhage                 <N-SAH.TXT>

ώ Decadron for Headache (Study from Brooke Arm Medical Center, SAEM 2004)
 - Decadron 10 mg IV
 - 2-3 day followup by phone.
 - 9.7% of those with Decadron had recurrence
 - 58.3% of those with placebo had recurrence
 - Statistically significant decrease also in previous studies (Innes CJEM 1999,
   Jones AEM 2003)
 - No difference in 10-20 mg of Decadron in previoius studies
 - Complications minimal
 - ? if PO as good as IV as has been shown for croup, needs study
   [Bader E. Intravenous dexamethasone to prevent the recurrence of benign
   headache following discharge from the Emergency Department: A randomized
   placebo-controlled trial. AEM 2004; 11(5): 436.]

ώ ACEP Policy on Headache
  [ACEP Clinical policy for the initial approach to adolescents and
  adults presenting to the ED with a chief complaint of headache. Ann
  Emerg Med June 1996;27:821-844.]
  Take home points:
 - pregnancy, current or recent:  consider dural sinus thrombosis
   <N-Sinus.TXT>
 - headache localized to the vertex:  consider sphenoid sinusitis
 - ipsilateral ptosis and miosis (Horner's syndrome):  carotid
   dissection

ώ Important causes of headache to rule out:
 - subarachnoid bleed
 - meningitis
 - subdural hematoma
 - brain abscess
 - temporal arteritis
 - CO poisoning

ώ Evaluation:
 - Note that CT is not 100% sensitive for a subarachnoid hemorrhage:  remember
   to follow up with an LP.  SAH can be 100% ruled out only by a negative LP
   performed at the proper time.  But NOTE that thunderclap headache can be a
   sign of aneurysm (? sudden expansion), with _no_ signs of actual bleeding.
   See <N-SAH.TXT> for more.

ώ Morning headaches: suggestive of intracranial tumors, also seen in CSF shunt
  obstruction (due to increased CSF pressure in the AM due to recumbency).

ώ "Setting Sun Sign":
 - Hydrocephalus can cause pressure on the midbrain by the dilated third
   ventricle, leading to paralysis of upward gaze.
 - This leads to a somewhat downward gaze so that a rim of white sclera can be
   seen between the iris and the upper lid.  This resembles a setting sun.