Episode 14 Part 1: Migraine Headache and Subarachnoid Hemorrhage

Emergency Medicine Cases

Dr. Anton Helman

Science, Courses, Medicine, Health & Fitness, Education

4.7 • 602 Ratings

🗓️ 9 May 2011

⏱️ 65 minutes

🔗️ Recording | iTunes | RSS

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Summary

In Part 1 of this episode on Headache Pearls & Pitfalls - Migraine Headache & Subarachnoid Hemorrhage, Dr. Anil Chopra and Dr. Stella Yiu discuss the best evidenced-based management of migraine headache in the ED including the use of dexamethasone, dopamine antagonists, the problems with narcotics and the efficacy of 'triptans'. An easy way to remember the worrisome symptoms of headache indicating a serious cause is reviewed followed by a detailed discussion of the pearls, pitfalls and controversies around the work-up of Subarachnoid Hemorrhage (SAH) in light of some exciting recent literature, including the basis for a new Canadian decision rule for SAH.

Transcript

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0:00.0	Welcome to Emergency Medicine Cases.com.
0:05.6	I'm your host, Dr. Anton Hellman, bringing you Canada's brightest minds in emergency medicine from EMC Studios in Toronto.
0:18.4	On this episode number 14, headache pearls and pitfalls we have with with us Dr. Anil Chopra and Dr. Stella Yu.
0:25.7	Dr. Chopra is an emergency physician at the University Health Network in Toronto and an associate professor in the Department of Medicine at the University of Toronto.
0:33.2	He's the head and medical director of emergency medicine at the University Health Network.
0:37.9	Dr. Yu is an emergency physician at the University Health Network in Toronto and the Ottawa Hospital.
0:43.4	She's a faculty member at both the University of Toronto and the University of Ottawa.
0:47.6	She was the assistant director of education at the Department of Emergency Medicine at UHN.
0:51.9	She contributes regularly to various blogs and podcasts on academic emergency
0:55.7	medicine. The vast majority of patients with headache we see in the ED will have one of the three
1:01.0	so-called benign headaches, tension, migraine, or cluster. Nonetheless, what the EM doc must keep
1:08.8	at the forefront of their mind for any patient who presents
1:11.4	with headache are the more serious life, limb, or vision-threatening causes, and not just subarachnoid
1:18.0	hemorrhage. In this episode, with the blinding brilliance of Anil Chopra and Stella You,
1:24.3	will cover not just the nuances of diagnosing and managing subarachnoid hemorrhage,
1:29.0	but also how to diagnose and manage some of the less common and challenging causes of headache.
1:34.7	I usually keep a list of about 10 serious causes in the back of my head
1:39.2	every time I see a patient in the ED with headache.
1:43.1	By the end of this episode, it's my hope that you too will not only have that list at your disposal,
1:48.5	but know the key diagnostic pearls for each so that the next clinical encounter you have with a headache patient on your next shift will be a hugely satisfying one.
2:13.2	Dr. U. is no stranger to internet-based emergency medicine education.
2:18.0	She's a regular blogger on our friend Michelle Lynn's very cool website,
	...

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