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Acute Neurology Headaches Dr. Ommid Rafie

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Acute NeurologyHeadachesDr. Ommid RafePopulation per NeurologistHow Common is Acute Neurology?A&E ReferralsMAU ReferralsA wee in A&EMost Common MAU PresentationsMost Common MAU PresentationsEpileptic !ei"ures #$%&'()A*!troe #+,&'Headache #,-&'............./0&How many saw a neurologist?()A*!troe #12&' #,%0'Epileptic !ei"ures #$%&' #,+3'Headache #,-&' #+,'How many didnt?Headache #31&' #,+0'Epileptic !ei"ures #1%&' #+$%'()A*!troe #$,&' #13'HeadachesHeadaches3% of headaches are referred to secondary care3% of headaches are referred to secondary care)nternational Classi4cation(ension5Episodic or Chronic56ilateral5Pressing or tightening5Rarely incapacitating7 rarely consulted5(reatment with Paracetamol or Aspirin #,g' ha8e 9oth 9een shown to 9e e:ecti8e in /%&Lifetime prevalence >40%Lifetime prevalence >40%Migraine without Aura5Unilateral5;radual56uilds up o8er hours5Moderate to !e8ere5Pulsating5Associated Nausea*(riptanProchlorpera"ine*MetoclopramideProphyla?is(opiramate ,00Propanolol ,10Costs the UK 2 billion a yearCosts the UK 2 billion a yearMigraine with Aura5Positi8e (ransient Hemianopic >istur9ance !preading !cintillating !cotoma Parasthesia5Negati8e ilated pupil)mpaired 8isionHalos around eyes>ilated pupil5Bpthalmic emergencyRaised )CP5 )ntracranial (umour Rarely cause headache Most common tumour to cause headache is pituitary and is presenting complaint in $A-& More commonly present with cogniti8e change*sei"ure5 )diopathic )ntracranial Hypertension (ransient 8isual o9scurity Pulsatile tinnitus 1th Ner8e palsy 6lind spot*Papilloedema)ntracranial Hypotension5Most commonly traumatic5>e8elops on standing5Resol8es on lying downCB Poisoning5Nausea5i""iness5Heaness56lurred 8isionReferences- N)CE ;uideline 103%$- 6ritish Association for the study of headache- !);N ;uideline C >iagnosis and Management of Headache in Adults- AmericanHeadache!ociety- Acute Neurological Emergencies in Adults +00+7 Association of 6ritish Neurologists- Mechanism of migraine and action of antimigraine medicationsI Med Clin North AmI +00, EulJ3%#-'K2-$A%37 8iA8iiI- (ensionA(ype Headache A @ars 6endtsen7 M>7 Ph>L7 RigmorEensen7 M>7 Ph> - >iagnosis and Management of ;iant Cell Arteritis7 Royal College of Physicians- Acute neurological pro9lemsK freMuency7 consultation patterns and the uses of a rapid access neurology clinicE R Coll Physicians Edin9 +002J $2K+21C$00 doiK,0I-22/*ERCPEI+002I-0+ Nuestions?