Patients who have recovered sometimes still experience lingering symptoms related to the inflammation brought on by COVID-19.
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Nurse practitioner Rachel Hisim discusses vestibular migraine headaches, which are categorized as atypical and marked by dizziness, ear pain, sinus pressure or ringing in the ear. #VestibularMigraine #JohnsHopkins https://www.hopkinsmedicine.org/health/conditions-and-diseases/vestibular-migraine
With their severe and sudden onset, thunderclap headaches are not only excruciatingly painful — they’re deadly. Neurologist Dr. Steven Rider explains the symptoms and advises on what to do if you experience this kind of headache. For more health information visit wwwdrbobshow.com.
This video is intended to serve as an overview of the approach to diagnosing a patient with thunderclap headache (fastest “worst headache” of life). Learners will define the thunderclap headache, review three major categories of dangerous pathologies (five cerebrovascular pathologies, three disorders causing intracranial pressure dysregulation, and one type of cerebral infection) and review the structure and function of the neurovascular unit and the associated disorders. We will also discuss CT-based early diagnostic workup (non-contrast head CT and CTA with contrast) for a patient with thunderclap headache, and briefly review the management and outcomes of one particular cause of thunderclap headache – reversible cerebral vasoconstruction syndrome. The video is summarized with a protocolized approach.
00:00 – INTRO
00:58 – OBJECTIVES
01:49 – CASE
03:27 – DEFINITION of Thunderclap Headache
06:17 – Pathological DIFFERENTIAL DIAGNOSIS
08:46 – Cerebrovascular Pathologies
10:25 – Aneurysmal Subarachnoid Hemorrhage
15:15 – Reversible Cerebral Vasoconstriction Syndrome
17:27 – Spontaneous Cervical Dissections
20:29 – Neurovascular Unit and Disorders of Vascular Tone
22:18 – Autoregulation Curve
23:28 – Posterior Reversible Encephalopathy Syndrome
25:47 – Cerebral Venous Thrombosis
28:46 – Intracranial Pressure Abnormalities
33:44 – Cerebral infections
38:30 – DIAGNOSTIC WORK-UP
38:35 – Non-contrast Head CT
44:08 – CT Angiogram with contrast
50:50 – BACK TO THE CASE…
53:51 – RCVS2 score
54:39 – MANAGEMENT AND OUTCOMES of RCVS
57:39 – SUMMARY/ALGORITHM
Created, produced and narrated by:
Abigail Knowles
MD Candidate, Class of 2024
Rutgers Robert Wood Johnson Medical School
with
Igor Rybinnik MD
Associate Professor
Neurology Clerkship Director
Division of Stroke and Critical Care
Rutgers Robert Wood Johnson Medical School
Content experts:
Ram Gowda MD, Igor Rybinnik MD
Division of Stroke and Neurocritical Care
Department of Neurology
Rutgers Robert Wood Johnson Medical School
Images adapted from:
– Hendricks BK, Hartman J, Cohen-Gadol AA. Operative Neurosurg 2018;15(6):613-23
– Brisman JL, Song JK, Newell DW. NEJM 2006;355:928-39
– Adapted from Schievink WI. NEJM 2001;344(12):898
– Kandel ER, et al. Principles of Neural Science 5th Edition. McGraw Hill, 2012
– Coelho-Santos V, Shih AY. WIREs Dev Biol 2020;9:e363.
– Kaplan L, Chow BW, Gu C. Nature 2020, 21, 416-431
– Gorelick PB, et al. Stroke 2017;48:e00
– Gregg L, 2020
– Houk JL, et al. JNS 2021,136(6):1796-1803
– Farb RI, et al. AJNR 2019;40:745–53
– Case courtesy of Albakheet SS, Radiopaedia.org, rID 52865
– Case courtesy of Di Muzio B, Radiopaedia.org, rID 55441
– Case courtesy of Gaillard F, Radiopaedia.org, rID 169151
References:
– Goldstein JN, et al. Cephalalgia 2006;26(6):684-690
– Cephalalgia 2018 Jan;38(1):1-211
– Devenney E, et al. J Headache Pain 2014;15:49
– Roberts T, et al. Emerg Med J 2022;39:803–809
– Debette S, CADISP Group. Neurology 2011 Sep 20;77(12):1174-81
– Bejot Y, et al. Stroke 2014;45:37-41
– Rose JC, Mayer SA. Neurocrit Care 2004;1:287-99
– Lidington D, et al. Front Neurol 2021;12:1-29
– Anderson RG, et al. Frontiers of Neurology 2020;11(463):1-10
– Duman T, et al. JSCVD 2017;26(8):1848–57
– Beaumont TL, et al. J Neurosurg 2016;125:1420-1430
– O’Neill AH, et al. J of Clinical Neuroscience 2018;53:122–126
– Donegan D, Erickson D. J of the Endocrine Society 2022;6:1–10
– Schievink WI. NEJM 2021;385:2173-8
– Dobrocky T, et al. Lancet Neurol 2022;21:369–80
– Dobrocky T, et al. JAMA Neurol 2019;76(5):580-587
– Cheema S, et al. J Neurol Neurosurg Psych 2023;94:835–843
– Roberts T, et al. Emerg Med J 2022;39:803–9
– Walton M, et al. Emerg Med J 2022;39:818–25
– Perry JJ, et al. JAMA 2013;310:1248–55
– Rocha EA, et al. Neurology 2019;92(7):e639-47
– John S, et al. Cephalalgia 2016;36(4):387
Music, Sounds:
– “Feels” by Patrick Patrikios
DISCLAIMER: Please note that this material was simplified for educational purposes. For patient management, please review your clinical society’s guidelines and engage expert consultation where appropriate. Also, the opinions of the presenters do not necessarily reflect those of Rutgers Robert Wood Johnson Medical School, Robert Wood Johnson University Hospital, RWJBarnabus Health, or Rutgers University as a whole.
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“Cluster headache attack is an intense and severe strictly unilateral pain around the eye. It is describe as the worst ever headache, using comparisons such as childbirth, fractures and renal stones. The pain ramps up quite quickly once it starts and typically remains for 15–180 min when untreated.”
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There are headaches, there are migraines, and then there are headaches so painful they’re called “suicide headaches.” Dr. Max Gomez has more on a new device that may offer a new hope for relief.
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Symptoms
https://covid.joinzoe.com/post/early-covid-signs
Headache and Fatigue
Dark Horses of COVID Symptoms
Most commonly experienced early symptoms are:
Headache, 82%
Fatigue 72%
This is the case for all age groups
9% of COVID-positive adults aged 18 – 65 didn’t experience headache or fatigue
1% of people who reported fatigue and/or headache tested positive for COVID
3% of people who tested positive had headache and fatigue alone
Therefore
Having either or both of those symptoms alone is unlikely to be indicative of COVID.
The Classic Three are Still Key
Cough, fever, loss of smell
40% of all age groups, fever in the first seven days
Infographics
https://covid.joinzoe.com/earlysymptomsdiscoveries
British association of dermatologists
https://covidskinsigns.com
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Researchers hope a new project will provide relief for sufferers of cluster headaches.
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The Doctors share why some people get headaches while weight lifting and explain when someone should be worried about frequent headaches while working out.
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Now in its eighth season, The Doctors celebrity guests have included Academy Award Winners Sally Field, Barbra Streisand, Jane Fonda, Marcia Gay Harden, Kathy Bates and Marisa Tomei; reality stars from Teen Mom and The Real Housewives, as well as Kris Jenner, Caitlyn Jenner, Melissa Rivers, Sharon Osbourne, Tim Gunn and Amber Rose; actors Jessica Alba, Christina Applegate, Julie Bowen, Patricia Heaton, Chevy Chase, Kristin Davis, Lou Ferrigno, Harrison Ford, Grace Gealey, Cedric the Entertainer, Valerie Harper, Debra Messing, Chris O’Donnell, Betty White, Linda Gray, Fran Drescher, Emmy Rossum, Roseanne Barr, Valerie Bertinelli, Suzanne Somers; athletes Magic Johnson, Apolo Ohno and Danica Patrick; musicians Tim McGraw, Justin Bieber, Clint Black, LL Cool J, Nick Carter, Kristin Chenoweth, Paula Abdul, Gloria Gaynor, La Toya Jackson, Barry Manilow, Bret Michaels, Gene Simmons and Jordin Sparks; and celebrity chefs Wolfgang Puck, Guy Fieri and Curtis Stone.
This video contains an explanation of cluster headaches, aimed at helping medical students and healthcare professionals prepare for exams.
More written notes and diagrams about cluster headaches are available on the website at https://zerotofinals.com/medicine/neurology/clusterheadaches/.
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https://www.corechiropractic.net –
CORE Chiropractic
1770 Saint James Place #210
Houston, TX 77056
(713) 622-3300
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Perhaps one of the most common reason for a patient visit to an ENT office is for a chronic sinus headache. The most common complaints include nasal congestion, chronic pain or pressure over the face or eyes, no fever, and no purulent drainage. The headaches typically are between the eyes, forehead, cheeks, or all these regions. Other symptoms that may or may not be present, include light and/or noise sensitivity, pain worsening with movement, nausea and/or vomiting, runny nose, and watery eyes. These headaches last ~4-72 hours, with or without antibiotics, and occurs regularly, up to several times a month.
However, the reality is that ~80% of such patients are actually suffering from migraines or some other type of neurologic condition.
More information on sinus headaches:
https://www.FauquierENT.net/sinusheadache.htm
Online store for OTC migraine treatment:
https://www.FauquierENT.net/store_migraine.htm
Video produced by Dr. Chris Chang:
https://www.FauquierENT.net
References:
The Sinus, Allergy and Migraine Study (SAMS). Headache 2007 Feb; 47 (2) : 213-24.
http://www.ncbi.nlm.nih.gov/pubmed/17300361
Migraine misdiagnosis as a sinusitis, a delay that can last for many years. The Journal of Headache and Pain volume 14, Article number: 97 (2013). https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/1129-2377-14-97
Prevalence and diagnosis of migraine in patients consulting their physician with a complaint of headache: data from the Landmark Study. Headache. 2004 Oct;44(9):856-64. https://pubmed.ncbi.nlm.nih.gov/15447694/
Prevalence of migraine in patients with a history of self-reported or physician-diagnosed "sinus" headache. Archives of Internal Medicine 2004 Sep 13; 164 (16) : 1769-72. http://www.ncbi.nlm.nih.gov/pubmed/15364670
Sinus headache: a clinical conundrum. Otolaryngol Clin North Am. 2004 Apr;37(2):267-88. https://pubmed.ncbi.nlm.nih.gov/15064062/
Etiology of ‘Sinus Headache’-Moving the Focus from Rhinology to Neurology. A Systematic Review. Brain Sci. 2021 Jan 9;11(1):79. doi: 10.3390/brainsci11010079. https://pubmed.ncbi.nlm.nih.gov/33435283/
Evidence-based guideline update: pharmacologic treatment for episodic migraine prevention in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology. 2012 Apr 24;78(17):1337-45. doi: 10.1212/WNL.0b013e3182535d20. http://www.ncbi.nlm.nih.gov/pubmed/?term=22529202
Evidence-based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology. 2012 Apr 24;78(17):1346-53. doi: 10.1212/WNL.0b013e3182535d0c. http://www.ncbi.nlm.nih.gov/pubmed/?term=22529203
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#sinusheadache #migraine #sinuspain #nasalcongestion
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There is a common belief among patients and some clinicians, that sinusitis is present and causing a headache whenever there is pain over the sinuses. In this video, we use the International Classification of Headache Disorders Criteria to diagnose sinus headaches by differentiating sinus related headaches from migraines.
Join our Headaches Masterclass course today!
After course completion you will have the knowledge and skills to recognize and categorize primary headaches accurately, outline the warning signs of ominous headaches and those caused by medical conditions, and it teaches you how to help your patient to help themselves by recognizing triggers and adopting lifestyle changes.
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