; Template Headache

MDM:

We evaluated the patient for the following conditions:

• SAH: headache not maximal intensity at onset, not the worst headache of life, no syncope, not sudden onset, did not occur during exertion. Not different than the prior headaches patient has had.
• Occult Trauma: not on anticoagulation, denies trauma, no signs of abuse or neglect
• Meningitis: no fever, no neck stiffness, no jolt accentuation, not immuno-compromised, no signs of head/neck infection, no recent sinus infection
• Temporal Arteritis: ====unlikely given age====, no jaw claudication, no temporal tenderness or nodules, no visual loss
• Cancer with mass: HA not progressive, no history of malignancy, no history of weight loss, not worse in the morning, not worse when bending over
• CO toxicity: other people in house not affected, not worse in the morning. Denies space heaters or other sources
• Acute Glaucoma: eye examined: pupils reactive, no erythema
• Cervical/ Vertebral Artery Dissection:  no facial pain, no recent trauma, no cranial nerve deficits, no chiropractic manipulations
• Cerberal venous/sinus thrombosis: no neurological findings, no proptosis, no recent sinusitis, no history of hypercoaguable state
• Idiopathic Intracranial Hypertension: no hypercoaguable risk factors, no visual symptoms. =====Consider OCULAR Ultrasound====
• Spontaneous Intracranial Hypotension: No postural component to headache (not worse when standing, not relieved when lying down), no accompanying neurological findings
• Normal Pressure Hydrocephalus: No gait problems, no incontinence, no confusion

Given the absence of concerning findings, patient told they must follow-up with neurology within the next 2 weeks. Offered an appointment. Offered prescription for NSAIDs. Told to return immediately if any recurrence, worsening of symptoms, or continuation of the headache past 24 hours from discharge.