Now for patients who present with a migraine,
this is a very common presenting symptom to the Emergency Department.
This is something that we see relatively frequently.
Migraines are chronic causes of headaches
and can be very incapacitating to patients.
So patients who have a history of severe migraines
can get very severe headaches that limit their ability to get work done, to interact.
They most commonly begin in the second decade of life
and there is a genetic component.
So patients will often relate to the fact that their parents
or brothers, or sisters have similar headache symptoms that they experience.
Patients with migraines can present with lots of different symptoms.
A common one is that they may have an aura associated with their headache.
And what we mean by an aura is that they may see spots
prior to their headache, or they may have other sensations
that they experience prior to their headaches
or when their headaches are first beginning.
Patients with migraines also can present with a handful of other symptoms.
So common things that patients have are photophobia
which is when bright lights will bother patients.
The classic thing that you sometimes may see
is patients who present with migraine headaches
may come into the Emergency Department wearing sunglasses,
even though it’s kind of dark outside.
So at night, that’s a classic sign of patients who have migraine headaches.
Phonophobia is when loud noises might bother patients
as well as nausea and vomiting may be associated with migraine headaches.
In extreme cases, patients may also present with neurologic abnormalities
with their migraine headaches, such as dizziness
and actually patients may experience weakness as well
and really might mimic very closely a stroke.
So sometimes when this patients present with those symptoms
especially if they don’t have a headache, history of migraine headaches.
You definitely can sometimes be a little bit confused
or trying to sort out whether or not this is a migraine,
or more serious neurologic problem.
So what should we do for these patients?
So for some patients you may need to get some neuroimaging.
So you might need to get a head CT for patients who have a new headache.
So they say that I've never had a headache like this before.
For patients who are immunocompromised.
Patients who are on medications that might suppressed there immune system
or patients who have underlying diseases that can make them be immunocompromised,
the classic one being HIV or AIDS.
Any kind of neurologic abnormalities such as weakness, numbness, tingling,
problems with their ambulation, potentially problems with speech
might prompt you to get neuroimaging.
And then sudden onset of headache is the other thing that might
make you more concerned or point you in that direction.
You know, if your patient has a prior history of similar symptoms,
then they come in and they say this feels very similar to my migraine that I’ve had before,
that definitely kind of puts you out or points you in that direction
that this is in fact most likely a migraine headache.