If patients say this, suspect life-threatening headache
Don't undertriage patients
If you assume that patients complaining of headache are nontherapeutic medication seekers or chronic complainers, you risk undertriaging these patients, warns Rebekah Child, RN, MSN, CEN, CNIV, an ED nurse at Cedars-Sinai Medical Center in Los Angeles. "It is imperative to watch out for warning signs that may indicate a condition much more severe than a common migraine or tension headache," she says. If patients say the following, suspect a life-threatening condition:
• "This is the worst headache of my life."
Erica Buss, RN, BSN, an ED nurse at St. Francis Hospital and Medical Center in Hartford, CT, says, "I have found that nine times out of 10, patients with the worst headache of their life do come back showing a bleed on their CT scan or MRI."
The patient usually is nauseated, unable to focus on directions, and might present with unsteady gait, slurred speech, and weakness, add Buss.
• "My neck feels stiff."
A headache along with high fever and neck stiffness may indicate meningitis, says Buss.
• "My vision is blurred."
This blurred vision could indicate a hemorrhage on the brain, although patients with migraines also have vision changes, says Buss. "Do a neurological exam at triage to test muscle strength, pupil size and reaction, and if the patient can follow directions appropriately," advises Buss.
• "I have a terrible headache on one side."
For example, a 22-year-old male might say he has a severe unilateral headache that started while he was lifting weights about an hour ago at the gym, says Child. "The triage nurse asks him if he would call this the worst headache of his life. He says yes. This information should not be taken lightly," she says. "This patient is the perfect age and has the perfect story for an aneurysm."
The most common cause of nontraumatic subarachnoid hemorrhage is a ruptured aneurysm, says Child. "Aneurysms are present in 0.5%-1% of the population. Of these, 1%-2% rupture per year," she says.
• "I have severe, stabbing pain in the temples, and it hurts when I open my mouth."
This may be a sign of temporal arteritis, an inflammation of the branches of the carotid artery, says Child. "This condition leads to visual loss or blindness in approximately 50% of untreated patients," she says.
Sources
For more information on assessment of life-threatening headaches in the ED, contact:
- Erica Buss, RN, BSN, Emergency Department, St. Francis Hospital and Medical Center, Hartford, CT. Phone: (860) 714-4001. E-mail: [email protected].
- Rebekah Child, RN, MSN, CEN, CNIV, Emergency Department, Cedars-Sinai Medical Center, Los Angeles. Phone: (310) 423-0308. E-mail: [email protected].
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