Clinical Snippets September 26

But anyway, let's get on with migraines.

And I brought this up both because BPAC's recently released a really good comprehensive update on migraine management, but also A not infrequent complaint I see in my complaints work is delayed diagnosis of subarachnoid hemorrhage.

So it does have some link in with the migraine update.

I won't go through it in huge detail.

A lot of it was basic reminding about diagnosis, differential diagnosis, management of migraine.

But one useful thing I thought was the SNOOP4 mnemonic.

which is for identifying red flags associated with headache and might, I guess, reduce the risk of missing subarachnoid hemorrhage.

But the SNOOP, the S is systemic symptoms, so headache associated with fever, chills, myalgia, night sweats, or with a history of malignancy, HIV, or immunosuppression.

That's certainly a red flag.

N is neurological symptoms or signs, particularly confusion, diplopia, or neurological deficit.

O-onset, and I think this is one of the critical ones.

So sudden onset of headache reaching maximum intensity within minutes or thunderclap headache is most definitely a red flag.

And the interesting thing with subarachnoids is that you can get a sentinel bleed days to even a few weeks before the big bleed.

And often it just is a bit more subtle than your barn door type subarachnoid presentation.

But just, I think, a warning that that particularly if you get a severe headache and a couple of weeks before there'd been a moderately severe out of the blue headache, just to remember the sentinel bleed possibility.

O is older age, so onset after age 50 years.

And again, I've seen migraine diagnosed in 65-year-olds with sudden thunderclap headaches that have never had migraine before, not necessarily an appropriate diagnosis at that advanced age.

P, or the four P's are progressive headache, So change in headache features pattern or severity over days or weeks.

Second P, precipitated by Valsalva, cough or sneeze.

Third P is postural or exertional aggravation, such as the headache worsened by standing, lying down or exercise.

And the fourth P is presence of papilledema.

And I'm not sure how good we are at finding papilledema, but it's worth having a look at the fundi if you've got your ophthalmoscope handy.

So the linked resources in the article include some useful resources.

There's a downloadable headache diary, and there's also the migraine disability assessment tool.

And that's just a fairly basic tool, five sets of questions, quantifying severity of migraine, differing aspects of the severity of migraine, and it gives you a score and a severity quantification tool.

But anyway, let's get on with migraines.

And I brought this up both because BPAC's recently released a really good comprehensive update on migraine management, but also A not infrequent complaint I see in my complaints work is delayed diagnosis of subarachnoid hemorrhage.

So it does have some link in with the migraine update.

I won't go through it in huge detail.

A lot of it was basic reminding about diagnosis, differential diagnosis, management of migraine.

But one useful thing I thought was the SNOOP4 mnemonic.

which is for identifying red flags associated with headache and might, I guess, reduce the risk of missing subarachnoid hemorrhage.

But the SNOOP, the S is systemic symptoms, so headache associated with fever, chills, myalgia, night sweats, or with a history of malignancy, HIV, or immunosuppression.

That's certainly a red flag.

N is neurological symptoms or signs, particularly confusion, diplopia, or neurological deficit.

O-onset, and I think this is one of the critical ones.

So sudden onset of headache reaching maximum intensity within minutes or thunderclap headache is most definitely a red flag.

And the interesting thing with subarachnoids is that you can get a sentinel bleed days to even a few weeks before the big bleed.

And often it just is a bit more subtle than your barn door type subarachnoid presentation.

But just, I think, a warning that that particularly if you get a severe headache and a couple of weeks before there'd been a moderately severe out of the blue headache, just to remember the sentinel bleed possibility.

O is older age, so onset after age 50 years.

And again, I've seen migraine diagnosed in 65-year-olds with sudden thunderclap headaches that have never had migraine before, not necessarily an appropriate diagnosis at that advanced age.

P, or the four P's are progressive headache, So change in headache features pattern or severity over days or weeks.

Second P, precipitated by Valsalva, cough or sneeze.

Third P is postural or exertional aggravation, such as the headache worsened by standing, lying down or exercise.

And the fourth P is presence of papilledema.

And I'm not sure how good we are at finding papilledema, but it's worth having a look at the fundi if you've got your ophthalmoscope handy.

So the linked resources in the article include some useful resources.

There's a downloadable headache diary, and there's also the migraine disability assessment tool.

And that's just a fairly basic tool, five sets of questions, quantifying severity of migraine, differing aspects of the severity of migraine, and it gives you a score and a severity quantification tool.