I came out at 2:45 this morning to write another gripping blogpost. I was so excited about it that I couldn’t sleep. Something like that.
I had planned to write about a couple of bad headaches. Now, all headaches are bad, but some are truly worse than others. And the future son-in-law, Doc, was telling me about them on one of his visits.
So I brought out all the off-grid medical texts to see what they had to say. Only one, Armageddon Medicine, contained a scant mention of temporal arteritis. The others had zip. Curious.
When dealing with someone with a serious headache, the SNOOPP mnemonic may aid diagnosis.
S Sudden onset, like a thunderclap or gunshot
N Neurological signs or lowered conscious state
O Onset pattern different from normal (not their usual headache)
O Older (over 50 and more weight given to this symptom as age increases)
P Pattern. Some headaches have a harmless pain pattern; others are more sinister.
P Postural. Does the pain get worse when patient lies down?[1]
Doc and I discussed this a bit. He mentioned that his preceptor (apparently physicians teaching in med school are not called teachers—they are preceptors) had two patients with giant cell, or temporal, arteritis. Both lived in rural areas, and you know us rural folk, we tend to dismiss symptoms that don’t bother us too much. Most issues will resolve without intervention, and besides, it’s a long way to the doctor. Both dismissed their headaches, and both went blind.
Giant cell (temporal) arteritis is believed to be an autoimmune disease that involves inflammation of the blood vessels supplying the head, neck, and arms. When it develops in the arteries supplying the scalp, temporal lobes, jaw, and eyes, headache pain in the temporal lobes is one of the symptoms.[2] The arteries are usually visible and palpable. Untreated, blindness may result.
The treatment is a steroid, (10-20 mg prednisone daily per Dr. Koelker, 40-60 mg daily per the Cleveland Clinic), for several weeks, and then tapered.[3] [4] It affects 1 in 5000 people and occurs more often in women than men, though men are more likely to suffer blindness.[5]
Survival and Austere Medicine, 3rd Edition, contains some helpful patterns for diagnosing some of the more serious headaches.
Severe headache + fever = meningitis (viral illnesses may be accompanied by a mild to moderate headache, not severe)
Severe headache + fever + neurological signs = meningitis
Altered conscious state (drowsy) + fever = meningitis
Headache + neurological signs = intracranial bleeding
Worsening headache over months + new neurological signs = brain tumor
Bad headaches in the morning which get better over the day = brain tumor[6]
Aneurysms aren’t discussed in the off-grid texts, either. While they have many signs depending on where they occur, one commonly reported symptom is a headache that worsens when lying down.
We won’t be able to do much about most truly bad headaches, those resulting from brain tumors and budding aneurysms. We’ll only be able to guess about the cause and outcome, and perhaps suggest that the patient gather with family and express final goodbyes.
[1] https://www.medmastery.com/guides/headaches-clinical-guide/recognizing-red-flags-headache-history-snoopp
[2] https://my.clevelandclinic.org/health/diseases/temporal-arteritis-giant-cell-arteritis
[3] Cynthia Koelker, Armageddon Medicine, 2012, 359.
[4] https://my.clevelandclinic.org/health/diseases/temporal-arteritis-giant-cell-arteritis
[5] https://my.clevelandclinic.org/health/diseases/temporal-arteritis-giant-cell-arteritis
[6] Survival and Austere Medicine, 3rd Edition, 2017, 128.
No comments:
Post a Comment