Acute Onset, Severe Headache


• Scene – EKG, IV, CBG, VS

• En Route – EKG VS, further exam, Zofran 4mg IV

• Hospital – unknown


• Response to treatment – Zofran helped with nausea

• Disposition – unknown


Mark Shelton Paramedic Woodburn Ambulance


David Tauber, EMT Editorial Board

David M. Spiro, MD, MPH Professor of Pediatrics University of Arkansas Medical Center


• Migraine headache

Differential Diagnosis

• Migraine

• Hypertension

• Depression

• Meningitis

• Closed head injury


• Neoplasm


• Conversion disorder

• Pain seeking behavior

Patient Workup History

• Patient states – 2 months history of severe migraine; “abnormal” MRI with no conclusive diagnosis; unable to afford prescribed migraine medications

Physical Exam

• Light-sensitive

• Hypertension

• EKG – SR

• CBG – 112

• GCS – 15

Editor’s Notes

Headache can be a challenging diagnosis in the prehospital setting. This patient seemed to exhibit photophobia. -Dr. David Spiro. • Consider lowering the lights in ambulance or give her a towel to cover her eyes. In addition to the anti-emetic, I would feel comfortable giving an analgesic: Toradol or Fentanyl

~ David Tauber, Director of Paramedic Education, Yale New Haven Sponsored Hospital

Suggested References

Migraine headache


• Gender: Female

• Age: 49 years

• Height: Not Available

• Weight: Not Available


• Temperature: Not Available

• Blood Pressure: 171/115

• Heart Rate: 75

• Respiratory Rate: 16

• Pulse Oximetry: 98% RA

Signs and Symptoms

Severe headache, shortness of breath

History Medical

• PMH: 2-month history of depression; migraine; hypertension; asthma

• Allergies: None

• Dispatch info: Severe migraine, shortness of breath.


• Lives with spouse; runs an adult foster care home.


• Albuterol, lisinopril, Depakote

Related videos