Here’s a roundup of FOAM materials—Holiday edition…
I. http://www.smartem.org/podcasts/smart-sah-picture-worth-thousand-lps
David Newman MD advocates CT Head alone (no LP, no CT angio) for working up thunderclap headache in the first 6 hours of symptoms. Listen to this podcast to hear his argument.
II. http://www.bmj.com/content/bmj/343/bmj.d4277.full.pdf
Here’s Jeffery Perry’s (aka the Godfather of SAH) article regarding the high sensitivity (100% in the article) of CT within 6 hours of symptom onset. Juxtapose Perry’s article with this retrospective study out of Kaiser in CA:
http://www.ncbi.nlm.nih.gov/pubmed/23026788
Over a 10 year period the authors report 11 cases of missed SAH on CT performed within 6 hours of symptom onset. The workup of SAH continues to evolve and the CT/LP approach may change in the near future (or not).
III. http://www.ncbi.nlm.nih.gov/pubmed/25278139
There was a nice discussion of migraine therapy during journal club yesterday. Here’s another migraine therapy to put in your toolbox—magnesium sulfate 1 gm IV over 15 minutes. Overall the data is mixed but the recent RCT above suggests some benefit. Consider Mg in patients who don’t respond to the standard anti-dopamanergic/NSAID therapy.
-Leave your thoughts in the comments below (especially your approach to diagnosing SAH and treating migraines).
