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Atypical Headaches
Diagnostics, Grand Rounds Jeffery Hill, MD M.Ed Diagnostics, Grand Rounds Jeffery Hill, MD M.Ed

Atypical Headaches

Headaches account for approximately 4 million, nearly 3% of all ED visits annually. [1] We classify headaches as either primary (benign) or secondary, with secondary headaches occurring due to underlying pathology. In the ED, the goal is to alleviate symptoms safely and effectively while excluding dangerous causes of headaches. While nearly 98% of headaches in the ED are primary or benign [2], ruling out secondary causes of headaches is imperative as failing to diagnose correctly may result in significant morbidity or mortality.

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All that Pukes: Cyclic Vomiting Syndrome, Gastroparesis and More
Diagnostics, Grand Rounds Jeffery Hill, MD M.Ed Diagnostics, Grand Rounds Jeffery Hill, MD M.Ed

All that Pukes: Cyclic Vomiting Syndrome, Gastroparesis and More

Nausea and vomiting accounts for one of the most frequent chief complaints we see in the emergency department. For those presenting with another complaint, N/V is often an associated symptom. Treatment of these symptoms not only improves patient satisfaction, but also decreases associated complications, like dehydration and electrolyte abnormalities.

The etiology behind a patient’s N/V is highly variable, with a broad differential that stretches across all organ systems. Although often an acute presentation, N/V is increasingly being linked to set of chronic disorders, such as gastroparesis (GP), cyclic vomiting syndrome (CVS) and cannabinoid hyperemesis syndrome (CHS). While the work-up and initial evaluation in the ED is similar for all, specifically ruling out potentially life-threatening diagnosis or complications, the clinical presentation and management vary subtly between these syndromes.

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