In this post, I link to and excerpt from Emergency Medicine Cases outstanding Ep 161 Red Flag Headaches: General Approach and Cervical Artery Dissections*.
*Helman, A. Shah, A. Baskind, B. Episode 161 Red Flag Headaches: General Approach and Cervical Artery Dissections. Emergency Medicine Cases. November, 2021. https://emergencymedicinecases.com/red-flag-headaches-cervical-artery-dissections. Accessed 4-16-2023.
All that follows is from the above resource.
The big 4 causes of emergency headaches that are not routinely identified on plain CT
Headaches are one the most common ED presentations. About 98% of these patients have a benign cause of their headache. Of the remaining 2%, 1% can be diagnosed with a CT head or LP, such as a subarachnoid hemorrhage or meningitis, however the final 1% causes of headaches cannot be ruled out on plain CT/LP alone. The big four commonly missed emergency causes of headaches that cannot routinely be ruled out on plain CT:
- Cervical artery dissection (carotid and vertebral)
- Cerebral venous thrombosis (CVT)
- CO poisoning
- Giant cell arteritis
In this part 1 of our 2-part podcast on red flag headaches we focus on a general approach to headaches in the ED and cervical artery dissection – one of the big five causes of emergency headaches that does not show up routinely on plain CT, requiring a CT angiogram of the head and neck to confirm the diagnosis.
