![]() The combination of headache, papilloedema and vomiting is considered indicative of raised ICP the headache is oftentimes worse on waking, straining and bending. However, management of headache in the acute setting should focus on excluding serious secondary causes, of which raised ICP is one. The majority of patients presenting with headache have primary headaches, with migraine being the most frequent diagnosis. Secondary headaches are a symptom of another disorder. Primary headaches, such as migraine, are usually benign. Headaches are classified as either primary or secondary. Headache is a common symptom associated with many conditions and accounts for up to 5% of attendances to emergency departments and acute medical units. ![]() Suggestions to encourage carrying out fundoscopy included making it a part of the clerking proforma and the delivery of teaching sessions. Respondents ranked readily available ophthalmoscopes as the most likely intervention to encourage them to perform fundoscopy, followed by further knowledge on fundoscopy technique and interpretation of findings. The most frequent reasons given for not performing fundoscopy were: lack of ophthalmoscopes and dilating eyedrops (and / or lack of awareness of their location), insufficient knowledge on fundoscopy technique, and low confidence when interpreting findings. Seventy percent of respondents were not aware of the BASH guidelines. ![]() Nine percent of respondents declared they always perform fundoscopy, 42% sometimes and 49% never. Thirty-three responses to the survey were received. Of the remaining 52/59 (88%) patients who did not have fundoscopy performed, none had it done on the subsequent post take ward round.Furthermore, a survey was emailed to all doctors within the Trust to gather information on their level of awareness of BASH guidelines, whether they perform fundoscopy in patients presenting with headache, what they believed were obstacles and what interventions they felt would help to increase the likelihood of them doing so. Papilloedema is the clue”įundoscopy was performed in the initial acute medical clerking of 7/59 (12%) patients, only one of whom had documentation that their pupils were dilated beforehand. “Fundoscopy plays a crucial role in uncovering a diagnosis of raised ICP. The majority (71%) of clerkings were carried out by junior and senior house officers. Patients’ age ranged from 18 to over 70 years the most numerous age group consisted of patients 70+ years old (27%). ![]() ResultsĪ total of 59 acute medical clerkings with a presentation of headache to our district general hospital between August and October 2017 were reviewed, 38/59 (64%) of whom were female and 21/59 (36%) male. We have therefore sought to assess the compliance of our acute medical department with BASH guidelines, and to bring to light the impediments to delivering appropriate management in patients presenting with headache and suggest improvements. However, studies have revealed that a minority of doctors would perform fundoscopy in such cases. ![]() Papilloedema is optic disc swelling specifically secondary to raised ICP and is a vital clue for accurate diagnosis performing fundoscopy is essential in detecting this sign. įigure 1: Numbers of respondents who perform fundoscopy on a patient presenting with headache.įigure 2: Pie chart showing whether respondents were aware of the BASH guidelines.Ī worrying cause of headache is raised intracranial pressure (ICP). Additionally, The National Institute for Health and Care Excellence (NICE) also advises carrying out fundoscopy as part of a neurological examination for headache, as well as cranial and peripheral nerve examination. The British Association for the Study of Headache (BASH) National Headache Management System for Adults 2019 guidelines recommend a thorough neurological investigation including fundoscopy when assessing a patient with headache. The likelihood of headache sufferers seeking help is low, and when they do, the condition is less than optimally managed. Neurological emergencies, of which headaches account for a significant proportion, are the third leading trigger of acute medical presentations and represent up to 25% of the medical take this is second only to cardiac and respiratory cases. The authors review the use of fundoscopy in their own district general hospital. Papilloedema is a vital clue for accurate diagnosis and performing fundoscopy is essential in detecting this sign. A worrying cause of headache is raised intracranial pressure (ICP). ![]()
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