Assessing Headaches in Hospitalized Patients, with Stephanie Nahas, MD, MSEd

In a session at the American College of Physicians (ACP) Internal Medicine Meeting in Boston, Stephanie Nahas, MD, MSEd, associate professor of neurology at Thomas Jefferson University, gave an overview of headaches in hospitalized patients, focusing on important considerations when assessing and treating these individuals.

In an interview with HCPLive, Nahas emphasized the importance of considering patient history to determine if a new headache in a hospitalized patient is actually brand new, saying “It all starts with history, always, always, always.”

Specifically, she highlighted the need to obtain a thorough understanding of both the acute presentation as well as what other symptoms the patient is experiencing besides headache, such as light or sound sensitivity, nausea or vomiting, neck pain, fever, or other systemic symptoms.

“You don't want to be jumping right to doing testing, except in the hyperacute scenario,” Nahas explained. “When you've got the time to take a history, history is what guides us. Diagnostic testing results out of the context of a history also don't really help you, and a nonorderly, nonsystematic approach to diagnostic testing wastes time and resources.”

Nahas was also careful to note that in addition to symptomatic approaches to treating headaches with medication, it is also important to consider other factors not related to utilizing medical therapy or that might be a consequence of medical therapy leading to a headache, specifically citing the negative impact of opioids on headaches and migraines. She further described insufficient sleep, caffeine withdrawal, and compression of the occipital nerves as potential hospital-related factors causing headaches.

“Headache is something that a lot of clinicians fear. When they hear it from their patients, they're worried that something very scary is going on that they're going to miss,” Nahas said. “I want all clinicians to feel empowered to be able to assess this very, very common problem… you really need to be on the lookout for it and not shying away from it because the initial approach and management is actually pretty simple, and when you can help these patients there and in the moment, it's very gratifying for the both of you.”

Nahas has relevant disclosures with AbbVie, BioDelivery Sciences International, Inc., Eli Lilly, H. Lundbeck A S, Pfizer, and Teva Pharmaceuticals USA, Inc.