Headache

Peter Goadsby recently reviewed headache in the BMJ, see "Recent advances in the diagnosis and management of migraine BMJ, Jan 2006; 332: 25 - 29".

There was lots of information in their for the GP and as it's a review and summary I took away some messages.

Migraine - worth diagnosing because there are some effective treatments. Diagnosis relies on:
Repeated headache lasting 4-72 hours, normal physical examination, no other reasonable cause for the headache, at least two of

• Unilateral pain
• Throbbing pain
• Aggravation of pain by movement
• Moderate or severe intensity of pain with at least one of
• Nausea or vomiting
• Photophobia and phonophobia

Secondary Headache is the one that worries us GP's. Are we missing a sinister cause? Warning signs for secondary headache include:

• Pain of sudden onset
• Fever
• Marked change in pain character or timing
• Neck stiffness
• Pain associated with higher centre complaints
• Pain associatedwith neurological disturbance, such as clumsiness or weakness
• Pain associated with local tenderness, such as of the temporal artery

The article also considers the pathophysiology of migraine, treatments and differentiating different sorts of headache.

Resuscitation training

Last week saw me access my annual cardio-pulmonary resuscitation training. At the start of the session one member of the group expressed anxiety that the guidance is continually changing. "For the better" said our trainer - reminding us that the guidance is based on evidence. Studies of survival after CPR have influenced the guidance.
As of April this year, but not before, he is allowed to teach the latest methods! This was odd to say the least, but I was pleased to learn that he was happy to fill us in on what the new guidance entailed. In essence, it's all the same BUT instead of 15 chest compressions to 2 breaths we need to do a ratio of 30:2. If we are concerned that as resuscitators we are at high risk of HIV/Hepatitis from resuscitating, then it is acceptable to just do chest compressions (100 per minute) providing the airway can be maintained! Apparently this has been done in the US and survival is as good or better than chest compressions + respirations. Providing the airway is open, chest compressions allow some air in and out of the chest.

See BMJ 2005;331:1281-1282 for "A new international consensus on cardiopulmonary resuscitation"

A New Year

Well, we are 10 days into January and I am yet to make a post. I confess that not much learning went on over Christmas and the early New Year has been blighted by my handing my notice in at work - I am returning to mainstream general medical practice in April.

Perhaps it's time to reflect on the blog so far. Why am I bothering to do it?

Well - I have access to the internet at all the places where I work and at home. It's easy to use the blog to collect my thoughts and learning experiences all in one place. I can access it from anywhere. I could use paper but by now a notebook would be either very tatty or lost (or more likely - both). Additionally, a paper based system would be less easily searchable. I could just keep a big text file on one PC at home and this would certainly be more personal but would lack the "write it up anywhere" feature that makes the blog so appealing. So at least for now I aim to continue with 1-3 posts per month concentrating on learning experiences.