Page 120 - PJ MED OPS Handbook 8th Ed

Headache

SPECIAL CONSIDERATIONS:
1. The number of differential diagnoses for the acute headache is large and includes disor-
ders that encompass the spectrum of minor to severe underlying disorders.
2. Consider altitude sickness, intracranial bleeds, meningitis, and carbon monoxide poisoning.

Signs and Symptoms:
1. If the headache is atypical for the patient, check for elevated blood pressure (if possible), fever,
neck rigidity, visual symptoms, mental status changes, motor-sensory deficits, and hydration.

Management:
1. If the patient has fever, stiff neck, photophobia, petechial rash, or nausea and vomiting, treat per
Meningitis Protocol.
2. Treat per pain, nausea/vomiting, dehydration, altitude as indicated.

DISPOSITION:
1. Evacuation is usually not required if the headache responds to therapy.
2. Acute headache in the presence of fever, severe nausea and vomiting, mental status
changes, focal neurological signs, or preceding seizures, loss of consciousness, or a history
of “it’s the worst headache in my life” constitutes a true emergency and requires Urgent
evacuation.
3. Consider Urgent or Priority evacuation for anyone without a prior history of headaches if
their pain is severe.

118 n Pararescue Medical Operations Handbook / 8th Edition