|
 | Presentation
 | Person with history of HTN now has a headache. |
|
| History
| Describe HA: character, location, duration, when
they occur (tension = pm, HTN = am) |
| Aggravating/ameliorating factors |
| Current medications (esp. NSAIDs) |
| SH: Smoking, EtOH, diet, caffeine |
| Changes in vision |
| Blood pressure diary |
| PMH: diabetes, heart dz, asthma |
| Provide counseling on exercise, diet,
modifiable risk factors |
|
| Physical
| Vitals: Repeat BP bilaterally, orthostatics |
| HEENT: fundoscopic exam for retinal changes |
| CV: auscultate heart, bruits, JVD, PMI |
| Lungs: auscultate |
| Ext: pulses, edema |
| Neuro: Kernig's, Brudzinski's |
|
| Differential
| Tension HA, migraine |
| Medication-induced HA (Ca++ channel blocker) |
| Subarachnoid hemorrhage |
| Meningitis |
| Aneurysm, CVA |
|
| Laboratory
| CBC w/ diff |
| BMP |
| Lipid panel |
| UA |
|
| Treatment
| B-blocker: For migraine also. Contraindicated
in DM, asthma, CHF. |
| HCTZ, esp. if pt is African American |
| ACE-inhibitor for DM, CHF (fosinopril if renal
insufficiency) |
| Drug side effects
 | Ca++ blockers: HA |
| Nifedipine: edema |
| Verpamil: constipation |
| ACE-i: cough |
| HCTZ: hypokalemia |
|
|
| Miscellaneous
| Retinal changes in hypertension
| Grade I: silver wiring, tortuosity |
| Grade II: above, plus AV nicking |
| Grade III: above, plus hemorrhages, cotton wool
spots |
| Grade IV: above, plus papilledema |
|
|
|
