Severe Headache (Adult) |
| Status | |
| Severe Headache: Pain Score >7 |
| Assess |
| • Suspected cerebral bleed • Potential Meningeal Infection |
| If suspected Meningococcal infection manage as per Meningococcal Septicaemia Manage seizures as per Continuous Seizures |
| Stop | |
| If uncertain, manage as suspected intracranial bleed as per Non Traumatic Intra-Cranial Event |
| In the first instance consider managing all headache: | |||||
| Stemetil 12.5 mg IM | |||||
| Methoxyflurane 3ml - If effective, repeat Methoxyflurane 3ml if required (max. 6ml) |
| Assess | |||||
| If after 15 minutes of above therapy and patient still c/o severe headache (>7) and destination hospital remains >15 minutes: | |||||
| IV Access | If not able to gain IV access: | ||||
| Morphine 2.5mg IV 5 minutely, titrated to pain or side effects (max. dose 20mg) - Aim is to reduce pain to <7 |
If age <60 and >60kg: Fentanyl 100mcg IN - Repeat up to 25mcg Fentanyl IN 5 minutely, titrated to pain or side effects (max. dose 200mcg) |
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| If alergic or sensitive to morphine: Fentanyl 25 mcg IV 5 minutely, titrated to pain or side effects (max. dose 200mcg) |
- If age >60 and/or <60kg: Fentanyl 50mcg IN - Repeat up to 25mcg Fentanyl IN 5 minutely, titrated to pain or side effects (max. dose 100mcg) |
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| Special notes |
| The max of Methoxyflurane is 6ml per 24hr period |
| If respiratory depression occurs due to narcotic administration - manage as per Overdose |
Stemetil is indicated in the management of the severe headache irrespective of nausea and vomiting |
| The administration of high flow oxygen therapy may be of assistance in managing the severe headache |
| The management of severe dehydration where indicated may be of assistance in the management of the severe headache |
| Narcotic pain relief should not be administered during late second stage of labour. If narcotics have been administered, Naloxone should not be administered to the newborn. |