Background: Migraine headache is a common pediatric disorder frequently leading to hospital admission. Inpatient migraine headache treatment involves increasingly complex treatments, including fluid resuscitation and a variety of medications and therapies. Our previous study(1) has shown that the cost of inpatient treatment for pediatric migraine headache is increasing at a higher rate than reported overall [...]

Background: Migraine headache (MHA) is a common pediatric disorder, which frequently leads to hospital admission. Inpatient MHA treatment involves ever-increasingly complex treatment plans, including fluid resuscitation and a variety of medications. Severe Migraine headache may require more aggressive therapy such as dihydroergotamine (DHE) and sphenopalatine ganglion (SPG) block that may prolong hospital stay and increase [...]

Background: Migraine headache (MHA) is a common pediatric illness with up to 75% of children experiencing an episode by the age of 15. Up to 58% of adult MHA patients have a psychiatric comorbidity (PC), but the percentage of children with MHA and PC is unknown. At Phoenix Children’s Hospital (PCH), migraine is one of [...]

Background: Migraine headache (MHA) is a common pediatric disorder, which frequently leads to hospital admission. Inpatient MHA treatment involves various medications, including a combination of fluids, antiemetics, non-steroidal anti-inflammatory drugs, steroids, and anti-convulsants. Severe or recalcitrant headache may require more aggressive therapies, including dihydroergotamine (DHE). Opiates are not recommended in the treatment of MHA; however [...]

Background: CT Head imaging for patients with altered mental status is a common procedure that many clinicians utilize to establish a diagnosis. As health care costs rise, practitioners are becoming more conscious about ordering costly imaging studies that are unlikely to change management. The purpose of the study is to determine when obtaining CT imaging [...]

Case Presentation: An 11 year old boy was admitted to the hospital due to 4 days of headache and vomiting. He described the pain as constant, sharp, occipital/frontal in location, and worse in the morning and overnight, specifically with laying down. Treatment with ibuprofen and acetaminophen had not provided relief. 6 months prior to this [...]

Background: Ventilator associated pneumonia (VAP) is the leading cause of death from nosocomial infections in critically-ill patients. The CDC recommends maintaining Head-of-Bed (HOB) elevation at a target recumbency range of 30º-45º due to evidence that a semi-recumbent position significantly reduces VAP. Current methods for evaluating patient recumbency utilize “eyeballing” or built-in HOB protractors, which are [...]

Case Presentation: A 5 year old boy presented with a 6 month history of headache (“my brain hurts”), vertigo, nausea and vomiting. No neurologic deficits noted on exam. MRI brain showed acute posterior circulation stroke involving the left cerebellar hemisphere and corpora medullaris. MRA head and neck were normal. Extensive work up evaluating for coagulopathic, [...]

Case Presentation: A 71-year-old woman with a past medical history of hypertension, hyperlipidemia, and osteoarthritis presented with four days of fevers, intermittent confusion, subjective weakness, and pain in the neck and left shoulder. On examination, she exhibited tenderness to palpation of the neck with significantly limited rotational range of motion. The left shoulder was also [...]

Case Presentation: A 46-year-old Hispanic male with no significant past medical history presents with acute onset of headache, nausea, and vomiting for the past day, preceded by six months of progressively worsening peripheral vision and blurry vision in the right eye. Patient described a right-sided headache that became generalized and worsened within a few minutes [...]