How often do you see patients who tell you they are having a sinus headache need antibiotics. There are so many things wrong with that, not the least of which is the antibiotics part, but ….what about the cause of the headache in the first place? Is this headache a migraine? 2006 JAMA Rational Clinical Exam Series: Does This Patient With Headache Have a Migraine or Need Neuroimaging? If you have a patient who has some scomoata, maybe shimmering lights that start small, get bigger, a little nausea followed by headache- what is that? it’s a migraine. Done. But it’s not always so clear cut. The POUNDing mnemonic can help sort this out.
Is it a Pulsating head- ache? Does it last between 4 and 72 hOurs without medication? Is it Unilateral? Is there Nausea? Is the headache Disabling? Disabling headaches are those that disrupt a patient’s daily activities.
If the patient answers “yes” to 4 or more of the 5 ques- tions, the LR is 24. We like to see a positive likelihood ration of at least
