Low Back Pain, Generalized Anxiety Disorder, Headaches

Are epidural steroid injections effective for low back pain?

Treatment with epidural steroid injections in the lower spine is not effective for reducing pain and disability. The injections may be more effective than placebo at short-term follow-up, but the effects are not clinically meaningful. Read the full article.

When should secondary causes be evaluated in patients who present with a headache?

Patients with a headache and red flags (acute thunderclap headache, fever with meningeal irritation on physical examination, papilledema with focal neurologic signs or impaired consciousness, concern for acute glaucoma) in their history or physical examination warrant further investigation for secondary causes of headache. Consider giant cell arteritis in patients older than 50 years who present with a new or evolving headache. Patients with acute thunderclap headache should be sent to the emergency department and should receive computed tomography of the head within 12 hours of symptom onset. Lumbar puncture must follow a normal computed tomography scan to exclude subarachnoid hemorrhage. Patients with stable primary headache disorders (i.e., no red flags and a normal neurologic examination) do not need neuroimaging. Read the full article.

❯ ❯ AFP Clinical Answers distills evidence-based answers to clinical questions from AFP content for use at the point of care. Visit our online collection for more.

Tip for Using AFP at the Point of Care