Aust Fam Physician
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Concussion is common in many sports and recreational activities. It is thought to reflect a functional rather than structural injury to the brain. The clinical features are typically short-lived and usually resolve spontaneously. Complications, however, can occur and may include prolonged symptoms and/or cognitive deficits in the short term, as well as depression and cumulative deterioration in brain function in the longer term. ⋯ The critical issues in the clinical management of concussion in sport include making a diagnosis, differentiating between concussion and other pathologies (particularly structural head injury), recognising the presence of any modifying factors (which may increase the risk of complications) and determining when the patient can safely return to competition. The key components of safe return-to-play decisions include rest, neuropsychological testing and a graded program of exertion before return to sport.
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Headache remains the most common cause of neurological consultation in clinical practice for which correct diagnosis and treatment are essential. ⋯ By far the most important diagnostic tool for proper headache diagnosis is the taking of a concise and representative history of the headaches. Migraine and TTH exist along a continuum and identification of the patient's position on this continuum has important implications for management.
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Epilepsy is a common disorder and most adult patients will be managed primarily by general practitioners. Despite new developments in the classification and treatment of epilepsy, basic principles of diagnosis and treatment remain valid, such as the importance of an accurate, detailed history and adjusting antiepileptic drug (AED) doses on the basis of seizure control and adverse effects rather than blood test results. ⋯ Older AEDs are still prescribed commonly; newer AEDs have similar efficacy and improved tolerability. Human leukocyte-associated antigen (HLA) testing is recommended before commencing Asian patients on carbamazepine to minimise the risk of Stevens-Johnson syndrome (SJS). Referral to an epilepsy specialist is recommended if seizures are not controlled after trialling two AEDs. Important issues pertaining to reproductive and bone health are complex and poorly understood.