Three days before admission, he developed the abrupt onset of severe posterior headache. Headache attributed to nonvascular intracranial disorder 8. Differential diagnosis of headache in adults ijhbr. Headache knowledge for medical students and physicians. Headache is pain localised to any part of the head, behind the eyes or ears, or in the upper neck. Feverweaknesssyncopealtered mental statusseizuredizziness and vertigoheadachesore throatdyspneachest painabdominal painnausea and vomitinggastrointestinal bleedingacute pelvic painback pain pathophysiology of headache cephalalgia sensation via. Differential diagnosis of dizziness yvonne chan introduction dizziness is a nonspeci. Here are some simplified examples of what a differential diagnosis may look like for some common conditions. Promethazine can also be used for the symptomatic relief of nausea. Part ii, differential diagnosis and management of infectious. A pain in the head with the pain being above the eyes or the ears, behind the head occipital, or in the back of the upper neck. Primary headaches consist of migraines, cluster headaches and tension headaches. Feb 15, 2002 if the headache is associated with alteration of consciousness or abnormal involuntary movement, the differential diagnosis will include complex partial seizure disorders, and eeg may be required. The headache was associated with vertigo and nauseavomiting.
Asking the right questions is the key to make the correct diagnosis. Migraine misdiagnosis as a sinusitis, a delay that can last. Migraine headache in adults differential diagnosis. An overview of the approach to the patient with a chief complaint of headache is presented here. This article presents three categories that represent the most common types of headache pain. The headache came on suddenly, felt sharp, 710 in severity and radiated from the posterior occiput to his forehead on the right side. Differential diagnosis of headache based on 3 questions author. The main symptoms of a cervicogenic headache are a combination of unilateral pain, ipsilateral diffuse shoulder, and arm pain.
Thunderclap headache is an uncommon type of headache, but recognition and diagnosis are important because of the possibility of a serious underlying brain disorder. Assessment of acute headache in adults bmj best practice. Information concerning cervicogenic headache was collected by using article databases, such as pubmed, web of knowledge and sciencedirect. The complete headache chart type symptoms precipitating factors treatment prevention hangover headaches migraine. For each type of acute headache there is a fairly well defined differential diagnosis. Differential diagnosis of chronic headache jmaj 473.
Thunderclap headache an overview sciencedirect topics. Acute headache accounts for about 3% of acute medical unit admissions 1 and up to 8% of emergency room attendances 2. Alcohol, which causes dilation and irritation of the blood vessels of the brain and surrounding tissue. Differential diagnosis for migraine not for sale or. Then try this headache mnemonic for usmle step 2 cs.
The approach to the headache history given in table 3 and discussed in the following sections facilitates the generation of a differential diagnosis and preliminary classification of the headache. Headache attributed to a substance or its withdrawal 9. Table 4 differential diagnosis of chronic daily headache headache occurring on more than 15 days per month. Each key word gives of articles but the most relevant were. Differential diagnosis of headache based on 3 questions how long have you been having headaches. Oct 23, 2007 chronic daily headaches cdhs refers to primary headaches that happen on at least 15 days per month, for 4 or more hours per day, for at least three consecutive months. A detailed article on differential diagnosis of headaches is given in the pdf file below.
Headache is one of the most common physical complaints. Assessment of acute headache in adults differential. Cluster headache is another primary headache that is part of the differential diagnosis for migraine without aura. About 90% of men and 95% of women have at least one headache per year. Headaches in children and adolescents american family physician. Migraine is typically manifest by episodic disabling headache, though it is more than just head pain.
Evaluation of acute headaches in adults american family. The presenting features can be complex and similar to many primary headache syndromes that are encountered daily. Diagnosis and classification of primary headache disorders. Usually it is easy to differentiate between cluster.
Headache is mild to moderate in intensity compared to migraine or cluster headache. A cervicogenic headache is a common cause of a chronic headache that is often misdiagnosed. Despite their obvious differences, tensiontype headache is often. Tensiontype headache must be distinguished from other primary and secondary headache disorders. Wed like to understand how you use our websites in order to improve them. It may be a migraine sharp or throbbing pain, tensiontype headaches and cluster headaches. Headache is a symptom commonly encountered in everyday clinical practice, and, according to the who, one of the ten most common causes of functional disability. Diagnostic clues should be derived primarily from history.
This typically complicates migraine which is then transformed into a chronic daily headache similar to chronic tth often with some migrainous features. Initial diagnostic testing should be directed at excluding lifethreatening, common, and treatable etiologies. Differential diagnosis is from tension type headache tth, with which migraine is comorbid this differential is also discussed from the other perspective elsewhere in this supplement. Sep 14, 2015 the headache came on suddenly, felt sharp, 710 in severity and radiated from the posterior occiput to his forehead on the right side. Tension headache is not preceded or accompanied by aura like symptoms. An overview of different forms of secondary headache is given, outlining diagnostic procedures and the morphologic imaging features of each syndrome.
Nov 21, 2017 the international headache society ihs began developing a classification system for headaches in 1985. Diagnosis the international headache society criteria2 are very helpful in the diagnosis of migraine. Radiological diagnosis and differential diagnosis of headache. The differential diagnosis of chronic daily headaches. See evaluation of the adult with nontraumatic headache in the emergency department.
The differential diagnosis of cdhs is challenging and should proceed in an orderly fashion. Differential diagnosis of headache based on 3 questions. In a patient with a prior history of migraine, worsening of headache in response to head trauma is considered to be an aggravation of migraine. John visits his doctor complaining of pain in his chest. Chronic migraine, classification, differential diagnosis. Headaches in children and adolescents american family. Differential dx strategies university of massachusetts. May 25, 2018 tension headache may be once or few times a week or continuous for a several days. May 11, 2018 here are some simplified examples of what a differential diagnosis may look like for some common conditions. Jun 07, 2019 cluster headache ch, also known as histamine headache, is a primary neurovascular primary headache disorder, the pathophysiology and etiology of which are not well understood. Differential diagnosis of meningitis and encephalitis.
Migraine misdiagnosis as a sinusitis, a delay that can. The approach begins with a search for red flags that suggest the possibility of a secondary headache. Otherprimarysecondary headache disorders that worsen with changes in postureactivity differential diagnosis sihorthostatic headache dsmdigital subtraction myelography sihspontaneousintracranial hypotension ihintracranialhypotension ohorthostatic headache schievinkwi, et al. Learn about the differential diagnosis of headache. Headaches are classified on primary and secondary bases. Headache differential diagnosis pdf that was all about the differential diagnosis of headaches. Headaches represent 2% of all emergency department visits. One month before admission,he began to experience mild, nonprogressive pain and stiffness in the posterior neck.
It was a wonderful dinner last night and very heartwarming. Headache attributed to trauma or injury to the head andor neck 6. Because less than 1% of all headaches are lifethreatening, the challenge is to reassure and appropriately treat patients with benign headaches while finding the rare, lifethreatening headache without excessive evaluation. Headache diagnosis and testing american headache society. Differential diagnosis headache made easy with mnemonics headaches are of 200 types. The mean duration of headache in misdiagnosed patients was 11. Atypical migraines with neurological findings basilar, ophthalmoplegic, ophthalmic, hemiplegic minutes to days. Dec 12, 20 the mean duration of headache in misdiagnosed patients was 11. Hospital consultation exclusion of organic headache obtaining characteristics based on questionnaire fig. Cluster headache ch, also known as histamine headache, is a primary neurovascular primary headache disorder, the pathophysiology and etiology of which are not well understood. Sep 14, 2015 cardinal presentations this post is part of a series called cardinal presentations, based on rosens emergency medicine 8th edition.
Understanding headache classification and diagnosis. Tensiontype headache is usually diagnosed on clinical grounds by obtaining a targeted headache history. Some are fatal or lifethreatening and some are harmless. Its bilateral location, mild to moderate pain intensity, and absence of autonomic features make differentiating it from cluster headache relatively easy see chapter 11, cluster headache. Now in its third edition beta version, this system includes a tensiontype headache tth category, further defined as either episodic or chronic. The practitioner needs to be familiar with various headache symptoms in order to make an accurate diagnosis of each patients problems. A headache, like a chest pain or back ache, has many causes. Table 1 presents the differential diagnosis of acute low back pain. Tension headache may be once or few times a week or continuous for a several days. Differential diagnosis headache made easy with mnemonics. Classifying headaches as primary migraine, tensiontype or cluster or secondary can. Feb 15, 2001 the approach to the headache history given in table 3 and discussed in the following sections facilitates the generation of a differential diagnosis and preliminary classification of the headache. Even when trying to make a diagnosis accord ing to the classification1 of the international.
New onset explosive acute posttraumatic headache subarachnoid hemorrage thunderclap headache carotid disection stroke pituitary apoplexy new onset, gradual, progressive for hours, days or weeks. Are you having trouble remembering all the important questions to ask during your patient encounter. What is orthostasis, orthostatic hypotension, orthostatic headache what can gravity do to the head and neck what is dural traction and why does it hurt nonsih causes of orthostatic ha diagnostic definitions of sih what matters. These can present with headache in addition to symptoms such as.
Type symptoms precipitating factors treatment prevention hangover headaches. The differential diagnosis of meningitis and encephalitis includes bacterial, viral, fungal, and autoimmune etiologies. Headache attributed to cranial or cervical vascular disorder 7. Most importantly, sah, other intracranial hemorrhages, or cerebral venous thrombosis should be excluded by ct, or, if the ct scan is. As the name suggests, ch involves a grouping of headaches, usually over a period of several weeks. Firstline treatment of adults with acute migraine in the emergency department should include an intravenous antiemetic e.
Headache is a most common complaint, with pain arising from odontogenic, neurologic, and myogenic sources. Hallmark physical signs are often absent, and many. Posttraumatic headache is diagnosed only when a new type of headache begins for the first time within 7 days of head or neck injury. Evaluation of acute headaches in adults american family physician. New drugs effective for migraine, including triptan, have been released. Rom in the neck is reduced, and pain is relieved with. The chart below might help you in the differential diagnosis of headaches or commonly the ddx of headaches. What follows is an approach to this problem based on the characteristics of the presenting headache type. Migraine headache in adults treatment options epocrates. Differential diagnosis migraine, tensiontype headache, cluster headache, etc. Headache is the most common physical complaint and can be bothering if occurs every day. Dizziness is among the most common complaints leading to a visit to a physician for all age groups. Differential diagnosis of headache 19990101 ahc media.
If tension headache last for 15 days or more in one month it is considered chronic tension headache. Not unexpectedly, the differential diagnosis of this highly prevalent symptom is vast, with over 300 different headache types and etiologies. Review the clinical features, diagnostic criteria, and differential diagnosis of migraine. Headache is one of the highly tested cases on usmle step 2 cs since it is very common. Headache is one of the most frequent problems in daily general medical practice. If the headache is associated with alteration of consciousness or abnormal involuntary movement, the differential diagnosis will include complex partial seizure disorders, and eeg may be required.
This article will discuss the differential diagnosis of headaches, types of headaches, and when you should be really concerned about your headache. Waldman md, jd, in atlas of common pain syndromes fourth edition, 2019. Headache is among the most common medical complaints. Differential diagnosis of headaches definition, types ddx. Im going to talk about headaches, which is rather like opening pandoras box, but well do our best. At the same time, the patient noticed that he was no longer able to walk, describing weakness on the right side. The differential diagnosis for negative ct is broad and in the setting of a severe headache or thunderclap headache includes a number of pathologies including aneurysm, arteriovenous fistula avm or arteriovenous fistula avf, rcvs, posterior reversible encephalopathy syndrome pres, angiographically occult vascular malformation and other.
The differential diagnosis may include cervicogenic dizziness, benign parox. The approach begins with a search for red flags that suggest the possibility of a secondary. No routine laboratory tests or imaging are recommended. Though very few chances, sometimes headache can be lifethreatening, therefore it becomes important to appropriately treat the patients. Initial treatment confirmation by headache diary etc. The headache consistently occurred within 1 minute after assuming. Chronic daily headaches cdhs refers to primary headaches that happen on at least 15 days per month, for 4 or more hours per day, for at least three consecutive months. Cluster headache differential diagnoses medscape reference. Standards of care for headache diagnosis and treatment. Consider diagnostic workup based on the suspected diagnosis primary headache is a clinical diagnosis and typically does not require. Clinical presentation, diagnostic criteria, and differential diagnosis fabio antonaci, md, phd, torbjorn a. Diagnostic evaluation should be performed based on risk stratification and the suspected diagnosis lowrisk headache. Differential diagnosis of orthostatic headache outline terms.
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