The complete headache chart type symptoms precipitating factors treatment prevention hangover headaches migraine. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Accurate patient history is the most important diagnostic tool in correctly diagnosing headache type and cause. Headache is the most common somatic complaint in children and adolescents. This may therefore lead to inappropriate diagnosis and treatment. Diagnosis and classification of primary headache disorders. Headache attributed to trauma or injury to the head andor neck 6. Most headaches are caused by one of four syndromes. What follows is an approach to this problem based on the characteristics of the presenting headache type. Migraine is the most common primary headache disorder. Differential diagnosis of headache based on 3 questions how long have you been having headaches. Some are fatal or lifethreatening and some are harmless. Differential diagnosis of orthostatic headache outline terms. Credits can be earned by building a differential or looking up a diagnosis.
Clinical, endoscopic, or imaging ct, mri evidence of acute, or acuteonchronic, rhinosinusitis 3. Nov 21, 2017 the international headache society ihs began developing a classification system for headaches in 1985. An overview of the approach to the patient with a chief complaint of headache is presented here. 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. Sep 14, 2015 cardinal presentations this post is part of a series called cardinal presentations, based on rosens emergency medicine 8th edition. For primary headaches, headache trigger trackers and headache diaries can be effective tools to help diagnosis the cause of your headaches. Medicationoveruse headache medicationoveruse headache moh may occur in people who have frequent migraine, cluster, or tensiontype headaches, which leads them to overuse pain medications. A vicious cycle occurs whereby frequent headaches cause the person to take medication frequently often nonprescription medication, which then. Migraine headache in adults treatment options epocrates online. It is a well known fact that the causes of headaches are diverse. Understanding headache classification and diagnosis. An additional criterion is a normal clinicalneurological finding 1.
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. Although there are many causes of secondary headache, clinical. Regardless, it is clear that primary care practitioners are faced with patients with headache on a frequent basis. Differential diagnosis headache made easy with mnemonics. Differential diagnosis for headache flashcards quizlet. Not unexpectedly, the differential diagnosis of this highly prevalent symptom is vast, with over 300 different headache types and etiologies.
The commonly missed diagnosis of intracranial hypotension. It can damage the nerve that carries information from the eye to the brain. Feverweaknesssyncopealtered mental statusseizuredizziness and vertigoheadachesore throatdyspneachest painabdominal painnausea and vomitinggastrointestinal bleedingacute pelvic painback pain pathophysiology of headache cephalalgia sensation via. Frontal headache, with pain in one of the following. Firstline treatment of adults with acute migraine in the emergency department should include an intravenous antiemetic e. The differential diagnosis of cdhs is challenging and should proceed in an orderly fashion. Some headaches are extremely debilitating and have significant impact on an individuals quality of life. If the headache that the patient is seeking treatment for is clearly chronic and recurrent, there is. Headache classification committee of the international headache society.
Many patients with trigeminal neuralgia complain that. Differential diagnosis 143 distinctive features of stabbing headache from other types of paroxysmal headache type of headache frequency duration intensity chronobiology location trigge pain dysautonomi. Usually it is easy to differentiate between cluster. The differential diagnosis of headache plus focal findings is broad and workup should be guided by the patients profile of other risk factors. Differential diagnosis of chronic headache jmaj 473. The reality of clinical practice is patients are often over imaged for. Chronic daily headache is defined as the presence of a headache on 15 days or more per month for at least three months.
Although headaches have been described since ancient times, headache incidence and prevalence seem to be increasing. The headache may be described as throbbing or nonthrobbing and will most often be localized to the occipital andor the frontotemporal regions. Pain in the facial area may be due to neurological or vascular causes, but equally well may be dental in origin. New drugs effective for migraine, including triptan, have been released. Diagnosis of tensiontype headache, migraine and cluster headache. Posttraumatic headache is diagnosed only when a new type of headache begins for the first time within 7 days of head or neck injury. Cluster headache is another primary headache that is part of the differential diagnosis for migraine without aura. An approach to identifying headache patients that require. Acute headache accounts for about 3% of acute medical unit admissions 1 and up to 8% of emergency room attendances 2. To be updated when it is complete please like us on facebook, follow us on twitter or subscribe on youtube using the follow us buttons.
Conjunctival injection, lacrimation, rhinorrhea, miosis, eyelid edema. An overview of different forms of secondary headache is given, outlining diagnostic procedures and the morphologic imaging features of each syndrome. This disease is caused by the buildup of fluid and pressure in the eye. Secondary headaches are characterized by excruciating pain, usually caused by another, more serious, condition. Consider the following cant miss headache causes at least once in your evaluation of a newonset headache or a change in an existing headache pattern.
Overview of diagnosis and management of paediatric. The differential diagnosis of headache begins with the headache history, followed by physical exam, laboratory tests and other diagnostic evaluations. Aids to management of headache disorders in primary care 2nd. D senior resident saudi board of emergency medicine 2. A bout one fifth of the patients seen by a general neurologist in the uk will present with headache. Age of onset 38 ch t i db d l tcharacterized by gradual onset, bil t lbilateral, nonthrobbing aching pain over the frontal and temporal regions, which often spreads to the occipital. Migraine headache in adults differential diagnosis. Evaluation of acute headaches in adults american family. It may be a migraine sharp or throbbing pain, tensiontype headaches and cluster headaches. Differential diagnosis for migraine not for sale or. As the name suggests, ch involves a grouping of headaches, usually over a period of several weeks. The differential diagnosis of chronic daily headaches. Diagnosis the international headache society criteria2 are very helpful in the diagnosis of migraine.
A primary headache is not a symptom of an underlying disease or condition. 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 headache is a pain that occurs in head and neck region. About 90% of men and 95% of women have at least one headache per year. Introduction to abbreviated pocket version the international classification of headache disorders, 2nd edition, is published by international headache society in cephalalgia 2004. Differential diagnosis of headaches definition, types ddx.
Differential diagnosis of headache based on 3 questions. Can induced headache be used in the differential diagnosis. This typically complicates migraine which is then transformed into a chronic daily headache similar to chronic tth often with some migrainous features. Key features to elicit when obtaining patient history include age of onset, chronicity of headaches, pattern of headaches including duration and frequency, onsettopeak time, location of headache pain, severity and character of headache pain, and the presence of any premonitory. Diagnosis episodic tensiontype headache chronic tensiontype headache2 episodic migraine with or without aura chronic migraine with or without aura episodic cluster headache chronic cluster headache 1 headache pain can be felt in the head, face or neck. Start studying differential diagnosis for headache. By courtney cassella, md resident physician, icahn school of medicine at mount sinai. Headache can be differentiated in primary and secondary forms. Diagnosis and management of childhood headache sciencedirect. Acute headache in the emergency department journal of.
Differential diagnosis for headache acute oxford medical. Headache triggers episodic tensiontype headache diagnostic criteria clinical features of the trigeminal autonomic cephalalgias diagnostic criteria for cluster headache etiologies of thunderclap headache differential diagnosis of headache with fever. Initial treatment confirmation by headache diary etc. Most patients are assessed in the relative peace and calm of the outpatient clinic, and their management is dealt with elsewhere in this supplement. Diagnosis of tensiontype headache, migraine and cluster.
The most common types of chronic daily headache are chronic migraines and. Assessment of acute headache in adults differential. Radiological diagnosis and differential diagnosis of headache. Stabbing headache in patients with unusual primary headache disorders. 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.
Atypical migraines with neurological findings basilar, ophthalmoplegic, ophthalmic, hemiplegic minutes to days. Which of the following types of primary chronic headache is not one from which chronic migraine must be differentiated. The approach begins with a search for red flags that suggest the possibility of a secondary headache. Patients often describe the pain as an anvil sitting on top of the head or a pulling sensation from the head down to the neck 4. New onset explosive acute posttraumatic headache subarachnoid hemorrage thunderclap headache carotid disection stroke pituitary apoplexy new onset, gradual, progressive for hours, days or weeks.
Now in its third edition beta version, this system includes a tensiontype headache tth category, further defined as either episodic or chronic. Overview of diagnosis and management of paediatric headache. For technical reasons, the english full text will be published approximately two weeks after the german print edition has been published. Standards of care for headache diagnosis and treatment. Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. See evaluation of the adult with nontraumatic headache in the emergency department. History and exam help to differentiate primary and secondary headaches. For each type of acute headache there is a fairly well defined differential diagnosis. At the same time, the patient noticed that he was no longer able to walk, describing weakness on the right side. The approach to the headache history given in table 3 and discussed in the following sections facilitates the generation of a differential diagnosis and. Cluster headache differential diagnoses medscape reference.
Headaches represent 2% of all emergency department visits. The headache came on suddenly, felt sharp, 710 in severity and radiated from the posterior occiput to his forehead on the right side. The common headache disorders migraine, tensiontype headache and medicationoveruse headache are major causes of ill health. 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. 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.
Symptomatic malignancy is usually visualized on routine noncontrast head computed tomography ct. A headache, like a chest pain or back ache, has many causes. Suspicion of these disorders mandates emergent diagnostic testing to exclude the disease. Tensiontype headache migraine headache chronic daily headache cluster headache the causes and diagnosis of nonmigraine headaches are discussed here. Clinical presentation, diagnostic criteria, and differential diagnosis fabio antonaci, md, phd, torbjorn a. Age of onset 38 ch t i db d l tcharacterized by gradual onset, bil t lbilateral, nonthrobbing aching pain over the frontal and temporal regions, which often spreads to.
Can induced headache be used in the differential diagnosis of. Diagnostic evaluation and differential diagnosis of cluster headache the diagnosis of cluster headache is made clinically according to the criteria set out in the international classification of headache disorders ichdii box 1. Were going to cover the following basics of headache. Headache is pain localised to any part of the head, behind the eyes or ears, or in the upper neck. Migraine headache in adults treatment options, diagnosis, and images at epocrates online, the leading provider of drug and disease decision support tools. Tension headache differential diagnoses medscape reference. Differential diagnosis for headache acute common and important causes of headache acute for doctors and medical students this page is currently being written and will be available soon. Headache is an extremely common symptom and collectively headache disorders are among the most common of the nervous system disorders, with a prevalence of 48. Hallmark physical signs are often absent, and many. Headache classification committee of the international.
Differential diagnosis migraine, tensiontype headache, cluster headache, etc. 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. The evaluation should include detailed history of children and adolescents completed by detailed general and neurological examinations. Effective options for acute treatment include the triptans, which are serotonin 1bd agonists.
Headache attributed to cranial or cervical vascular disorder 7. Differential diagnosis of headache based on 3 questions author. Moreover, the possible role of psychological factors, life events and excessively stressful lifestyle in influencing recurrent headache need to be checked. Important elements in the headache history include. Headache is among the most common medical complaints. Hospital consultation exclusion of organic headache obtaining characteristics based on questionnaire fig. Create a concrete differential diagnosis to rule out cant miss causes of headache using the data c.
The objectives of this study are to create headache by visual stimulationvs, to examine the similarities between spontaneous headaches and visually stimulated headaches if the latter occurs, to determine if vs can be used as a model in headache researches and to evaluate if it can be used as a diagnostic tool for the differential diagnosis of primary headaches. Headaches can be quite debilitating, although most headaches are not caused by lifethreatening disorders. Differential diagnosis of chronic migraine clinical. Diagnostic clues should be derived primarily from history. Alcohol, which causes dilation and irritation of the blood vessels of the brain and surrounding tissue. Some headaches are extremely debilitating and have. A small proportion of headache patients will present.
The patient will often make the first attempt at diagnosis in that he or she chooses to consult either the dentist or the doctor. A 56yearold woman with a past medical history of hypertension and diabetes mellitus presents with a gradual onset, severe headache for the past 8. This allows the clinician to classify the headache as primary or secondary and treat accordingly. The headache was associated with vertigo and nauseavomiting. Headache attributed to a substance or its withdrawal 9.
The international classification of headache disorders. 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. Knighttime tension headache tensiontype headache most common headache females males. This article will discuss the differential diagnosis of headaches, types of headaches, and when you should be really concerned about your headache. Headaches are classified on primary and secondary bases. Pdf headache, an almost universal human experience, is one of the most common complaints. Migraine headache in adults treatment options epocrates. Headache is one of the most frequent problems in daily general medical practice.
1281 392 1363 204 1150 1106 957 487 868 738 1024 1285 50 1127 1129 1197 1376 685 1054 444 1377 245 1581 140 425 1450 1425 1191 936 1501 759 1262 604 463 1124 1468 363 1364 436 727