Its clinical diagnosis is based chiefly on negative features that is, absence of symptoms that characterize other primary or secondary headaches. We report on a patient with cluster headache, who complained about an atypical interval of dull headache between the cluster attacks, thus excluding the differential diagnosis of hemicrania continua. Headache is one of the highly tested cases on usmle step 2 cs since it is very common. 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. This headache and facial pain self diagnosis tool has been developed by a headache specialist neurologist as an educational service, since many patients do not have easy access to a headache specialist. Cluster headache is a stereotyped primary pain syndrome characterised by strictly unilateral severe pain, localised in or around the eye and accompanied by ipsilateral autonomic features. A bout one fifth of the patients seen by a general neurologist in the uk will present with headache. Evaluation of acute headaches in adults american family. Chronic daily headache, differential diagnosis, strategy. Abc of emergency differential diagnosis pdf free download section. A headache, like a chest pain or back ache, has many causes. Headache attributed to a substance or its withdrawal 9. Although tension type headache is present in up to 78% of headache patients in populationbased studies, it is the least distinct of all headache types. Assessment of acute headache in adults differential.
Headache differential diagnosis pdf that was all about the differential diagnosis of headaches. Understanding headache classification and diagnosis. The international classification of headache disorders 3rd edition classifies headaches into primary and secondary headaches. Then try this headache mnemonic for usmle step 2 cs. Headache attributed to trauma or injury to the head andor neck 6.
Differential diagnosis of headache based on 3 questions. Cluster headache differential diagnoses medscape reference. It may be a migraine sharp or throbbing pain, tensiontype headaches and cluster headaches. A primary headache is not a symptom of an underlying disease or condition. Tensiontype headache migraine headache chronic daily headache cluster headache the causes and diagnosis of nonmigraine headaches are discussed here. Primary headaches, which include migraine, tensiontype headache and cluster headache, are benign. Diagnosis of tensiontype headache, migraine and cluster headache. Diagnosis of tensiontype headache, migraine and cluster. Differential diagnosis of chronic migraine clinical. Nov 20, 2008 headache is common and has a lifetime prevalence of over 90% in the united kingdom.
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. Headaches can be quite debilitating, although most headaches are not caused by lifethreatening disorders. A headache is a pain that occurs in head and neck region. Abdul basit is a final year medical student at bolan university of medical and health sciences, quetta, balochistan. At the same time, the patient noticed that he was no longer able to walk, describing weakness on the right side. 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. This headache and facial pain selfdiagnosis tool has been developed by a headache specialist neurologist as an educational service, since many patients do not have easy access to a headache specialist. Migraine headache in adults treatment options epocrates online. Posttraumatic headache is diagnosed only when a new type of headache begins for the first time within 7 days of head or neck injury. Most patients are assessed in the relative peace and calm of the outpatient clinic, and their management is dealt with elsewhere in this supplement. 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. Figure 201 shows the potential diagnoses in a more algorithmic form as they are often considered clinically. Differential diagnosis of headache based on 3 questions how long have you been having headaches.
Start studying differential diagnosis for headache. Tension headache differential diagnoses medscape reference. Churchills pocketbook of differential diagnosis is the best differential diagnosis book for medical students who are working or are looking forward to more of the clinical approach to the field. Some are fatal or lifethreatening and some are harmless. Tensiontype headache must be distinguished from other primary and secondary headache disorders. When a headache is present for more than 15 days per month for at least three months, it is described as a chronic daily headache.
Most common causes are migraines and tensiontype headaches. New drugs effective for migraine, including triptan, have been released. Finally, in this section of the article, you will be able to get access to the abc of emergency differential diagnosis pdf free download file in. See evaluation of the adult with nontraumatic headache in the emergency department. Also, the abc of emergency differential diagnosis pdf free download file is on an online repository for the safer. Headache diagnosis tool, headache treatment, migraine. Differential diagnosis for headache flashcards quizlet. Acute headache accounts for about 3% of acute medical unit admissions 1 and up to 8% of emergency room attendances 2. Headache is pain localised to any part of the head, behind the eyes or ears, or in the upper neck.
Headache is a common feature of both systemic nervous system and cns infections, and has no consistent clinical characteristics. Not unexpectedly, the differential diagnosis of this highly prevalent symptom is vast, with over 300 different headache types and etiologies. Tensiontype headache is not as well studied as migraine and was once thought to be primarily psychogenic. Which of the following types of primary chronic headache is not one from which chronic migraine must be differentiated. 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. 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. 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. Headache attributed to cranial or cervical vascular disorder 7.
What follows is an approach to this problem based on the characteristics of the presenting headache type. 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. For each type of acute headache there is a fairly well defined differential diagnosis. Chronic daily headache is not a type of headache but a category that includes frequent headaches of various kinds. Headache attributed to nonvascular intracranial disorder 8. Differential diagnosis of headache 19990101 ahc media. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Acute headache in the emergency department journal of. Standards of care for headache diagnosis and treatment.
Primary headaches are often chronic and the diagnosis is established early in adulthood. 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. Differential diagnosis of headache based on 3 questions author. Hallmark physical signs are often absent, and many. Understanding headache classification and diagnosis is, therefore, a clinical imperative and a requisite for diagnostic testing and treatment. 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. Most serious causes are meningitis, subarachnoid hemorrhage, and temporal arteritis. Initial treatment confirmation by headache diary etc.
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. Cluster headache is another primary headache that is part of the differential diagnosis for migraine without aura. Conjunctival injection, lacrimation, rhinorrhea, miosis, eyelid edema. Headaches are classified on primary and secondary bases. Headache diagnosis and testing american headache society. Headache is common and has a lifetime prevalence of over 90% in the united kingdom. This disorder presents more commonly in obese, young women, presenting commonly as headaches and papilledema. The differential diagnosis of chronic daily headaches. Diagnostic clues should be derived primarily from history. Firstline treatment of adults with acute migraine in the emergency department should include an intravenous antiemetic e. For primary headaches, headache trigger trackers and headache diaries can be effective tools to help diagnosis the cause of your headaches.
The differential diagnosis of cdhs is challenging and should proceed in an orderly fashion. Knighttime tension headache tensiontype headache most common headache females males. Differential diagnosis headache made easy with mnemonics. Even when trying to make a diagnosis accord ing to the classification1 of the international. 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.
The differential diagnoses in patients presenting with possible migraine include temporal. Headache is one of the most frequent problems in daily general medical practice. Idiopathic intracranial hypertension iih, previously referred to as pseudotumor cerebri, is a disorder of increased intracranial pressure. Migraine headache in adults differential diagnosis. Differential diagnosis for headache acute oxford medical.
As the name suggests, ch involves a grouping of headaches, usually over a period of several weeks. Headaches represent 2% of all emergency department visits. This article will discuss the differential diagnosis of headaches, types of headaches, and when you should be really concerned about your headache. Diagnosis and classification of primary headache disorders. A detailed article on differential diagnosis of headaches is given in the pdf file below. Asking the right questions is the key to make the correct diagnosis. Differential diagnosis migraine, tensiontype headache, cluster headache, etc. Differential diagnosis of headaches definition, types ddx. If there are any features of migraine, diagnose chronic migraine. Review the clinical features, diagnostic criteria, and differential diagnosis of migraine. Headache is among the most common medical complaints. Acute headache in the emergency department journal. In hypnic headache the patient will retire to bed to sleep completely pain free, but is woken from sleep with an.
Differential diagnosis of chronic headache jmaj 473. Successful headache diagnosis needs recognition of the most likely diagnostic. Now in its third edition beta version, this system includes a tensiontype headache tth category, further defined as either episodic or chronic. Usually it is easy to differentiate between cluster. Download button for current diagnosis and treatment 3rd edition pdf.
Feverweaknesssyncopealtered mental statusseizuredizziness and vertigoheadachesore throatdyspneachest painabdominal painnausea and vomitinggastrointestinal bleedingacute pelvic painback pain pathophysiology of headache cephalalgia sensation via. Hospital consultation exclusion of organic headache obtaining characteristics based on questionnaire fig. Primary headache types migraine location duration patient appearance tension cluster 6070% unilateral 472 hr bilateral unilateral 0. The syndrome is characterised by the circadian rhythmicity of the shortlived attacks, and the regular recurrence of headache bouts, which are interspersed by periods of complete remission in most individuals. Sep 14, 2015 cardinal presentations this post is part of a series called cardinal presentations, based on rosens emergency medicine 8th edition. Symptoms and signs can overlap so if in doubt early neuroradiological imaging can ensure diagnostic accuracy. 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. About 90% of men and 95% of women have at least one headache per year. A small proportion of headache patients will present. Current diagnosis and treatment neurology 3rd edition pdf free. The syndrome is characterised by the circadian rhythmicity of the shortlived attacks, and the regular recurrence of headache bouts, which are interspersed by periods of complete.
We report on a patient with cluster headache, who complained about an atypical interval of dull headache between the cluster attacks, thus excluding. Some people develop very frequent headaches, as frequent as every day in some cases. The chart below might help you in the differential diagnosis of headaches or commonly the ddx of headaches. This group has the most diverse range of possible diagnoses. Migraine headache in adults treatment options, diagnosis, and images at epocrates online, the leading provider of drug and disease decision support tools. Most headaches are caused by one of four syndromes. The complete headache chart type symptoms precipitating factors treatment prevention hangover headaches migraine. Are you having trouble remembering all the important questions to ask during your patient encounter. Differential diagnosis for migraine not for sale or. Indolent cns infections, however, can be more difficult to diagnose. Tension headache is the most common type of headache, with a reported lifetime prevalence as high as 78%. Pdf the differential diagnosis of chronic daily headaches. An overview of the approach to the patient with a chief complaint of headache is presented here.
The approach begins with a search for red flags that suggest the possibility of a secondary. New onset explosive acute posttraumatic headache subarachnoid hemorrage thunderclap headache carotid disection stroke pituitary apoplexy new onset, gradual, progressive for hours, days or weeks. Part ii, differential diagnosis and management of infectious. Atypical migraines with neurological findings basilar, ophthalmoplegic, ophthalmic, hemiplegic minutes to days. Shown below is a white download button for current diagnosis and treatment 3rd edition pdf. Dec 12, 2019 idiopathic intracranial hypertension iih, previously referred to as pseudotumor cerebri, is a disorder of increased intracranial pressure. Churchills pocketbook of differential diagnosis pdf 4th. Diagnosis and treatment of headache in the ambulatory care setting. Migraine headache in adults treatment options epocrates. Pdf chronic daily headaches cdhs refers to primary headaches that happen on at least 15 days per month, for 4 or more hours. The headache was associated with vertigo and nauseavomiting. Type symptoms precipitating factors treatment prevention hangover headaches migraine. Headache society ihs, which can be called the bible of headache. The diagnosis is straightforward in the presence of a high fever or altered consciousness.
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. Migraine is typically manifest by episodic disabling headache, though it is more than just head pain. Screening and diagnosis 04012020 frequent headaches. Nov 21, 2017 the international headache society ihs began developing a classification system for headaches in 1985. Credits can be earned by building a differential or looking up a diagnosis. The headache came on suddenly, felt sharp, 710 in severity and radiated from the posterior occiput to his forehead on the right side. Promethazine can also be used for the symptomatic relief of nausea.
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