Assessment of acute headache in adults differential. 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. It can be categorized into three subtypes according to the international classification of headache disorders based on headache frequency. Understanding headache classification and diagnosis. Headache can be differentiated in primary and secondary forms. Tumor headache pain progressively worsens, projectile vomiting, possible visual disturbances speech or personality changes. 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. The appropriate headache diagnosis must be made before a treatment can be selected. 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. About 90% of men and 95% of women have at least one headache per year. Diagnosis and treatment of headache in the ambulatory care setting. Diagnosis, differential diagnosis, therapy primary headache like migraine or tension headache are very common among women at the age of 20 to 45 years.
Tensiontype headache migraine headache chronic daily headache cluster headache the causes and diagnosis of nonmigraine headaches are discussed here. Sep 14, 2015 cardinal presentations this post is part of a series called cardinal presentations, based on rosens emergency medicine 8th edition. Secondary headaches are characterized by excruciating pain, usually caused by another, more serious, condition. Some people develop very frequent headaches, as frequent as every day in some cases. Chronic daily headache is defined as the presence of a headache on 15 days or more per month for at least three months. Standards of care for headache diagnosis and treatment. Differential diagnosis of headache based on 3 questions how long have you been having headaches. Nov 21, 2017 the international headache society ihs began developing a classification system for headaches in 1985. Cluster headache is another primary headache that is part of the differential diagnosis for migraine without aura. The differential diagnosis of chronic daily headaches. Headache attributed to cranial or cervical vascular disorder 7.
Radiological diagnosis and differential diagnosis of headache. Making the correct diagnosis requires knowledge of underlying pathophysiology and thorough differential diagnosis. Differential diagnosis the most important step in the diagnosis of any headache is the differentiation of dangerous versus benign causes. Red flags for secondary disorders include sudden onset of headache, onset of headache after 50 years of age, increased frequency or severity of headache, new onset of headache with an underlying medical condition.
Effective options for acute treatment include the triptans, which are serotonin 1bd agonists. Differential diagnosis of orthostatic headache outline terms. 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. Migraine misdiagnosis as a sinusitis, a delay that can last. 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. Diagnostic clues should be derived primarily from history. 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. Primary headaches are headache syndromes not due to another cause. Headaches represent 2% of all emergency room visits. Headaches represent 2% of all emergency department visits.
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. Conjunctival injection, lacrimation, rhinorrhea, miosis, eyelid edema. Headaches can be quite debilitating, although most headaches are not caused by lifethreatening disorders. The most common types of chronic daily headache are chronic migraines and. These will help in understanding the differential diagnosis of headaches, some common types include. The differential diagnosis of cdhs is challenging and should proceed in an orderly fashion. The list might be prioritized by likelihood and urgency. The differential diagnosis of headache plus focal findings is broad and workup should be guided by the patients profile of other risk factors. Vestibular differential diagnosis vestibular migraine central symptoms diagnostic criteria 5 or more attacks of moderate vestibular symptoms 1 min 72 hrs minutes to days episodes of vertigo, positional vertigo, visual or head motion induced vertigo, nausea history of migraine with headache, photophobia, phonophoria, visual aura.
Diagnosis the international headache society criteria2 are very helpful in the diagnosis of migraine. Differential diagnosis headache made easy with mnemonics. While in some cases they first treat the underlying cause. A detailed headache history helps to distinguish among the primary headache disorders. Patients with palpitations often present to urgent care clinics. What follows is an approach to this problem based on the characteristics of the presenting headache type.
Headache is pain localised to any part of the head, behind the eyes or ears, or in the upper neck. Trigeminal autonomic cephalalgias other than cluster headaches other primary headache disorders. Abc of emergency differential diagnosis pdf free download. Symptomatic malignancy is usually visualized on routine noncontrast head computed tomography ct. Evaluation of acute headache in adults differential. 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. History and exam help to differentiate primary and secondary headaches. For each type of acute headache there is a fairly well defined differential diagnosis. An overview of different forms of secondary headache is given, outlining diagnostic procedures and the morphologic imaging features of each syndrome. It enables appropriate testing to rule out possibilities and confirm a final diagnosis. Not unexpectedly, the differential diagnosis of this highly prevalent symptom is vast, with over 300 different headache types and etiologies.
Diagnosis and classification of primary headache disorders. Headache attributed to nonvascular intracranial disorder 8. Churchills pocketbook of differential diagnosis pdf 4th. Diagnosis, differential diagnosis, therapy primary headache like migraine or tension headache are very common among women at. Headache is pain localized to any part of the head, behind the eyes or ears, or in the upper neck. Headache attributed to a substance or its withdrawal 9. New drugs effective for migraine, including triptan, have been released. Stabbing headache in patients with unusual primary headache disorders. 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. Most headaches are caused by one of four syndromes. 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.
Dec 12, 20 the mean duration of headache in misdiagnosed patients was 11. Abc of emergency differential diagnosis 3mb pdf if you found this book helpful then please like, subscribe and share. Headache is one of the most frequent problems in daily general medical practice. Suspicion of these disorders mandates emergent diagnostic testing to exclude the disease. A useful framework for the differential diagnosis of acute sore throat is shown below. Differential diagnosis of facial pain 7 the trigeminal autonomic cephalalgias goadsby and lipton, 1997 which include cluster headache, chronic paroxysmal hemicrania, sunct and hemicrania continua, are responsible for pain in the upper part of the face, centered on the eye, but the most frequent causes of upper facial pains are ten. Most of the headache treatments are symptomatic so doctors always suggest you the pain medications which include antianalgesics mostly paracetamol. The child with headache in a pediatric emergency department. Tensiontype headache definition tensiontype headache tth is the most common form of headache. Cluster headache differential diagnoses medscape reference. Cervical artery dissection requires dedicated imaging of the cervical.
Atypical migraines with neurological findings basilar, ophthalmoplegic, ophthalmic, hemiplegic minutes to days. Differential diagnosis of chronic headache jmaj 473. Differential diagnosis of headache based on 3 questions author. 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. Evaluation of acute headaches in adults american family. Chronic daily headache is not a type of headache but a category that includes frequent headaches of various kinds. Hallmark physical signs are often absent, and many. Differential diagnosis of headache based on 3 questions. Differential diagnosis between primary and secondary headaches can be very dif. 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 is the most common primary headache disorder. This typically complicates migraine which is then transformed into a chronic daily headache similar to chronic tth often with some migrainous features. As the name suggests, ch involves a grouping of headaches, usually over a period of several weeks. Headache attributed to trauma or injury to the head andor neck 6.
Differential diagnosis for migraine not for sale or. The approach begins with a search for red flags that suggest the possibility of a secondary. Liddle, md assistant professor of orthopedics assistant professor of internal medicine vanderbilt university medical center nashville, tn. Now in its third edition beta version, this system includes a tensiontype headache tth category, further defined as either episodic or chronic. New onset explosive acute posttraumatic headache subarachnoid hemorrage thunderclap headache carotid disection stroke pituitary apoplexy new onset, gradual, progressive for hours, days or weeks. Primary headaches are often chronic and the diagnosis is established early in adulthood. Cluster headache diagnosis cluster headache is a rare variety of primary headache, having a population frequency of 0. Differential diagnosis of headaches definition, types ddx. Hing differential diagnosis and classification of neck. Differential diagnosis for orofacial pain, including sinusitis, tmd, trigeminal neuralgia.
Knighttime tension headache tensiontype headache most common headache females males. Headache types mixedcomorbid time days 0 30 60 symptoms evaluation of headache detailed history physical examination neurological examination formulate a differential diagnosis laboratory tests treatment followup post surgical headache poor documentation of post surgical headaches in general headache following epilepsy surgery is. The majority of headaches are secondary to respiratory infectious diseases and minor head trauma. Case examples to pediatric headaches set the stage clinical. These headache syndromes can be compared with other shortlasting headache disorders, such as hypnic headache, and with a chronic. Alcohol, which causes dilation and irritation of the blood vessels of the brain and surrounding tissue. The complete headache chart type symptoms precipitating factors treatment prevention hangover headaches migraine. The approach begins with a search for red flags that suggest the possibility of a secondary headache. For primary headaches, headache trigger trackers and headache diaries can be effective tools to help diagnosis the cause of your headaches. Dangerous benign meningitis migraine encephalitis tension headaches hemorrhage sinusitis space occupying lesions nonmeningeal infections vasculitis minor trauma shunt blockages cluster headaches 5. Acute headache accounts for about 3% of acute medical unit admissions 1 and up to 8% of emergency room attendances 2. This framework divides the diagnoses into those caused by infection bacterial and viral and those caused by noninfectious processes.