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