Differential Diagnosis of Headache

Differential Diagnosis of Headache
	Subarachnoid Hemorrhage	Meningitis	Temporal Arteritis	Hypertensive	Migraine	Cluster	Muscle Contraction
Onset	Acute	Acute or chronic	Acute or chronic	Acute or Chronic	Acute	Acute	Chronic
Location	Global	Global	Localized	Localized	Unilateral	Unilateral	Global unilateral
Associated Symptoms	N, V, LOC, meningismus, focal neurologic symptoms	N, V, fever, photophobia miningismus, focal symptoms, seizures	Weight loss, PMR, fever, decreased vision, jaw claudication	N, V, focal neurologic symptoms	N, V, photophobia, phonophobia	Rhinorrhea, lacrimation of side	Multisomatic complaints
Pain characteristics	worst ever	severe throbbing	severe throbbing over affected area	Throbbing	Throbbing	Sharp, stabbing	Ache
Duration	Brief	Brief	Prolonged	Brief	Prolonged	30 min-2 hrs	Daily
Prior history	(-)	(-)	(-)	(+)	(+)	(+)	(+)
Diagnostic tests	CT 80-90%	LP (+), CBC	WSR (+)	CT scan to rule out bleeding	-	-	-
Physical Examination	Focal signs, decreased LOC, meningismus	Miningismus, decreased LOC, irritability, rash	Tender temporal arteries, myalgias, fever	Papilledema, decreased venous pulsations, decreased LOC, cerebrovascular changes	N, V, photophobia, phonophobia	Unilateral rhinorrhea, lacrimation, partial Homer’s syndrome	(-)
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Types of Headache in the Emergency Department
Final Diagnosis	Percentage
Infection—Other than intracranial	39.3
Tension headache	19.3
Miscellaneous	14.9
Post-traumatic	9.3
Hypertension related	4.8
Vascular (Migraine type)	4.5
No diagnosis	6.0
Subarachnoid hemorrhage	0.9
Meningitis	0.6
Migraine and tension	0.5
Source: Michael Gerardi, MD, FAAP, FACEP _________________________________________________________________________________

Types of Headache in the Emergency Department