Differential Diagnosis of Headache
January 1, 1999 2 minutes read
Differential Diagnosis of Headache |
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| 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
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