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 | (-) |
_____________________________________________________________________________________________ |
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 _________________________________________________________________________________ |