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Differential Diagnosis of Headache

Differential Diagnosis of Headache

Subarachnoid
Hemorrhage
MeningitisTemporal Arteritis HypertensiveMigraineClusterMuscle Contraction
OnsetAcuteAcute or chronicAcute or chronicAcute or ChronicAcuteAcuteChronic
LocationGlobalGlobalLocalizedLocalizedUnilateralUnilateralGlobal unilateral
Associated SymptomsN, V, LOC, meningismus, focal neurologic symptomsN, V, fever, photophobia miningismus, focal symptoms, seizuresWeight loss, PMR, fever, decreased vision, jaw claudicationN, V, focal neurologic symptomsN, V, photophobia, phonophobiaRhinorrhea, lacrimation of sideMultisomatic complaints
Pain
characteristics
worst eversevere throbbingsevere throbbing over affected area ThrobbingThrobbingSharp, stabbingAche
DurationBriefBriefProlongedBriefProlonged30 min-2 hrsDaily
Prior history(-)(-)(-)(+)(+)(+)(+)
Diagnostic testsCT 80-90%LP (+), CBCWSR (+)CT scan to rule out bleeding---
Physical ExaminationFocal signs, decreased LOC, meningismusMiningismus, decreased LOC, irritability, rashTender temporal arteries, myalgias, feverPapilledema, decreased venous pulsations, decreased LOC,
cerebrovascular changes
N, V, photophobia, phonophobiaUnilateral rhinorrhea, lacrimation, partial Homer’s syndrome(-)
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Types of Headache in the Emergency Department

Final DiagnosisPercentage
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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