Headache differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sabeeh Islam, MBBS[2]


Disease History and Physical Examination PMHx Diagnostic approach
Unilateral Bilateral Throbbing character Autonomic symptoms Fever Photophobia Aphasia LOC Aura Nause/vomiting Rash Neck stiffness Vision changes Facial tenderness Neurologic deficits Labs and CSF findings CT/MRI Gold standard test
Migraine + - + - - + - - + + - - + - - Trigger factors, family hx - - Clinical assesment
Tension-type headache (TTH) - + - - - - - - - - - - - - - stress, genetics - - Clinical assesment
Cluster headache + - - + - - - - - - - - + - - episodic history - - Clinical assesment
Seizure - + - - - - +/- + +/- - - - - - +/- Hx of seizures prolactin level +/- mass lesion EEG
Meningitis - + - - + +/- +/- - - +/- +/- + - - + Hx of fever, malaise <math>\uparrow</math>WBC

<math>\uparrow</math>Protein

<math>\downarrow</math>glucose

+/- CSF analysis
Encephalitis - + +/- - + +/- +/- - - - +/- + - - + Hx of fever, malaise elevated WBC, low glucose + CSF PCR
Brain tumor - + - - - - +/- - - +/- - - +/- - +/- weight loss, fatigue neuromarkers +/- mass MRI
Subdural hemorrhage -/+ -/+ +/- - - - +/-
Subarachnoid hemorrhage -/+ + +/- - - +/- +/-
Hypertensive encephalopathy - + +/- - - +/- -
CNS abscess -/+ -/+ - - + - +/-
Conversion disorder -/+ -/+ - - - - +/-
Multiple sclerosis -/+ -/+ - - - - -
Hemorrhagic stroke -/+ -/+ +/- - - - +/-
Neurosyphilis -/+ -/+ - - - - -
Wernicke’s encephalopathy - -/+ - - - - +/- Clinical assesment and lab findings
Drug toxicity - -/+ - - +/- - -
Metabolic disturbances - -/+ - - - - -
NPH - -/+ - - - - -
Sinusitis - -/+ - - +/- - -

References


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