Headache differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Headache}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Headache]]
'''For the WikiDoc page for this topic, click [[Headache|here]]'''
{{CMG}} {{AE}} {{SAI}}
{{CMG}} {{AE}} {{SAI}}
Differential diagnosis of headache includes: Migraine, tension-type headache, cluster headache, seizure, meningitis, encephalitis, neurosyphilis, SAH, subdural hematoma, brain tumor, hypertensive encephalopathy, brain abscess, multiple sclerosis, hemorrhagic stroke, Wernickes encephalopathy, and drug toxicity etc.<ref name="pmid14503985">{{cite journal |vauthors= |title=National guidelines for analysis of cerebrospinal fluid for bilirubin in suspected subarachnoid haemorrhage |journal=Ann. Clin. Biochem. |volume=40 |issue=Pt 5 |pages=481–8 |date=September 2003 |pmid=14503985 |doi=10.1258/000456303322326399 |url=}}</ref><ref name="pmid23717798">{{cite journal| author=Le Rhun E, Taillibert S, Chamberlain MC| title=Carcinomatous meningitis: Leptomeningeal metastases in solid tumors. | journal=Surg Neurol Int | year= 2013 | volume= 4 | issue= Suppl 4 | pages= S265-88 | pmid=23717798 | doi=10.4103/2152-7806.111304 | pmc=3656567 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23717798  }} </ref><ref name="pmid24326618">{{cite journal| author=Chow E, Troy SB| title=The differential diagnosis of hypoglycorrhachia in adult patients. | journal=Am J Med Sci | year= 2014 | volume= 348 | issue= 3 | pages= 186-90 | pmid=24326618 | doi=10.1097/MAJ.0000000000000217 | pmc=4065645 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24326618  }} </ref><ref name="pmid22880096">{{cite journal| author=Leen WG, Willemsen MA, Wevers RA, Verbeek MM| title=Cerebrospinal fluid glucose and lactate: age-specific reference values and implications for clinical practice. | journal=PLoS One | year= 2012 | volume= 7 | issue= 8 | pages= e42745 | pmid=22880096 | doi=10.1371/journal.pone.0042745 | pmc=3412827 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22880096  }} </ref><ref name="pmid10654948">{{cite journal| author=Negrini B, Kelleher KJ, Wald ER| title=Cerebrospinal fluid findings in aseptic versus bacterial meningitis. | journal=Pediatrics | year= 2000 | volume= 105 | issue= 2 | pages= 316-9 | pmid=10654948 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10654948  }} </ref><ref name="pmid20610819">{{cite journal| author=Brouwer MC, Tunkel AR, van de Beek D| title=Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis. | journal=Clin Microbiol Rev | year= 2010 | volume= 23 | issue= 3 | pages= 467-92 | pmid=20610819 | doi=10.1128/CMR.00070-09 | pmc=2901656 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20610819  }} </ref><ref name="pmid2769274">{{cite journal |vauthors=Vermeulen M, Hasan D, Blijenberg BG, Hijdra A, van Gijn J |title=Xanthochromia after subarachnoid haemorrhage needs no revisitation |journal=J. Neurol. Neurosurg. Psychiatry |volume=52 |issue=7 |pages=826–8 |date=July 1989 |pmid=2769274 |pmc=1031927 |doi=10.1136/jnnp.52.7.826 |url=}}</ref><ref name="pmid15885053">{{cite journal |vauthors=Wasay M, Mekan SF, Khelaeni B, Saeed Z, Hassan A, Cheema Z, Bakshi R |title=Extra temporal involvement in herpes simplex encephalitis |journal=Eur. J. Neurol. |volume=12 |issue=6 |pages=475–9 |date=June 2005 |pmid=15885053 |doi=10.1111/j.1468-1331.2005.00999.x |url=}}</ref><ref name="pmid17109290">{{cite journal |vauthors=Glaser CA, Honarmand S, Anderson LJ, Schnurr DP, Forghani B, Cossen CK, Schuster FL, Christie LJ, Tureen JH |title=Beyond viruses: clinical profiles and etiologies associated with encephalitis |journal=Clin. Infect. Dis. |volume=43 |issue=12 |pages=1565–77 |date=December 2006 |pmid=17109290 |doi=10.1086/509330 |url=}}</ref><ref name="pmid21490181">{{cite journal |vauthors=Meltzer EO, Hamilos DL |title=Rhinosinusitis diagnosis and management for the clinician: a synopsis of recent consensus guidelines |journal=Mayo Clin. Proc. |volume=86 |issue=5 |pages=427–43 |date=May 2011 |pmid=21490181 |pmc=3084646 |doi=10.4065/mcp.2010.0392 |url=}}</ref><ref name="pmid1941010">{{cite journal |vauthors=Rasmussen BK, Jensen R, Schroll M, Olesen J |title=Epidemiology of headache in a general population--a prevalence study |journal=J Clin Epidemiol |volume=44 |issue=11 |pages=1147–57 |date=1991 |pmid=1941010 |doi=10.1016/0895-4356(91)90147-2 |url=}}</ref><ref name="pmid15447695">{{cite journal |vauthors=Kelman L |title=The premonitory symptoms (prodrome): a tertiary care study of 893 migraineurs |journal=Headache |volume=44 |issue=9 |pages=865–72 |date=October 2004 |pmid=15447695 |doi=10.1111/j.1526-4610.2004.04168.x |url=}}</ref><ref name="pmid26643378">{{cite journal |vauthors=Laurell K, Artto V, Bendtsen L, Hagen K, Häggström J, Linde M, Söderström L, Tronvik E, Wessman M, Zwart JA, Kallela M |title=Premonitory symptoms in migraine: A cross-sectional study in 2714 persons |journal=Cephalalgia |volume=36 |issue=10 |pages=951–9 |date=September 2016 |pmid=26643378 |doi=10.1177/0333102415620251 |url=}}</ref><ref>{{cite web | author=Charlotte E. Grayson and The Cleveland Clinic Neuroscience Center | title=Cluster Headaches  |url=http://www.webmd.com/content/article/46/1826_50688.htm | date=October 2004 | publisher=WebMD | accessdate=2006-09-22}}</ref><ref name="pmid7888747">{{cite journal |vauthors=Drummond PD |title=Sweating and vascular responses in the face: normal regulation and dysfunction in migraine, cluster headache and harlequin syndrome |journal=Clin. Auton. Res. |volume=4 |issue=5 |pages=273–85 |date=October 1994 |pmid=7888747 |doi=10.1007/BF01827433 |url=}}</ref><ref name="pmid16686902">{{cite journal |vauthors=Drummond PD |title=Mechanisms of autonomic disturbance in the face during and between attacks of cluster headache |journal=Cephalalgia |volume=26 |issue=6 |pages=633–41 |date=June 2006 |pmid=16686902 |doi=10.1111/j.1468-2982.2006.01106.x |url=}}</ref><ref name="pmid2245469">{{cite journal |vauthors=Ekbom K |title=Evaluation of clinical criteria for cluster headache with special reference to the classification of the International Headache Society |journal=Cephalalgia |volume=10 |issue=4 |pages=195–7 |date=August 1990 |pmid=2245469 |doi=10.1046/j.1468-2982.1990.1004195.x |url=}}</ref><ref name="pmid7697707">{{cite journal |vauthors=Sandrini G, Antonaci F, Pucci E, Bono G, Nappi G |title=Comparative study with EMG, pressure algometry and manual palpation in tension-type headache and migraine |journal=Cephalalgia |volume=14 |issue=6 |pages=451–7; discussion 394–5 |date=December 1994 |pmid=7697707 |doi=10.1046/j.1468-2982.1994.1406451.x |url=}}</ref><ref name="pmid7515793">{{cite journal |vauthors=Jensen R, Fuglsang-Frederiksen A |title=Quantitative surface EMG of pericranial muscles. Relation to age and sex in a general population |journal=Electroencephalogr Clin Neurophysiol |volume=93 |issue=3 |pages=175–83 |date=June 1994 |pmid=7515793 |doi=10.1016/0168-5597(94)90038-8 |url=}}</ref>


</small></small>
</small></small>
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|+
|+
! rowspan="2" |Disease
! rowspan="2" |Disease
! colspan="15" |History and Physical Examination
! colspan="13" |History and Physical Examination
! rowspan="2" |PMHx
! rowspan="2" |PMHx
! colspan="3" |Diagnostic approach
! colspan="3" |Diagnostic approach
|-
|-
!Unilateral
!Bilateral
!Bilateral
!Throbbing character
!Throbbing character
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!LOC
!LOC
!Aura
!Aura
!Nause/vomiting
!Nause/
Vomiting
!Rash
!Rash
!Neck stiffness
!Neck stiffness
!Vision changes
!Vision changes
!Facial tenderness
!Neurologic  deficits
!Neurologic  deficits
!Labs and CSF findings
!Labs and CSF findings
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!Gold standard test
!Gold standard test
|-
|-
|Migraine
|[[Migraine]]
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
| +
| +
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|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
| +
| +
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|Trigger factors, family hx
|Trigger factors, family hx
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|Clinical assesment  
|Clinical assesment  
|-
|-
|Tension-type headache (TTH)
|[[Tension-type headache|Tension-type headache (TTH)]]
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
| -
| -
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| -
| -
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|[[stress]], [[genetics]]
|stress, genetics
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|Clinical assesment  
|Clinical assesment  
|-
|-
|Cluster headache
|[[Cluster headache]]
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
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|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|episodic history  
|episodic history  
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|-
|-
|[[Seizure]]
|[[Seizure]]
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
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|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
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|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|Hx of seizures
|Hx of [[Seizure|seizures]]
|prolactin level
|prolactin level
|<nowiki>+/- mass lesion</nowiki>
|<nowiki>+/- mass lesion</nowiki>
|[[EEG]] <ref name="pmid11385043">{{cite journal| author=Manford M| title=Assessment and investigation of possible epileptic seizures. | journal=J Neurol Neurosurg Psychiatry | year= 2001 | volume= 70 Suppl 2 | issue=  | pages= II3-8 | pmid=11385043 | doi= | pmc=1765557 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11385043  }}</ref>
|[[EEG]] <ref name="pmid11385043">{{cite journal| author=Manford M| title=Assessment and investigation of possible epileptic seizures. | journal=J Neurol Neurosurg Psychiatry | year= 2001 | volume= 70 Suppl 2 | issue=  | pages= II3-8 | pmid=11385043 | doi= | pmc=1765557 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11385043  }}</ref>
|-
|-
|Meningitis
|[[Meningitis]]
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
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|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|Hx of fever, malaise
|Hx of [[fever]], [[malaise]]
|<math>\uparrow</math>WBC
|[[Leukocytosis|<math>\uparrow</math>WBC]]


<math>\uparrow</math>Protein
<math>\uparrow</math>Protein
Line 139: Line 132:
|[[CSF analysis]]<ref name="pmid19398286">{{cite journal| author=Carbonnelle E| title=[Laboratory diagnosis of bacterial meningitis: usefulness of various tests for the determination of the etiological agent]. | journal=Med Mal Infect | year= 2009 | volume= 39 | issue= 7-8 | pages= 581-605 | pmid=19398286 | doi=10.1016/j.medmal.2009.02.017 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19398286  }}</ref>
|[[CSF analysis]]<ref name="pmid19398286">{{cite journal| author=Carbonnelle E| title=[Laboratory diagnosis of bacterial meningitis: usefulness of various tests for the determination of the etiological agent]. | journal=Med Mal Infect | year= 2009 | volume= 39 | issue= 7-8 | pages= 581-605 | pmid=19398286 | doi=10.1016/j.medmal.2009.02.017 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19398286  }}</ref>
|-
|-
|Encephalitis
|[[Encephalitis]]
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
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|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|Hx of fever, malaise
|Hx of [[fever]], [[malaise]]
|elevated WBC, low glucose
|elevated WBC, low glucose
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
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|-
|-
|[[Brain tumor]]<ref name="pmid10582668">{{cite journal| author=Morgenstern LB, Frankowski RF| title=Brain tumor masquerading as stroke. | journal=J Neurooncol | year= 1999 | volume= 44 | issue= 1 | pages= 47-52 | pmid=10582668 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10582668  }}</ref>
|[[Brain tumor]]<ref name="pmid10582668">{{cite journal| author=Morgenstern LB, Frankowski RF| title=Brain tumor masquerading as stroke. | journal=J Neurooncol | year= 1999 | volume= 44 | issue= 1 | pages= 47-52 | pmid=10582668 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10582668  }}</ref>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
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|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|weight loss, fatigue
|[[weight loss]], [[fatigue]]
|neuromarkers,
|neuromarkers,
Cancer cells<ref name="pmid21371327">{{cite journal| author=Weston CL, Glantz MJ, Connor JR| title=Detection of cancer cells in the cerebrospinal fluid: current methods and future directions. | journal=Fluids Barriers CNS | year= 2011 | volume= 8 | issue= 1 | pages= 14 | pmid=21371327 | doi=10.1186/2045-8118-8-14 | pmc=3059292 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21371327  }}</ref>
Cancer cells<ref name="pmid21371327">{{cite journal| author=Weston CL, Glantz MJ, Connor JR| title=Detection of cancer cells in the cerebrospinal fluid: current methods and future directions. | journal=Fluids Barriers CNS | year= 2011 | volume= 8 | issue= 1 | pages= 14 | pmid=21371327 | doi=10.1186/2045-8118-8-14 | pmc=3059292 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21371327  }}</ref>
|<nowiki>+/- mass</nowiki>
|<nowiki>+/- mass</nowiki>
|MRI
|[[MRI]]
|-
|-
|[[Subdural hematoma|Subdural hemorrhage]]
|[[Subdural hematoma|Subdural hemorrhage]]
|<nowiki>-/+</nowiki>
|<nowiki>-/+</nowiki>
|<nowiki>-/+</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
Line 196: Line 184:
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|Trauma, fall
|[[Trauma]], [[fall]]
|Xanthochromia
|Xanthochromia
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|CT w/o contrast
|CT w/o contrast
|-
|-
|Subarachnoid hemorrhage
|[[Subarachnoid hemorrhage]]
|<nowiki>-/+</nowiki>
| -/+
|<nowiki>+</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
Line 217: Line 203:
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|thunderclap headache
|[[thunderclap headache]]
|<math>\uparrow</math>opening pressure, xanthochromia
|<math>\uparrow</math>opening pressure, xanthochromia
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|CT w/o contrast
|CT w/o contrast
|-
|-
|Hypertensive encephalopathy
|[[Hypertensive encephalopathy]]
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
Line 239: Line 223:
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|[[Hypertension]]
|Hypertension
|UA +/-
|UA +/-
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
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|-
|-
|[[Brain abscess|CNS abscess]]
|[[Brain abscess|CNS abscess]]
|<nowiki>-/+</nowiki>
|<nowiki>-/+</nowiki>
|<nowiki>-/+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
Line 259: Line 241:
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|History of [[drug abuse]], [[endocarditis]], [[immunosupression]]
|History of [[drug abuse]], [[endocarditis]], [[immunosupression]]
|'''↑''' leukocytes, '''↓''' glucose and '''↑''' protien
|'''↑''' [[Leukocytosis|leukocytes]], '''↓''' [[glucose]] and '''↑''' protien
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|MRI
|[[MRI]]
|-
|-
|[[Conversion disorder]]
|[[Conversion disorder]]
|<nowiki>-/+</nowiki>
|<nowiki>-/+</nowiki>
|<nowiki>-/+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
Line 280: Line 260:
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|History of [[emotional stress]]
|History of [[emotional stress]]
Line 288: Line 267:
|-
|-
|[[Multiple sclerosis]]
|[[Multiple sclerosis]]
|<nowiki>-/+</nowiki>
|<nowiki>-/+</nowiki>
|<nowiki>-/+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
Line 301: Line 279:
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|History of relapses and remissions
|History of relapses and remissions
|'''↑'''  CSF IgG levels
|'''↑'''  [[CSF]] [[IgG]] levels


(monoclonal bands)
(monoclonal bands)
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|MRI
|[[MRI]]
|-
|-
|[[Hemorrhagic stroke]]
|[[Hemorrhagic stroke]]
|<nowiki>-/+</nowiki>
|<nowiki>-/+</nowiki>
|<nowiki>-/+</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
Line 324: Line 300:
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|HTN
|[[Hypertension|HTN]]
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|CT scan  without contrast<ref name="pmid21694755">{{cite journal| author=Birenbaum D, Bancroft LW, Felsberg GJ| title=Imaging in acute stroke. | journal=West J Emerg Med | year= 2011 | volume= 12 | issue= 1 | pages= 67-76 | pmid=21694755 | doi= | pmc=3088377 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21694755  }}</ref><ref name="pmid21807345">{{cite journal| author=DeLaPaz RL, Wippold FJ, Cornelius RS, Amin-Hanjani S, Angtuaco EJ, Broderick DF et al.| title=ACR Appropriateness Criteria® on cerebrovascular disease. | journal=J Am Coll Radiol | year= 2011 | volume= 8 | issue= 8 | pages= 532-8 | pmid=21807345 | doi=10.1016/j.jacr.2011.05.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21807345  }}</ref>
|[[CT scan]] without contrast<ref name="pmid21694755">{{cite journal| author=Birenbaum D, Bancroft LW, Felsberg GJ| title=Imaging in acute stroke. | journal=West J Emerg Med | year= 2011 | volume= 12 | issue= 1 | pages= 67-76 | pmid=21694755 | doi= | pmc=3088377 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21694755  }}</ref><ref name="pmid21807345">{{cite journal| author=DeLaPaz RL, Wippold FJ, Cornelius RS, Amin-Hanjani S, Angtuaco EJ, Broderick DF et al.| title=ACR Appropriateness Criteria® on cerebrovascular disease. | journal=J Am Coll Radiol | year= 2011 | volume= 8 | issue= 8 | pages= 532-8 | pmid=21807345 | doi=10.1016/j.jacr.2011.05.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21807345  }}</ref>
|-
|-
|[[Neurosyphilis]]<ref name="pmid22482824">{{cite journal| author=Liu LL, Zheng WH, Tong ML, Liu GL, Zhang HL, Fu ZG et al.| title=Ischemic stroke as a primary symptom of neurosyphilis among HIV-negative emergency patients. | journal=J Neurol Sci | year= 2012 | volume= 317 | issue= 1-2 | pages= 35-9 | pmid=22482824 | doi=10.1016/j.jns.2012.03.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22482824  }}</ref><ref name="pmid24365430">{{cite journal |vauthors=Berger JR, Dean D |title=Neurosyphilis |journal=Handb Clin Neurol |volume=121 |issue= |pages=1461–72 |year=2014 |pmid=24365430 |doi=10.1016/B978-0-7020-4088-7.00098-5 |url=}}</ref>
|[[Neurosyphilis]]<ref name="pmid22482824">{{cite journal| author=Liu LL, Zheng WH, Tong ML, Liu GL, Zhang HL, Fu ZG et al.| title=Ischemic stroke as a primary symptom of neurosyphilis among HIV-negative emergency patients. | journal=J Neurol Sci | year= 2012 | volume= 317 | issue= 1-2 | pages= 35-9 | pmid=22482824 | doi=10.1016/j.jns.2012.03.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22482824  }}</ref><ref name="pmid24365430">{{cite journal |vauthors=Berger JR, Dean D |title=Neurosyphilis |journal=Handb Clin Neurol |volume=121 |issue= |pages=1461–72 |year=2014 |pmid=24365430 |doi=10.1016/B978-0-7020-4088-7.00098-5 |url=}}</ref>
|<nowiki>-/+</nowiki>
|<nowiki>-/+</nowiki>
|<nowiki>-/+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
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|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|[[Sexually transmitted disease|STI]]<nowiki/>s
|[[Sexually transmitted disease|STI]]<nowiki/>s
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|-
|-
|[[Wernicke's encephalopathy|Wernicke’s encephalopathy]]
|[[Wernicke's encephalopathy|Wernicke’s encephalopathy]]
|<nowiki>-</nowiki>
|<nowiki>-/+</nowiki>
|<nowiki>-/+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
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|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|History of alcohal abuse
|History of alcohal abuse
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|-
|-
|[[Drug toxicity]]
|[[Drug toxicity]]
|<nowiki>-</nowiki>
|<nowiki>-/+</nowiki>
|<nowiki>-/+</nowiki>
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|<nowiki>-</nowiki>
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|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|Medication hx
|Medication hx
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|Drug screen test
|Drug screen test
|-
|-
|Metabolic disturbances  
|[[Metabolic disorder|Metabolic disturbances]]
|<nowiki>-</nowiki>
|<nowiki>-/+</nowiki>
|<nowiki>-/+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
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|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|Underlying CKD, CLD
|Underlying [[CKD]], CLD
|[[Hypoglycemia]], [[Hyponatremia|hypo]] and [[hypernatremia]], [[Hypokalemia|hypo]] and [[hyperkalemia]]
|[[Hypoglycemia]], [[Hyponatremia|hypo]] and [[hypernatremia]], [[Hypokalemia|hypo]] and [[hyperkalemia]]
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|Cause dependent
|Cause dependent
|-
|-
|NPH
|[[Sinusitis]]
|<nowiki>-</nowiki>
|<nowiki>-/+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
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|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|OCP use, meds
|<nowiki>-</nowiki>
|<nowiki>+/-</nowiki>
|CT  and clinical
|-
|Sinusitis
|<nowiki>-</nowiki>
|<nowiki>-/+</nowiki>
|<nowiki>-/+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
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|<nowiki>-</nowiki>
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|[[allergies]], seasonal
|allergies, seasonal
|[[leukocytosis]]
|leukocytosis
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|CT
|[[CT-scans|CT]]
|}
|}
</small></small>
</small></small>
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==References==
==References==
{{reflist|2}}
{{reflist|2}}
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[[Category:Headaches]]
[[Category:Headaches]]
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[[Category:Neurology]]
[[Category:Neurology]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Primary care]]
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Latest revision as of 21:58, 29 July 2020

For the WikiDoc page for this topic, click here Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sabeeh Islam, MBBS[2]

Differential diagnosis of headache includes: Migraine, tension-type headache, cluster headache, seizure, meningitis, encephalitis, neurosyphilis, SAH, subdural hematoma, brain tumor, hypertensive encephalopathy, brain abscess, multiple sclerosis, hemorrhagic stroke, Wernickes encephalopathy, and drug toxicity etc.[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]


Disease History and Physical Examination PMHx Diagnostic approach
Bilateral Throbbing character Autonomic symptoms Fever Photophobia Aphasia LOC Aura Nause/

Vomiting

Rash Neck stiffness Vision changes 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 [20]
Meningitis + - - + +/- +/- - - +/- +/- + - + Hx of fever, malaise <math>\uparrow</math>WBC

<math>\uparrow</math>Protein

<math>\downarrow</math>glucose

+/- CSF analysis[21]
Encephalitis + +/- - + +/- +/- - - - +/- + - + Hx of fever, malaise elevated WBC, low glucose + CSF PCR
Brain tumor[22] + - - - - +/- - - +/- - - +/- +/- weight loss, fatigue neuromarkers,

Cancer cells[23]

+/- mass MRI
Subdural hemorrhage -/+ +/- - - - +/- - - - - - +/- +/- Trauma, fall Xanthochromia + CT w/o contrast
Subarachnoid hemorrhage -/+ +/- - - +/- +/- - - - - +/- +/- +/- thunderclap headache <math>\uparrow</math>opening pressure, xanthochromia + CT w/o contrast
Hypertensive encephalopathy + +/- - - +/- - - - - - - +/- - Hypertension UA +/- +/- clinical assessment
CNS abscess -/+ - - + - +/- - - +/- +/- +/- +/- +/- History of drug abuse, endocarditis, immunosupression leukocytes, glucose and protien + MRI
Conversion disorder -/+ - - - - +/- - - - - +/- +/- +/- History of emotional stress - - Diagnosis of exclusion
Multiple sclerosis -/+ - - - - - - - - - - + +/- History of relapses and remissions CSF IgG levels

(monoclonal bands)

+ MRI
Hemorrhagic stroke -/+ +/- - - - +/- - - - - - +/- +/- HTN - + CT scan without contrast[24][25]
Neurosyphilis[26][27] -/+ - - - - - +/- - - +/- - +/- +/- STIs Leukocytes and protein + CSF VDRL-specifc

CSF FTA-Ab -sensitive[28]

Wernicke’s encephalopathy -/+ - - - - +/- - - - - - +/- +/- History of alcohal abuse blood ethanol levels +/- Clinical assesment and lab findings
Drug toxicity -/+ - - +/- - - +/- - +/- - +/- +/- +/- Medication hx Drug levels - Drug screen test
Metabolic disturbances -/+ - - - - - - - +/- - - +/- +/- Underlying CKD, CLD Hypoglycemia, hypo and hypernatremia, hypo and hyperkalemia - Cause dependent
Sinusitis -/+ - - +/- - - - - - - - - - allergies, seasonal leukocytosis + CT

Diagnsotic Labs For Meningitis

Diagnosis of meningitis, is based on clinical presentation in combination with CSF analysis. CSF analysis has major role for diagnosis and rule out other possibilities. The following table summarizes the CSF findings in different types of meningitis.[2][3][4][5][6]

Cerebrospinal fluid level Normal level Bacterial meningitis[5] Viral meningitis[5] Fungal meningitis Tuberculous meningitis[29] Neoplastic meningitis[2]
Cells/ul < 5 >300 10-1000 10-500 50-500 >4
Cells Lymphocyte Leukocyte > Lymphocyte Lymphocyte > Leukocyte Lymphocyte > Leukocyte Lymphocyte > Leukocyte Lymphocyte > Leukocyte
Total protein (mg/dl) 45-60 Typically 100-500 Normal or slightly high High Typically 100-200 >50
Glucose ratio (CSF/plasma)[3] > 0.5 < 0.3 > 0.6 <0.3 < 0.5 <0.5
Lactate (mmols/l)[4] < 2.1 > 2.1 < 2.1 >3.2 > 2.1 >2.1
Others Intra-cranial pressure (ICP) = 6-12 (cm H2O) CSF gram stain, CSF culture, CSF bacterial antigen PCR of HSV-DNA, VZV CSF gram stain, CSF india ink PCR of TB-DNA CSF tumour markers such as alpha fetoprotein, CEA


References

  1. "National guidelines for analysis of cerebrospinal fluid for bilirubin in suspected subarachnoid haemorrhage". Ann. Clin. Biochem. 40 (Pt 5): 481–8. September 2003. doi:10.1258/000456303322326399. PMID 14503985.
  2. 2.0 2.1 2.2 Le Rhun E, Taillibert S, Chamberlain MC (2013). "Carcinomatous meningitis: Leptomeningeal metastases in solid tumors". Surg Neurol Int. 4 (Suppl 4): S265–88. doi:10.4103/2152-7806.111304. PMC 3656567. PMID 23717798.
  3. 3.0 3.1 3.2 Chow E, Troy SB (2014). "The differential diagnosis of hypoglycorrhachia in adult patients". Am J Med Sci. 348 (3): 186–90. doi:10.1097/MAJ.0000000000000217. PMC 4065645. PMID 24326618.
  4. 4.0 4.1 4.2 Leen WG, Willemsen MA, Wevers RA, Verbeek MM (2012). "Cerebrospinal fluid glucose and lactate: age-specific reference values and implications for clinical practice". PLoS One. 7 (8): e42745. doi:10.1371/journal.pone.0042745. PMC 3412827. PMID 22880096.
  5. 5.0 5.1 5.2 5.3 Negrini B, Kelleher KJ, Wald ER (2000). "Cerebrospinal fluid findings in aseptic versus bacterial meningitis". Pediatrics. 105 (2): 316–9. PMID 10654948.
  6. 6.0 6.1 Brouwer MC, Tunkel AR, van de Beek D (2010). "Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis". Clin Microbiol Rev. 23 (3): 467–92. doi:10.1128/CMR.00070-09. PMC 2901656. PMID 20610819.
  7. Vermeulen M, Hasan D, Blijenberg BG, Hijdra A, van Gijn J (July 1989). "Xanthochromia after subarachnoid haemorrhage needs no revisitation". J. Neurol. Neurosurg. Psychiatry. 52 (7): 826–8. doi:10.1136/jnnp.52.7.826. PMC 1031927. PMID 2769274.
  8. Wasay M, Mekan SF, Khelaeni B, Saeed Z, Hassan A, Cheema Z, Bakshi R (June 2005). "Extra temporal involvement in herpes simplex encephalitis". Eur. J. Neurol. 12 (6): 475–9. doi:10.1111/j.1468-1331.2005.00999.x. PMID 15885053.
  9. Glaser CA, Honarmand S, Anderson LJ, Schnurr DP, Forghani B, Cossen CK, Schuster FL, Christie LJ, Tureen JH (December 2006). "Beyond viruses: clinical profiles and etiologies associated with encephalitis". Clin. Infect. Dis. 43 (12): 1565–77. doi:10.1086/509330. PMID 17109290.
  10. Meltzer EO, Hamilos DL (May 2011). "Rhinosinusitis diagnosis and management for the clinician: a synopsis of recent consensus guidelines". Mayo Clin. Proc. 86 (5): 427–43. doi:10.4065/mcp.2010.0392. PMC 3084646. PMID 21490181.
  11. Rasmussen BK, Jensen R, Schroll M, Olesen J (1991). "Epidemiology of headache in a general population--a prevalence study". J Clin Epidemiol. 44 (11): 1147–57. doi:10.1016/0895-4356(91)90147-2. PMID 1941010.
  12. Kelman L (October 2004). "The premonitory symptoms (prodrome): a tertiary care study of 893 migraineurs". Headache. 44 (9): 865–72. doi:10.1111/j.1526-4610.2004.04168.x. PMID 15447695.
  13. Laurell K, Artto V, Bendtsen L, Hagen K, Häggström J, Linde M, Söderström L, Tronvik E, Wessman M, Zwart JA, Kallela M (September 2016). "Premonitory symptoms in migraine: A cross-sectional study in 2714 persons". Cephalalgia. 36 (10): 951–9. doi:10.1177/0333102415620251. PMID 26643378.
  14. Charlotte E. Grayson and The Cleveland Clinic Neuroscience Center (October 2004). "Cluster Headaches". WebMD. Retrieved 2006-09-22.
  15. Drummond PD (October 1994). "Sweating and vascular responses in the face: normal regulation and dysfunction in migraine, cluster headache and harlequin syndrome". Clin. Auton. Res. 4 (5): 273–85. doi:10.1007/BF01827433. PMID 7888747.
  16. Drummond PD (June 2006). "Mechanisms of autonomic disturbance in the face during and between attacks of cluster headache". Cephalalgia. 26 (6): 633–41. doi:10.1111/j.1468-2982.2006.01106.x. PMID 16686902.
  17. Ekbom K (August 1990). "Evaluation of clinical criteria for cluster headache with special reference to the classification of the International Headache Society". Cephalalgia. 10 (4): 195–7. doi:10.1046/j.1468-2982.1990.1004195.x. PMID 2245469.
  18. Sandrini G, Antonaci F, Pucci E, Bono G, Nappi G (December 1994). "Comparative study with EMG, pressure algometry and manual palpation in tension-type headache and migraine". Cephalalgia. 14 (6): 451–7, discussion 394–5. doi:10.1046/j.1468-2982.1994.1406451.x. PMID 7697707.
  19. Jensen R, Fuglsang-Frederiksen A (June 1994). "Quantitative surface EMG of pericranial muscles. Relation to age and sex in a general population". Electroencephalogr Clin Neurophysiol. 93 (3): 175–83. doi:10.1016/0168-5597(94)90038-8. PMID 7515793.
  20. Manford M (2001). "Assessment and investigation of possible epileptic seizures". J Neurol Neurosurg Psychiatry. 70 Suppl 2: II3–8. PMC 1765557. PMID 11385043.
  21. Carbonnelle E (2009). "[Laboratory diagnosis of bacterial meningitis: usefulness of various tests for the determination of the etiological agent]". Med Mal Infect. 39 (7–8): 581–605. doi:10.1016/j.medmal.2009.02.017. PMID 19398286.
  22. Morgenstern LB, Frankowski RF (1999). "Brain tumor masquerading as stroke". J Neurooncol. 44 (1): 47–52. PMID 10582668.
  23. Weston CL, Glantz MJ, Connor JR (2011). "Detection of cancer cells in the cerebrospinal fluid: current methods and future directions". Fluids Barriers CNS. 8 (1): 14. doi:10.1186/2045-8118-8-14. PMC 3059292. PMID 21371327.
  24. Birenbaum D, Bancroft LW, Felsberg GJ (2011). "Imaging in acute stroke". West J Emerg Med. 12 (1): 67–76. PMC 3088377. PMID 21694755.
  25. DeLaPaz RL, Wippold FJ, Cornelius RS, Amin-Hanjani S, Angtuaco EJ, Broderick DF; et al. (2011). "ACR Appropriateness Criteria® on cerebrovascular disease". J Am Coll Radiol. 8 (8): 532–8. doi:10.1016/j.jacr.2011.05.010. PMID 21807345.
  26. Liu LL, Zheng WH, Tong ML, Liu GL, Zhang HL, Fu ZG; et al. (2012). "Ischemic stroke as a primary symptom of neurosyphilis among HIV-negative emergency patients". J Neurol Sci. 317 (1–2): 35–9. doi:10.1016/j.jns.2012.03.003. PMID 22482824.
  27. Berger JR, Dean D (2014). "Neurosyphilis". Handb Clin Neurol. 121: 1461–72. doi:10.1016/B978-0-7020-4088-7.00098-5. PMID 24365430.
  28. Ho EL, Marra CM (2012). "Treponemal tests for neurosyphilis--less accurate than what we thought?". Sex Transm Dis. 39 (4): 298–9. doi:10.1097/OLQ.0b013e31824ee574. PMC 3746559. PMID 22421697.
  29. Caudie C, Tholance Y, Quadrio I, Peysson S (2010). "[Contribution of CSF analysis to diagnosis and follow-up of tuberculous meningitis]". Ann Biol Clin (Paris). 68 (1): 107–11. doi:10.1684/abc.2010.0407. PMID 20146981.

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