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	-/+	-/+	+/-	-	-	-	+/-	-	-	-	-	-	+/-	-	+/-	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	-/+	-/+	-	-	-	-	-	-	-	-	-	-	+	-	+/-
Hemorrhagic stroke	-/+	-/+	+/-	-	-	-	+/-	-	-	-	-	-	+/-	-	+/-
Neurosyphilis	-/+	-/+	-	-	-	-	-	+/-	-	-	+/-	-	+/-	-	+/-
Wernicke’s encephalopathy	-	-/+	-	-	-	-	+/-	-	-	-	-	-	+/-	-	+/-				Clinical assesment and lab findings
Drug toxicity	-	-/+	-	-	+/-	-	-	+/-	-	+/-	-	+/-	+/-	-	+/-
Metabolic disturbances	-	-/+	-	-	-	-	-	-	-	+/-	-	-	+/-	-	+/-
NPH	-	-/+	-	-	-	-	-	-	-	-	-	-	+/-	-	-
Sinusitis	-	-/+	-	-	+/-	-	-	-	-	-	-	-	-	-	-

References

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