Headache differential diagnosis: Difference between revisions

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Revision as of 06:10, 11 June 2020

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
Disease	Unilateral	Bilateral	Throbbing character	Autonomic symptoms	Fever	Photophobia	Aphasia	LOC	Aura	Nause/vomiting	Rash	Neck stiffness	Vision changes	Facial tenderness	Neurologic deficits	PMHx	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	-/+	-/+	-	-	-	-	-	-	-	-	-	-	+	-	+/-	History of relapses and remissions	↑ CSF IgG levels (monoclonal bands)	+	MRI
Hemorrhagic stroke	-/+	-/+	+/-	-	-	-	+/-	-	-	-	-	-	+/-	-	+/-	HTN	-	+	CT scan without contrast^[1]^[2]
Neurosyphilis	-/+	-/+	-	-	-	-	-	+/-	-	-	+/-	-	+/-	-	+/-	STIs	↑ Leukocytes and protein	+	CSF VDRL-specifc CSF FTA-Ab -sensitive^[3]
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
NPH	-	-/+	-	-	-	-	-	-	-	-	-	-	+/-	-	-	OCP use, meds	-	+/-	CT and clinical
Sinusitis	-	-/+	-	-	+/-	-	-	-	-	-	-	-	-	-	-	allergies, seasonal	leukocytosis	+	CT

References

↑ Birenbaum D, Bancroft LW, Felsberg GJ (2011). "Imaging in acute stroke". West J Emerg Med. 12 (1): 67–76. PMC 3088377. PMID 21694755.
↑ 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.
↑ 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.

Template:WikiDoc Sources

[pmid21694755-1] Birenbaum D, Bancroft LW, Felsberg GJ (2011). "Imaging in acute stroke". West J Emerg Med. 12 (1): 67–76. PMC 3088377. PMID 21694755.

[pmid21807345-2] 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.

[pmid22421697-3] 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.

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[2]

[3]

@@ Line 302: / Line 302: @@
 |<nowiki>-</nowiki>
 |<nowiki>+/-</nowiki>
-|
+|History of relapses and remissions
-|
+|'''↑'''  CSF IgG levels
-|
-|
+(monoclonal bands)
+|<nowiki>+</nowiki>
+|MRI
 |-
 |[[Hemorrhagic stroke]]
@@ Line 323: / Line 325: @@
 |<nowiki>-</nowiki>
 |<nowiki>+/-</nowiki>
-|
+|HTN
-|
+|<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>
 |-
 |[[Neurosyphilis]]
@@ Line 344: / Line 346: @@
 |<nowiki>-</nowiki>
 |<nowiki>+/-</nowiki>
-|
+|[[Sexually transmitted disease|STI]]<nowiki/>s
-|
+|'''↑''' [[Leukocytes]] and [[protein]]
-|
+|<nowiki>+</nowiki>
-|
+|CSF [[VDRL]]-specifc
+CSF FTA-Ab -sensitive<ref name="pmid22421697">{{cite journal| author=Ho EL, Marra CM| title=Treponemal tests for neurosyphilis--less accurate than what we thought? | journal=Sex Transm Dis | year= 2012 | volume= 39 | issue= 4 | pages= 298-9 | pmid=22421697 | doi=10.1097/OLQ.0b013e31824ee574 | pmc=3746559 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22421697  }}</ref>
 |-
 |[[Wernicke's encephalopathy|Wernicke’s encephalopathy]]
@@ Line 365: / Line 369: @@
 |<nowiki>-</nowiki>
 |<nowiki>+/-</nowiki>
-|
+|History of alcohal abuse
-|
+|blood ethanol levels
-|
+|<nowiki>+/-</nowiki>
 |Clinical assesment and lab findings
 |-
@@ Line 386: / Line 390: @@
 |<nowiki>-</nowiki>
 |<nowiki>+/-</nowiki>
-|
+|Medication hx
-|
+|Drug levels
-|
+|<nowiki>-</nowiki>
-|
+|Drug screen test
 |-
 |Metabolic disturbances
@@ Line 407: / Line 411: @@
 |<nowiki>-</nowiki>
 |<nowiki>+/-</nowiki>
-|
+|Underlying CKD, CLD
-|
+|[[Hypoglycemia]], [[Hyponatremia|hypo]] and [[hypernatremia]], [[Hypokalemia|hypo]] and [[hyperkalemia]]
-|
+|<nowiki>-</nowiki>
-|
+|Cause dependent
 |-
 |NPH
@@ Line 428: / Line 432: @@
 |<nowiki>-</nowiki>
 |<nowiki>-</nowiki>
-|
+|OCP use, meds
-|
+|<nowiki>-</nowiki>
-|
+|<nowiki>+/-</nowiki>
-|
+|CT  and clinical
 |-
 |Sinusitis
@@ Line 449: / Line 453: @@
 |<nowiki>-</nowiki>
 |<nowiki>-</nowiki>
-|
+|allergies, seasonal
-|
+|leukocytosis
-|
+|<nowiki>+</nowiki>
-|
+|CT
 |}
 </small></small>

Headache differential diagnosis: Difference between revisions

Revision as of 06:10, 11 June 2020

References

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