Common in adults; bilateral pain, general or localized in bandlike distribution; history of anxiety, stress, or depression
Tension-type headache (muscle)
Normal physical examination;neck muscle tightness or fasciculations may be palpated
Tension-type headache (muscle)
DIAGNOSTIC STUDIES OF Tension-type headache (muscle)?
NONE
More common in children; unilateral, throbbing pain; nausea
Migraine without aura (common)
Photophobia and phonophobia
Migraine without aura (common)
DIAGNOSTIC STUDIES OF Migraine without aura (common)?
None
Pain precipitated by environmental stimuli; visual disturbances (scintillating scotoma) precede pain
Migraine with aura (classic)
Nausea and vomiting, photophobia and phonophobia
Migraine with aura (classic)
DIAGNOSTIC STUDIES OF Migraine with aura (classic)?
None
Throbbing, constant pain during waking hours; muscle tightness; family history of migraine
Mixed headache
Mix of findings related to tension and migraine headache pain
Mixed headache
DIAGNOSTIC STUDIES OF Mixed headache?
None
Rare in children; abrupt, nighttime onset; unilateral periorbital pain that is severe
Cluster headache
Ipsilateral rhinorrhea, nasal stuffiness, conjunctival injection, sweating, ptosis
Cluster headache
DIAGNOSTIC STUDIES OF Cluster headache?
none
Sudden onset related to physical exertion, Valsalva maneuver, or coitus
Benign exertional headache
Normal physical examination
Benign exertional headache
DIAGNOSTIC STUDIES OF Benign exertional headache?
May need to distinguish from subarachnoid hemorrhage with CT scan
Frontal, upper molar, or periorbitalpain; cough, rhinorrhea
Sinusitis
Low to no fever; pain on palpation of frontal, maxillary sinuses; purulent nasal or postnasal discharge
Sinusitis
DIAGNOSTIC STUDIES OF Sinusitis?
Radiographs (Waters view)
Localized pain in jaw and top of head
Dental disorders
Malocclusion, caries, abscesses of teeth present, gum disease
Dental disorders
DIAGNOSTIC STUDIES OF Dental disorders?
Dental referral
Sore throat
Pharyngitis
Fever; infection of posterior pharynx
Pharyngitis
DIAGNOSTIC STUDIES OF Pharyngitis?
Throat culture
Ear pain, pain with swallowing
Otitis media
Fever; red, bulging tympanic membrane
Otitis media
DIAGNOSTIC STUDIES OF Otitis media?
None
Severe headache, chills, myalgias, stiff neck; toxic child or adult
Meningitis
Positive Kernigand Brudzinski signs; fever, photophobia, petechial rash may be present; mental status changes
Meningitis
DIAGNOSTIC STUDIES OF Meningitis?
Lumbar puncture
People >55 yr; bursts of sharp pain over face innervated by affected nerve ; triggered by stimulus to affected nerve
Trigeminal neuralgia
Normal physical examination; stimulation of triggers may provoke pain
Trigeminal neuralgia
DIAGNOSTIC STUDIES OF Trigeminal neuralgia?
None
Acute onset of pain with extraocular movement (EOM), followed by blurred vision
Optic neuritis
Diminished visual acuity, decreased papillary reflex, hyperemia of optic disc; pain with EOM
Optic neuritis
DIAGNOSTIC STUDIES OF Optic neuritis?
Ophthalmology referral
May have history of trauma; occipital pain, muscle stiffness
Cervical spine disorders
Normal physical examination or pain associated with neck motion
Cervical spine disorders
DIAGNOSTIC STUDIES OF Cervical spine disorders?
Cervical spine radiographs
Age >50 yr; sharp, localized temporal pain; malaise, anorexia; history of polymyalgia rheumatica
Temporal arteritis
Fever, weight loss; tender over a nodular temporal artery
Temporal arteritis
DIAGNOSTIC STUDIES OF Temporal arteritis?
Elevated ESR 050); immediate referral for treatment
History of exposure; throbbing headache, mild dyspnea
Carbon monoxide poisoning
Nausea, vomiting, change in mental status, lethargy, loss of consciousness
Carbon monoxide poisoning
DIAGNOSTIC STUDIES OF Carbon monoxide poisoning?
Blood gases and carboxyhemoglobin level
History of diabetes or medication, alcohol, and food ingestion; generalized headache, dizziness, sense of not feeling well
Severe hypoglycemia
Normal physical examination or pallor, sweating, and weakness
Severe hypoglycemia
DIAGNOSTIC STUDIES OF Severe hypoglycemia?
Blood glucose level; may need self-monitoring of blood glucose to establish pattern
Pattern of headache associated with stopping medication or substance use
Drug withdrawal
Normal physical examination
Drug withdrawal
DIAGNOSTIC STUDIES OF Drug withdrawal?
Blood chemistry
Mild to moderately severe headache after ingestion of foods or medication
Dietary ingestion
Normal physical examination
Dietary ingestion
DIAGNOSTIC STUDIES OF Dietary ingestion?
Blood chemistry
Sudden-onset headache that is progressive, exacerbated by coughing or exercise; worse in morning; history of trauma increases risk
Intracranial tumor
Papilledema, vomiting, asymmetrical reflexes, weakness, sensory deficit, or other neurological deficit
Intracranial tumor
DIAGNOSTIC STUDIES OF Intracranial tumor?
CT scan
Progressive headache, vomiting, irritability
Hydrocephalus
Rapid enlargement of head, bulging fontanels
Hydrocephalus
DIAGNOSTIC STUDIES OF Hydrocephalus?
CT scan and referral
History of head trauma, bleeding disorders, child abuse-, adult >35 yr; sudden onset of “worst headache ever,” often over eye; transient loss of consciousness
Subdural hematoma
Unequal pupils, photophobia, neurological changes, seizure
Subdural hematoma
DIAGNOSTIC STUDIES OF Subdural hematoma?
CT scan and neurosurgical referral
Teens, menopausal women; history of vitamin A or tetracycline ingestion; progressive headache
Pseudotumor cerebri
Papilledema may be present
Pseudotumor cerebri
DIAGNOSTIC STUDIES OF Pseudotumor cerebri?
CT scan, neurology referral to assess risk related to lumbar puncture
History of chronic ear infection or cyanotic heart disease
Brain abscess
Fever, seizures, focal neurological deficits
Brain abscess
DIAGNOSTIC STUDIES OF Brain abscess?
MRI
Risk factors; people >50 yr, withAIDS, taking anticoagulation therapy, hypertension
Intracerebralhemorrhage
If conscious, abnormal neurological findings correlated with extent of lesion
Intracerebralhemorrhage
DIAGNOSTIC STUDIES OF Intracerebralhemorrhage?
Emergency transport forimmediate evaluation (CT, MRI and possible surgical treatment)
