History and physical examination are vital. Most diagnoses can be made by history. It is important to rule out "red flags" that may indicate a headache secondary to something more ominous.
Red Flags:
1. Neck stiffness: possible meningitis
2. Focal neurologic deficits: mass lesion or infarction
3. Evidence of elevated intracranial pressure: headache worse in AM or on exertion, papilledema
4. Visual changes: think about temporal arteritis or elevated intracranial pressures
5. Constitutional symptoms: is there a malignant, inflammatory, or chronic infection causing this?
Based on History and Physical Exam, try determine whether you are dealing with a Primary or Secondary headache
Primary Headaches:
Migraine
Tension
Cluster
Secondary Headaches:
1. Infectious: think about meningitis, encephalitis, abscess
2. Vascular: hemorrhage (epidural, subdural, subarachnoid, intraparenchymal), arterio-venous malformations, sinus venous thrombosis, unruptured aneurysms
3. Mass effect: such as tumour, abscess, blood
4. Trigeminal neuralgia
5. Temporal Arteritis
6. Other: sinusitis, Temporal-Mandibular Joint pain, hydrocephalus, referred pain,
1. Here is a link to a good rational clinical exam on Meningitis
2. Here's another link written by local talent on the evaluation of headaches
1. Neck stiffness: possible meningitis
2. Focal neurologic deficits: mass lesion or infarction
3. Evidence of elevated intracranial pressure: headache worse in AM or on exertion, papilledema
4. Visual changes: think about temporal arteritis or elevated intracranial pressures
5. Constitutional symptoms: is there a malignant, inflammatory, or chronic infection causing this?
Based on History and Physical Exam, try determine whether you are dealing with a Primary or Secondary headache
Primary Headaches:
Migraine
Tension
Cluster
Secondary Headaches:
1. Infectious: think about meningitis, encephalitis, abscess
2. Vascular: hemorrhage (epidural, subdural, subarachnoid, intraparenchymal), arterio-venous malformations, sinus venous thrombosis, unruptured aneurysms
3. Mass effect: such as tumour, abscess, blood
4. Trigeminal neuralgia
5. Temporal Arteritis
6. Other: sinusitis, Temporal-Mandibular Joint pain, hydrocephalus, referred pain,
1. Here is a link to a good rational clinical exam on Meningitis
2. Here's another link written by local talent on the evaluation of headaches
2 comments :
Hi Chief Med Resident -
I found your blog post via a search on Google for Trigeminal Neuralgia. I know you only touch on it briefly, but my friend Ben and I started a patient to patient support group called LivingWithTN (www.livingwithtn.org) for people with Trigeminal Neuralgia. Check it out or refer a needy patient to it. we started it 2 weeks ago and already have 30+ people providing support to each other on it.
cheers,
Scott
Trigeminal Neuralgia is the most common type of neuralgic pain syndrome. People who suffer from this disorder can suffer from attacks of pain repeatedly throughout the day. Treatment mainly consists of medication regimen, which in most cases will cause the pain to subside. But in some situations, the Trigeminal Neuralgia does not respond to medication and the ultimate treatment is surgery. Consult Dr. Miller, who with his holistic medications may treat your pain. Here is the link http://holisticdoctors.tv/doctor_index_2364.html
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