Chapter 7: Differential Diagnosis and Treatment of Headache

Question 1

What is the definition of a primary headache?

Answer 1

not associated with other diseases; likely complex interplay of genetic, developmental, and environmental risk factors
Neurological exam between headaches is normal

Question 2

What is the definition of secondary headache?

Answer 2

Associated with or caused by other conditions; generally will not resolve until the specific cause is diagnosed and addressed
neuro exam typically reveals abnormalities that contribute to disease process
viral headache, ICH

Question 3

What is the mnemonic for red flag headaches

Answer 3

S- systemic symptoms- fever, weight loss- infection, cancer
S- secondary risk factors- HIV, malignancy, pregnancy
N- Neurological signs, symptoms- newly-acquired finding, including confusion, AMS, nuchal rigidity, papilledema, cranial nerve dysfunction- CNS infection, mass, stroke
O- onset- sudden, abrupt, “thunder-clap”. Onset of headache with exertion, sex, coughing and sneezing (Increased ICH)- SAH
O- onset- age of onset older and younger
P- Prior headache history- change in quality, frequency
P- Positional- change in upright vs laying down, neck position
P- Papilledema- visual problems

Question 4

What are the characteristics of tension-type headache?

Answer 4

Lasts 30 min to 7 d (usually 1-24 hour) with >2 of the following characteristics:
pressing, Non pulsatile pain
Mild to moderate in intensity
usually bilateral location