Evaluation of Headache

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Other features suggesting a specific headache source.

Other features which suggest a specific source of headache pain include the following:

 Chronic nasal stuffiness or chronic respiratory infection suggest a diagnosis of sinusitis

 Impaired vision or seeing "holes" around light suggest the presence of glaucoma

 Visual field defects suggest the presence of a compressed optic pathway (eg, due to a pituitary mass)

 Blurring of vision on forward bending of the head, headaches upon waking early in the morning that improve with sitting up, and double vision or loss of coordination and balance should raise the suspicion of raised intracranial pressure

 Chronic, daily, progressively worsening head

Fig.1 : AcuteManagement of Headache

What is the reason for presentation?

The patient can no longer tolerate

The headache is either:

Their typical recurrent headaches

1. The first headache of significant severity (or)

2. Sufficiently different or severe to alarm the patient.

Obtain history and neurologic exam Obtain history and neurologic exam

History typical Atypical history or Features suggestive of a focal or infectious for migraine or focal abnormality on lesion luster headache neurological exam and normal exam


1. Headache of sudden rapid onset

2. Onset during exertion

3. History of altered mental status

4. Posterior radiation of headache

5. First severe headache after 35

6. Prior or coexistent infectious disease


Abortive therapy and observe Patient responds: Patient does not respond:

Probably primary duration > 48 hours;

headache, referral for evidence of dehydration

1. Nuchal rigidity long-term treatment or electrolyte disturbance

2. Toxic appearance or fever (even low of headaches. from prolonged vomiting grade)

3. Papilledema

4. Any localizing or lateralizing abnor- mality 5. Decreased mental status.

Status migrainosus

Consider referral

Proceed to Next Figure

  • Aches associated with chronic nausea require a work-up to rule out raised intracranial pressure

  • Sudden, severe, unilateral vision loss is suggestive of optic neuritis

  • Headache, fatigue, generalized aches and pain, and night sweats in subjects age 55 or older suggest the presence of temporal arteritis

  • Intermittent headaches with high blood pressure is suggestive of pheochromocytoma.

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