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Discussion Starter #1
Hello,

I am yet to find a comprehensive source for all the high-yield sources of headaches and how to distinguish between them. I am hoping this thread can become that source. I will make an initial list and would love it if people could add details. I'm hoping in a week or so, this list can be complete!

Causes

Acute Closure Glaucoma
Periorbital, frontal pain. Pupil dilated and non-reactive to light. Vision loss, halo's around light.
Can be caused by atropine (Muscarinic antagonist)
Can be treated with pilocarpine (Muscarinic agonist), acetazolamide, mannitol, beta blockers

Cluster
Unilateral, male, brief and episodic pain, periorbital pain, lacrimation and rhinorrhea. May induce Horner's.

Acute Tx: 100% O2, sumatriptan (note: sumatriptan is contraindicated with CAD, HTN, and pregnancy)
Chronic Tx: Verapamil, lithium, ergot

I feel like Cluster HA and acute closure glaucoma will be challenge to distinguish.


Tension
Bilateral, stress and depression, steady pain.

Acute Tx: NSAIDS
Chronic Tx: Amytriptyline, propranalol

Migraine
Unilateral, female, pulsating pain, photo/phonophobia, "aura" is present.

Acute Tx: Dark and quiet environment, sumatriptan, NSAIDS
Chronic Tx: Amytriptyline, propranalol, verapamil, topiramate

Temporal Artritis
Temporal region, women over 50, elevated ESR, Jaw Claudication
Often occurs in conjunction with polymyalgia rheumatica (pain and stiffness in shoulders, fever, no weakness)

Tx for both TA and PR: corticosteroids

This one should be easy to pin-point.


Benign/idiopathic intracranial hypertension (pseudotumor cerebri)
Increased intracranial pressure, papilledema and vision loss can result
Cause: too much Vit A (acutane)
Tx: stop Vit A source, acetazolamide

Communicating Hydrocephalus
Increased intracranial pressure, papilledema and vision loss can result

Tx: VP shunt and vancomyocin

I have not idea how to distinguish Comm Hydro and pseudotumor cerebri!


Subarachnoid hemorrhage
"Worst headache of my life", nuchal rigidity may be present

Meningitis
Fever, nuchal rigidity, altered mental status may be present, photophobia if viral etiology

Is fever and the magnitude of the pain the only way to distinguish between meningitis and SA hemorrhage?


Neoplasia
Weight loss?

Trigeminal Neuralgia

Easy to diagnose because this is really not a headache. It is a sharp, burning facial pain. Note: it is associated with MS.
 

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Discussion Starter #2
Summary of questions

How to distinguish between:

1) Pseudotumor cerebri and communicating hydrocephalus

2) Meningitis and SA Hemorrhage

3) Cluster HA and Acute closure glaucoma

4) Is my list missing anything major?

Thanks!
 
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