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2 Posts
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.
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.
