Headache Differential + red flags

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Headache Differential

No signs on examination (good for osce....)

tension

migraine

cluster

post-trauma

drugs (nitrates, calcium channel antagonists)

carbon monoxide poisoning or anoxia

SAH

Signs of meningism?

meningitis (may have NO fever/rash)

SAH (exam may be normal)

Decreased Conscious lvl or localizing signs?

stroke

encephalitis/meningitis

cerebral abscess

SAH

venous sinus occlusion (focal neuro deficits)

tumor

subdural hematoma

TB meningitis

Papilledema?

tumor

Venous sinus occlusion (focal neuro deficits)

malignant (accelerated) hypertension

idiopathic intracranial hypertension

any CNS infect if prolonged eg >2w -eg TB meningitis

Others

Giant cell arteritis (ESR up)

Acute glaucoma

vertebral artery dissection (neck pain + cerebellar/medullary signs)

cervical spondylosis

sinusitis

paget's disease (alk phos +++)

altitude sickness

Worrying features or 'red flags'

1st and worst headache - SAH

thunderclap headache - SAH

unilat headache + eye pain - cluster headache, acute glaucoma

unilat headache + ipsilat symps - migraine, tumor, vascular

cough initiated - raise dICP/venous thrombosis

worse in morn or bend forward - raised ICP/venous thrombosis

persisting headache +/- scalp tenderness in >50's -giant cell arteritis

headache w/fever or neck stiff - meningitis

change in the patter of 'usual' headaches

decreased lvl of consciousness

Two other vital q's

-where have you been? (malaria)

-might you be pregnant? (pre-eclampsia, espec if proteinuria + BP up)

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