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Awaken 180 cost3/14/2023 Subarachnoid hemorrhage, pituitary apoplexy, hemorrhage into a mass lesion or vascular malformation, mass lesion (especially posterior fossa mass) Have you recently hurt your head or had a medical or dental procedure?Įrythrocyte sedimentation rate, neuroimaging What kind of pain do you have (throbbing, stabbing, dull, other)?ĭo you have other medical problems? If so, what? Where is your pain? Does the pain seem to spread to any other area? If so, where? When did this headache begin? How did it start (gradually, suddenly, other)? What symptoms do you have before the headache starts? What symptoms do you have during the headache? What symptoms do you have right now? 5 TABLE 3 Questions to Ask in Obtaining a Headache History Is this your first or worst headache? How bad is your pain on a scale of 1 to 10 (1 means not too bad, and 10 means very bad)? Do you have headaches on a regular basis? Is this headache like the ones you usually have? 3 This level of detail is also necessary to identify “red flags” that suggest an underlying organic disorder as the cause of headache. The approach to the headache history given in Table 3 and discussed in the following sections facilitates the generation of a differential diagnosis and preliminary classification of the headache type based on the criteria established by the International Headache Society. Headache or facial pain associated with disorder of cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cranial structuresĬranial neuralgias, nerve trunk pain and deafferentation painīecause most patients with headache have normal neurologic and general physical examinations, a thorough history is crucial to determining the etiology of a headache. Headache associated with metabolic disorder Headache associated with noncephalic infection Headache associated with substance use or withdrawal Low cerebrospinal fluid pressure (e.g., headache subsequent to lumbar puncture) Headache associated with nonvascular intracranial disorderīenign intracranial hypertension (pseudotumor cerebri) Headache associated with vascular disorders Referral is appropriate for patients with headaches that are difficult to diagnose, or that worsen or fail to respond to management. Cerebrospinal fluid (CSF) analysis can help to confirm or rule out hemorrhage, infection, tumor and disorders related to CSF hypertension or hypotension. Magnetic resonance imaging (MRI) is more expensive than CT scanning and less widely available however, MRI reveals more detail and is necessary for imaging the posterior fossa. The preferred imaging modality to rule out hemorrhage is noncontrast computed tomographic (CT) scanning followed by lumbar puncture if the CT scan is normal. A thorough neurologic examination should be performed, with abnormal findings warranting neuroimaging to rule out intracranial pathology. “Red flags” for secondary disorders include sudden onset of headache, onset of headache after 50 years of age, increased frequency or severity of headache, new onset of headache with an underlying medical condition, headache with concomitant systemic illness, focal neurologic signs or symptoms, papilledema and headache subsequent to head trauma. A detailed headache history helps to distinguish among the primary headache disorders. Classifying headaches as primary (migraine, tension-type or cluster) or secondary can facilitate evaluation and management.
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