Acute headache: diagnosis

Introduction
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By Stephanie J Nahas MD

Headache is a common chief complaint in acute settings. The diagnosis of acute headache can be challenging and should proceed in an orderly fashion. An important first step is to distinguish primary from secondary headaches. The approach is to seek “red flags” that suggest the possibility of secondary headache. If one of these features is identified, the physician must conduct the workup indicated by the red flag and, thereby, diagnose any secondary headache disorder that is present. In the absence of secondary headache, the clinician proceeds to diagnosing a primary headache disorder. In this clinical summary, we follow this approach to discuss the differential diagnosis of acute headaches.

Key points

  • Migraine is the most common diagnosis in the evaluation of acute headache.
  • Secondary causes must be ruled out in all cases of acute headache presentation, mainly based on “red flags” uncovered in the history and physical/neurologic examination.
  • A systematic approach to the headache, characterizing it in terms of duration, quality, location, and accompanying symptoms, speeds the diagnosis.

In This Article

Introduction
Overview
Approaching a patient with acute headache
Identifying secondary headaches
Diagnosing a primary headache disorder
Low-to-moderate frequency headaches of long duration
High-frequency headaches of long duration
Headaches of shorter duration
Conclusions
References cited
Contributors