Migraine differential diagnosis: Difference between revisions
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{| class="wikitable" | {| class="wikitable" | ||
! rowspan=" | ! rowspan="3" |Disease | ||
! rowspan=" | ! colspan="3" |Symptoms | ||
! | ! rowspan="3" |Gold Standard | ||
! rowspan="3" |CT/MRI | |||
! rowspan="3" |Other Investigation Findings | |||
|- | |- | ||
! | ! colspan="2" |'''Headache''' | ||
!Other | ! rowspan="2" |Other features | ||
|- | |- | ||
!Onset | |||
!Characterstics | |||
|- | |- | ||
|[[Subarachnoid hemorrhage]] | |[[Subarachnoid hemorrhage]] | ||
|Sudden | |||
| | |||
* [[Headache|Severe headache]] | |||
* <nowiki/>[[Thunderclap headache|Thunderclap]] | |||
* Described as the worst headache of life | |||
| | | | ||
* [[Double vision]] | * [[Double vision]] | ||
* [[Nausea]] and [[vomiting]] | * [[Nausea]] and [[vomiting]] | ||
* Symptoms of [[meningeal irritation]] | * Symptoms of [[meningeal irritation]] | ||
* Sudden [[Loss of consciousness|decreased level of consciousness]] | * Sudden [[Loss of consciousness|decreased level of consciousness]] | ||
|[[Digital subtraction angiography]] | |||
| | | | ||
* The modality of choice for diagnosis of [[subarachnoid hemorrhage]] is noncontrast head [[Computed tomography|computed tomography (CT)]], with or without [[lumbar puncture]].<sup>[[Subarachnoid hemorrhage CT#cite note-pmid7897421-1|[1]]]</sup> | * The modality of choice for diagnosis of [[subarachnoid hemorrhage]] is noncontrast head [[Computed tomography|computed tomography (CT)]], with or without [[lumbar puncture]].<sup>[[Subarachnoid hemorrhage CT#cite note-pmid7897421-1|[1]]]</sup> | ||
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|- | |- | ||
|[[Meningitis]] | |[[Meningitis]] | ||
| | |Sudden | ||
|[[Headache]] is associated with: | |||
* [[Fever]] | * [[Fever]] | ||
* [[Photophobia]] | * [[Neck stiffness]] | ||
* [[Phonophobia]] | | | ||
* [[Irritability]] | * [[Photophobia]] | ||
* [[Phonophobia]] | |||
* [[Irritability]] | |||
* [[Altered mental status]] | |||
|[[Lumbar puncture]] for [[CSF]] | |||
| | | | ||
* [[CT]] scan of the head may be performed before [[Lumbar puncture|LP]] to determine the risk of [[herniation]]. | * [[CT]] scan of the head may be performed before [[Lumbar puncture|LP]] to determine the risk of [[herniation]]. | ||
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|- | |- | ||
|[[Intracranial mass]] | |[[Intracranial mass]] | ||
|Gradual | |||
|[[Morning headache]] | |||
| | | | ||
* [[Nausea]] | * [[Nausea]] | ||
* [[Vomiting]] | * [[Vomiting]] | ||
* [[Change in mental status]] | * [[Change in mental status]] | ||
* [[Seizures]] | * [[Seizures]] | ||
* Focal | * Focal neurological deficits | ||
|[[MRI]] | |||
| | | | ||
* [[CT]] or [[MRI]] is the initial test to detect intracranial lesions. | * [[CT]] or [[MRI]] is the initial test to detect intracranial lesions (ring enhancing lesions). | ||
* These imaging tests determine the location of [[intracranial mass]] lesion(s) and help in guiding [[therapy]]. | * These imaging tests determine the location of [[intracranial mass]] lesion(s) and help in guiding [[therapy]]. | ||
| | | | ||
* [[Biopsy]] of the lesion | * [[Biopsy]] of the lesion may be done to identify the nature of the lesion such as: | ||
** [[Tumor]] | ** [[Tumor]] | ||
** [[Abscess]] | ** [[Abscess]] | ||
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|- | |- | ||
|[[Cerebral hemorrhage]] | |[[Cerebral hemorrhage]] | ||
|Sudden | |||
|Rapidly progressing headache | |||
| | | | ||
* | * Symptoms of [[increased intracranial pressure]] (ICP) | ||
* | * Focal neurological deficits | ||
|[[CT]] without [[Contrast medium|contrast]] | |||
(differentiate [[ischemic stroke]] from [[hemorrhagic stroke|hemorrhagic stroke.]]) | |||
| | | | ||
* [[CT]] is very sensitive for identifying acute [[hemorrhage]] which appears as hyperattenuating clot. | * [[CT]] is very sensitive for identifying acute [[hemorrhage]] which appears as hyperattenuating clot. | ||
* Gradient echo and T2 susceptibility-weighted [[MRI]] are as sensitive as [[CT]] for detection of acute hemorrhage and are more sensitive for identification of prior hemorrhage. | * Gradient echo and T2 susceptibility-weighted [[MRI]] are as sensitive as [[CT]] for detection of acute hemorrhage and are more sensitive for identification of prior hemorrhage. | ||
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|- | |- | ||
|[[ | |[[Intracranial venous thrombosis]] | ||
| | |Gradual | ||
| | | | ||
* [[ | * Diffuse [[headache]] | ||
* | * [[Headache]] can be the only symptom of [[Cerebral venous sinus thrombosis|cerebral venous thrombosis]] | ||
| | |||
| | | | ||
* | * Focal neurological deficits | ||
* [[Seizure|Seizures]] | |||
* [[Coma|Depressed level of consciousness]] | |||
* [[Seizure|Seizures]] | |[[Digital subtraction angiography]] | ||
* [[Coma|Depressed level of consciousness]] | |||
| | | | ||
* The classic finding of sinus thrombosis on unenhanced [[CT]] images is a hyperattenuating thrombus in the occluded sinus. | * The classic finding of sinus thrombosis on unenhanced [[CT]] images is a hyperattenuating thrombus in the occluded sinus. | ||
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* [[Cerebral angiography]] may demonstrate smaller clots, and obstructed veins may give the "corkscrew appearance". | * [[Cerebral angiography]] may demonstrate smaller clots, and obstructed veins may give the "corkscrew appearance". | ||
|- | |||
|[[Migraine]] | |||
|Sudden | |||
| | |||
* Severe to moderate [[headache]] | |||
* One-sided | |||
* Pulsating | |||
* Lasts between several hours to three days. | |||
| | |||
* [[Nausea and vomiting]] | |||
* Preceding [[Aura (symptom)|aura]] | |||
* [[Photophobia]] | |||
* [[Phonophobia]] | |||
|'''---''' | |||
| | |||
* [[CT]] and [[MRI]] may be needed to rule out other suspected possible causes of [[headache]]. | |||
|[[Migraine]] is a clinical [[diagnosis]] that does not require any laboratory tests. Laboratory tests can be ordered to rule out any suspected coexistent metabolic problems or to determine the baseline status of the patient before initiation of [[migraine]] therapy. | |||
|- | |- | ||
|[[Head injury]] | |[[Head injury]] | ||
|Sudden | |||
| | |||
* Dull | |||
* Throbbing | |||
* One sided or all around | |||
| | | | ||
* [[Confusion]] | * [[Confusion]] | ||
* [[Drowsiness]] | * [[Drowsiness]] | ||
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* [[Nausea]] and [[vomiting]] | * [[Nausea]] and [[vomiting]] | ||
* [[Headache|Loss of consciousness]] | * [[Headache|Loss of consciousness]] | ||
* [[ | * [[Lucid interval]] | ||
|[[CT]] scan without contrast | |||
| | | | ||
* [[CT]] scan is the first test performed and identifies [[cerebral hemorrhage]] (appears as hyperattenuating clot) following head injury | * [[CT]] scan is the first test performed and identifies [[cerebral hemorrhage]] (appears as hyperattenuating clot) following head injury. | ||
* [[MRI]] is more sensitive, takes more time and is done in patients with symptoms unexplained by [[Computed tomography|CT]] scan. | * [[MRI]] is more sensitive, takes more time and is done in patients with symptoms unexplained by [[Computed tomography|CT]] scan. | ||
| | | | ||
* The [[Glasgow Coma Scale]] is a tool for measuring degree of unconsciousness and is | * The [[Glasgow Coma Scale]] is a tool for measuring degree of unconsciousness and is a useful tool for determining severity of injury. | ||
* The [[Pediatric Glasgow Coma Scale]] is used in young children. | * The [[Pediatric Glasgow Coma Scale]] is used in young children. | ||
|- | |- | ||
|[[Lymphocytic hypophysitis]] | |[[Lymphocytic hypophysitis]] | ||
| | |Sudden | ||
| | |||
* Generalized | |||
* Retro-orbital or Bitemporal | |||
| | |||
* Most often seen in late pregnancy or the [[postpartum]] period | |||
* Mass lesion effect such as [[Visual field defect|visual field defects]] | |||
* [[Hypopituitarism]] | * [[Hypopituitarism]] | ||
|Pituitary biopsy | |||
| | | | ||
* [[CT]] & [[MRI]] typically reveal features of a pituitary mass. | * [[CT]] & [[MRI]] typically reveal features of a pituitary mass. | ||
| | | | ||
* The most accurate test is pituitary [[biopsy]] which will show [[lymphocytic]] [[Infiltration (medical)|infiltration]]. | * The most accurate test is pituitary [[biopsy]] which will show [[lymphocytic]] [[Infiltration (medical)|infiltration]]. | ||
| | |} | ||
| | ==References== | ||
{{Reflist|2}} | |||
{{reflist|2}} | |||
[[ | [[Category:Needs content]] | ||
[[Category:Emergency medicine]] | |||
[[Category:Endocrinology]] | |||
[[Category:Neurology]] | |||
[[Category:Obstetrics]] | |||
[[Category:Disease]] | |||
{{WH}} | |||
==Other Conditions causing headache== | ==Other Conditions causing headache== |
Revision as of 18:54, 1 August 2017
Migraine Microchapters |
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Migraine differential diagnosis On the Web |
American Roentgen Ray Society Images of Migraine differential diagnosis |
Risk calculators and risk factors for Migraine differential diagnosis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Other conditions that can cause similar symptoms to a migraine headache include temporal arteritis, cluster headaches, acute glaucoma, meningitis and subarachnoid hemorrhage.[1] Temporal arteritis typically occurs in people over 50 years old and presents with tenderness over the temple, cluster headaches presents with one-sided nose stuffiness, tears and severe pain around the orbits, acute glaucoma is associated with vision problems, meningitis with fevers, and subaracchnoid hemorrhage with a very fast onset.[1] Tension headaches typically occur on both sides, are not pounding, and are less disabling.[1]
Differentiating Migraine From Other Diseases
Migraine should be differentiated from other diseases causing severe headache for example: [2][3][4][5][6][7][8][9][10][11]
Disease | Symptoms | Gold Standard | CT/MRI | Other Investigation Findings | ||
---|---|---|---|---|---|---|
Headache | Other features | |||||
Onset | Characterstics | |||||
Subarachnoid hemorrhage | Sudden |
|
|
Digital subtraction angiography |
|
|
Meningitis | Sudden | Headache is associated with: | Lumbar puncture for CSF |
|
| |
Intracranial mass | Gradual | Morning headache |
|
MRI |
|
|
Cerebral hemorrhage | Sudden | Rapidly progressing headache |
|
CT without contrast
(differentiate ischemic stroke from hemorrhagic stroke.) |
|
|
Intracranial venous thrombosis | Gradual |
|
|
Digital subtraction angiography |
|
|
Migraine | Sudden |
|
|
--- | Migraine is a clinical diagnosis that does not require any laboratory tests. Laboratory tests can be ordered to rule out any suspected coexistent metabolic problems or to determine the baseline status of the patient before initiation of migraine therapy. | |
Head injury | Sudden |
|
|
CT scan without contrast |
|
|
Lymphocytic hypophysitis | Sudden |
|
|
Pituitary biopsy |
|
References
- ↑ 1.0 1.1 1.2 Gilmore B, Michael M (2011). "Treatment of acute migraine headache". Am Fam Physician. 83 (3): 271–80. PMID 21302868.
- ↑ Endrit Ziu & Fassil Mesfin (2017). "Subarachnoid Hemorrhage". PMID 28722987.
- ↑ Benedikt Schwermer, Daniel Eschle & Constantine Bloch-Infanger (2017). "[Fever and Headache after a Vacation in Thailand]". Deutsche medizinische Wochenschrift (1946). 142 (14): 1063–1066. doi:10.1055/s-0043-106282. PMID 28728201.
- ↑ Otto Rapalino & Mark E. Mullins (2017). "Intracranial Infectious and Inflammatory Diseases Presenting as Neurosurgical Pathologies". Neurosurgery. doi:10.1093/neuros/nyx201. PMID 28575459.
- ↑ I. B. Komarova, V. P. Zykov, L. V. Ushakova, E. K. Nazarova, E. B. Novikova, O. V. Shuleshko & M. G. Samigulina (2017). "[Clinical and neuroimaging signs of cardioembolic stroke laboratory in children]". Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova. 117 (3. Vyp. 2): 11–19. doi:10.17116/jnevro20171173211-19. PMID 28665364.
- ↑ Sanjay Konakondla, Clemens M. Schirmer, Fengwu Li, Xiaogun Geng & Yuchuan Ding (2017). "New Developments in the Pathophysiology, Workup, and Diagnosis of Dural Venous Sinus Thrombosis (DVST) and a Systematic Review of Endovascular Treatments". Aging and disease. 8 (2): 136–148. doi:10.14336/AD.2016.0915. PMID 28400981.
- ↑ Priyanka Yadav, Alec L. Bradley & Jonathan H. Smith (2017). "Recognition of Chronic Migraine by Medicine Trainees: A Cross-Sectional Survey". Headache. doi:10.1111/head.13133. PMID 28653369.
- ↑ S. Wulffeld, L. S. Rasmussen, B. Hojlund Bech & J. Steinmetz (2017). "The effect of CT scanners in the trauma room - an observational study". Acta anaesthesiologica Scandinavica. 61 (7): 832–840. doi:10.1111/aas.12927. PMID 28635146.
- ↑ Johnston PC, Chew LS, Hamrahian AH, Kennedy L (2015). "Lymphocytic infundibulo-neurohypophysitis: a clinical overview". Endocrine. 50 (3): 531–6. doi:10.1007/s12020-015-0707-6. PMID 26219407.
- ↑ Makale MT, McDonald CR, Hattangadi-Gluth JA, Kesari S (2017). "Mechanisms of radiotherapy-associated cognitive disability in patients with brain tumours". Nat Rev Neurol. 13 (1): 52–64. doi:10.1038/nrneurol.2016.185. PMID 27982041.
- ↑ Sato N, Sze G, Endo K (1998). "Hypophysitis: endocrinologic and dynamic MR findings". AJNR Am J Neuroradiol. 19 (3): 439–44. PMID 9541295.