Migraine differential diagnosis: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Migraine]] | |||
{{CMG}} | {{CMG}} | ||
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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 | |||
|- | |- | ||
|[[Migraine]] | |[[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]]. | * [[CT]] and [[MRI]] may be needed to rule out other suspected possible causes of [[headache]]. | ||
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|- | |- | ||
|[[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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|- | |- | ||
|[[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]]. | ||
|} | |||
Migraine must be differentiated from other causes of headache,seizures and loss of consciousness. | |||
{| | |||
|-style="background: #4479BA; color: #FFFFFF; text-align: center;" | |||
! rowspan="2" |<small>Diseases</small> | |||
! colspan="4" |<small>Symptoms | |||
! colspan="5" |<small>Physical Examination</small> | |||
! rowspan="2" |<small>Past medical history</small> | |||
! colspan="3" |<small>Diagnostic tests</small> | |||
! rowspan="2" |<small>Other Findings</small> | |||
|- style="background: #4479BA; color: #FFFFFF; text-align: center;" | |||
!<small>Headache</small> | |||
!↓<small>LOC</small> | |||
!<small>Motor weakness</small> | |||
!<small>Abnormal sensory</small> | |||
!<small>Motor Deficit</small> | |||
!<small>Sensory deficit</small> | |||
!<small>Speech difficulty</small> | |||
!<small>Gait abnormality</small> | |||
!<small>Cranial nerves</small> | |||
!<small>CT /MRI</small> | |||
!<small>CSF Findings</small> | |||
!<small>Gold standard test</small> | |||
|- | |||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Meningitis]] | |||
| style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
| style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
| style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
| style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
| style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
| style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
| style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
| style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
| style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
| style="background: #F5F5F5; padding: 5px text-align:center" |History of [[fever]] and [[malaise]] | |||
| style="background: #F5F5F5; padding: 5px;" | - | |||
| style="background: #F5F5F5; padding: 5px; text-align:center" |'''↑''' [[Leukocytes]], | |||
'''↑''' Protein | |||
↓ Glucose | |||
| style="background: #F5F5F5; padding: 5px;" |[[CSF analysis]]<ref name="pmid19398286">{{cite journal| author=Carbonnelle E| title=[Laboratory diagnosis of bacterial meningitis: usefulness of various tests for the determination of the etiological agent]. | journal=Med Mal Infect | year= 2009 | volume= 39 | issue= 7-8 | pages= 581-605 | pmid=19398286 | doi=10.1016/j.medmal.2009.02.017 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19398286 }}</ref> | |||
| style="background: #F5F5F5; padding: 5px;" |[[Fever]], [[Neck rigidity|neck]] | |||
[[Neck rigidity|rigidity]] | |||
|- | |||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Encephalitis]] | |||
| style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
| style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
| style="background: #F5F5F5; padding: 5px text-align:center" | +/- | |||
| style="background: #F5F5F5; padding: 5px text-align:center" | +/- | |||
| style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
| style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
| style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
| style="background: #F5F5F5; padding: 5px text-align:center" | +/- | |||
| style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
| style="background: #F5F5F5; padding: 5px text-align:center" |History of [[fever]] and [[malaise]] | |||
| style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
| style="background: #F5F5F5; padding: 5px text-align:center" |'''↑''' [[Leukocytes]], ↓ Glucose | |||
| style="background: #F5F5F5; padding: 5px text-align:center" |CSF [[PCR]] | |||
| style="background: #F5F5F5; padding: 5px text-align:center" |[[Fever]], [[Seizure|seizures]], [[Focal neurologic signs|focal neurologic abnormalities]] | |||
|- | |||
|style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Brain tumor]]<ref name="pmid10582668">{{cite journal| author=Morgenstern LB, Frankowski RF| title=Brain tumor masquerading as stroke. | journal=J Neurooncol | year= 1999 | volume= 44 | issue= 1 | pages= 47-52 | pmid=10582668 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10582668 }} </ref> | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" |[[Weight loss]], [[fatigue]] | |||
|style="background: #F5F5F5; padding: 5px; text-align:center"| + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" |Cancer cells<ref name="pmid21371327">{{cite journal| author=Weston CL, Glantz MJ, Connor JR| title=Detection of cancer cells in the cerebrospinal fluid: current methods and future directions. | journal=Fluids Barriers CNS | year= 2011 | volume= 8 | issue= 1 | pages= 14 | pmid=21371327 | doi=10.1186/2045-8118-8-14 | pmc=3059292 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21371327 }}</ref> | |||
|style="background: #F5F5F5; padding: 5px;" |MRI | |||
|style="background: #F5F5F5; padding: 5px;" |[[Cachexia]], gradual progression of symptoms | |||
|- | |||
|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hemorrhagic stroke]] | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
|style="background: #F5F5F5; padding: 5px text-align:center" |[[Hypertension]] | |||
|style="background: #F5F5F5; padding: 5px; text-align:center" | + | |||
| style="background: #F5F5F5; padding: 5px;" | - | |||
|style="background: #F5F5F5; padding: 5px;" |CT scan without contrast<ref name="pmid21694755">{{cite journal| author=Birenbaum D, Bancroft LW, Felsberg GJ| title=Imaging in acute stroke. | journal=West J Emerg Med | year= 2011 | volume= 12 | issue= 1 | pages= 67-76 | pmid=21694755 | doi= | pmc=3088377 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21694755 }}</ref><ref name="pmid21807345">{{cite journal| author=DeLaPaz RL, Wippold FJ, Cornelius RS, Amin-Hanjani S, Angtuaco EJ, Broderick DF et al.| title=ACR Appropriateness Criteria® on cerebrovascular disease. | journal=J Am Coll Radiol | year= 2011 | volume= 8 | issue= 8 | pages= 532-8 | pmid=21807345 | doi=10.1016/j.jacr.2011.05.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21807345 }}</ref> | |||
|style="background: #F5F5F5; padding: 5px;" |[[Neck stiffness]] | |||
|- | |||
|style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Subdural hematoma|Subdural hemorrhage]] | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" |[[Trauma]], fall | |||
|style="background: #F5F5F5; padding: 5px; text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px;" |Xanthochromia<ref name="pmid1198628">{{cite journal| author=Lee MC, Heaney LM, Jacobson RL, Klassen AC| title=Cerebrospinal fluid in cerebral hemorrhage and infarction. | journal=Stroke | year= 1975 | volume= 6 | issue= 6 | pages= 638-41 | pmid=1198628 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1198628 }}</ref> | |||
|style="background: #F5F5F5; padding: 5px;" |CT scan without contrast<ref name="pmid21694755">{{cite journal| author=Birenbaum D, Bancroft LW, Felsberg GJ| title=Imaging in acute stroke. | journal=West J Emerg Med | year= 2011 | volume= 12 | issue= 1 | pages= 67-76 | pmid=21694755 | doi= | pmc=3088377 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21694755 }}</ref><ref name="pmid21807345">{{cite journal| author=DeLaPaz RL, Wippold FJ, Cornelius RS, Amin-Hanjani S, Angtuaco EJ, Broderick DF et al.| title=ACR Appropriateness Criteria® on cerebrovascular disease. | journal=J Am Coll Radiol | year= 2011 | volume= 8 | issue= 8 | pages= 532-8 | pmid=21807345 | doi=10.1016/j.jacr.2011.05.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21807345 }}</ref> | |||
|style="background: #F5F5F5; padding: 5px;" |[[Confusion]], [[dizziness]], [[nausea]], [[vomiting]] | |||
|- | |- | ||
| | |style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Neurosyphilis]]<ref name="pmid22482824">{{cite journal| author=Liu LL, Zheng WH, Tong ML, Liu GL, Zhang HL, Fu ZG et al.| title=Ischemic stroke as a primary symptom of neurosyphilis among HIV-negative emergency patients. | journal=J Neurol Sci | year= 2012 | volume= 317 | issue= 1-2 | pages= 35-9 | pmid=22482824 | doi=10.1016/j.jns.2012.03.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22482824 }} </ref><ref name="pmid24365430">{{cite journal |vauthors=Berger JR, Dean D |title=Neurosyphilis |journal=Handb Clin Neurol |volume=121 |issue= |pages=1461–72 |year=2014 |pmid=24365430 |doi=10.1016/B978-0-7020-4088-7.00098-5 |url=}}</ref> | ||
| | |style="background: #F5F5F5; padding: 5px text-align:center" | + | ||
|style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
| | |style="background: #F5F5F5; padding: 5px text-align:center" | + | ||
[[ | |style="background: #F5F5F5; padding: 5px text-align:center" | + | ||
|style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
|[[ | |style="background: #F5F5F5; padding: 5px text-align:center" |[[Sexually transmitted disease|STI]]<nowiki/>s | ||
|style="background: #F5F5F5; padding: 5px; text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px;" |'''↑''' [[Leukocytes]] and [[protein]] | |||
|style="background: #F5F5F5; padding: 5px;" |CSF [[VDRL]]-specifc | |||
CSF FTA-Ab -sensitive<ref name="pmid22421697">{{cite journal| author=Ho EL, Marra CM| title=Treponemal tests for neurosyphilis--less accurate than what we thought? | journal=Sex Transm Dis | year= 2012 | volume= 39 | issue= 4 | pages= 298-9 | pmid=22421697 | doi=10.1097/OLQ.0b013e31824ee574 | pmc=3746559 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22421697 }}</ref> | |||
|style="background: #F5F5F5; padding: 5px;" |[[Blindness]], [[confusion]], [[depression]], | |||
Abnormal [[gait]] | |||
|- | |||
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Complex or atypical [[migraine]] | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
|style="background: #F5F5F5; padding: 5px text-align:center" |Family history of [[migraine]] | |||
| style="background: #F5F5F5; padding: 5px;" | - | |||
| style="background: #F5F5F5; padding: 5px;" | - | |||
|style="background: #F5F5F5; padding: 5px;" |Clinical assesment | |||
|style="background: #F5F5F5; padding: 5px;" |Presence of aura, [[nausea]], [[vomiting]] | |||
|- | |||
|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hypertensive encephalopathy]] | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
|style="background: #F5F5F5; padding: 5px text-align:center" |[[Hypertension]] | |||
|style="background: #F5F5F5; padding: 5px;" | + | |||
|style="background: #F5F5F5; padding: 5px;" | - | |||
|style="background: #F5F5F5; padding: 5px;" |Clinical assesment | |||
|style="background: #F5F5F5; padding: 5px;" |[[Delirium]], [[cortical blindness]], [[cerebral edema]], [[seizure]] | |||
|- | |||
|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Wernicke's encephalopathy|Wernicke’s encephalopathy]] | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" |History of alcohal abuse | |||
| style="background: #F5F5F5; padding: 5px;" | - | |||
| style="background: #F5F5F5; padding: 5px;" | - | |||
| style="background: #F5F5F5; padding: 5px;" |Clinical assesment and lab findings | |||
|style="background: #F5F5F5; padding: 5px;" |[[Ophthalmoplegia]], [[confusion]] | |||
|- | |||
|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Brain abscess|CNS abscess]] | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
|style="background: #F5F5F5; padding: 5px text-align:center" |History of [[drug abuse]], [[endocarditis]], [[immunosupression]] | |||
|style="background: #F5F5F5; padding: 5px;" | + | |||
|style="background: #F5F5F5; padding: 5px;" |'''↑''' leukocytes, '''↓''' glucose and '''↑''' protien | |||
|style="background: #F5F5F5; padding: 5px;" |MRI is more sensitive and specific | |||
|style="background: #F5F5F5; padding: 5px;" |High grade [[fever]], [[fatigue]],[[nausea]], [[vomiting]] | |||
|- | |||
|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Drug toxicity]] | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
| style="background: #F5F5F5; padding: 5px;" | - | |||
| style="background: #F5F5F5; padding: 5px;" | - | |||
| style="background: #F5F5F5; padding: 5px;" |Drug screen test | |||
|style="background: #F5F5F5; padding: 5px;" |[[Lithium]], [[Sedatives]], [[phenytoin]], [[carbamazepine]] | |||
|- | |||
|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Conversion disorder]] | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | | |||
|style="background: #F5F5F5; padding: 5px text-align:center" |History of [[emotional stress]] | |||
| style="background: #F5F5F5; padding: 5px;" | - | |||
| style="background: #F5F5F5; padding: 5px;" | - | |||
|style="background: #F5F5F5; padding: 5px;" |Diagnosis of exclusion | |||
|style="background: #F5F5F5; padding: 5px;" |[[Tremor|Tremors]], [[blindness]], difficulty [[swallowing]] | |||
|- | |||
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Metabolic disturbances ([[electrolyte imbalance]], [[hypoglycemia]]) | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
| style="background: #F5F5F5; padding: 5px;" | - | |||
| style="background: #F5F5F5; padding: 5px;" |[[Hypoglycemia]], [[Hyponatremia|hypo]] and [[hypernatremia]], [[Hypokalemia|hypo]] and [[hyperkalemia]] | |||
|style="background: #F5F5F5; padding: 5px;" |Depends on the cause | |||
| style="background: #F5F5F5; padding: 5px;" |[[Confusion]], [[seizure]], [[Palpitation|palpitations]], [[sweating]], [[dizziness]], [[hypoglycemia]] | |||
|- | |||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Multiple sclerosis]] exacerbation | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" |History of relapses and remissions | |||
| style="background: #F5F5F5; padding: 5px; text-align:center" | + | |||
| style="background: #F5F5F5; padding: 5px; text-align:center" |'''↑''' CSF IgG levels | |||
(monoclonal bands) | |||
| style="background: #F5F5F5; padding: 5px;" |Clinical assesment and [[MRI]] <ref name="pmid8274111">{{cite journal| author=Giang DW, Grow VM, Mooney C, Mushlin AI, Goodman AD, Mattson DH et al.| title=Clinical diagnosis of multiple sclerosis. The impact of magnetic resonance imaging and ancillary testing. Rochester-Toronto Magnetic Resonance Study Group. | journal=Arch Neurol | year= 1994 | volume= 51 | issue= 1 | pages= 61-6 | pmid=8274111 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8274111 }}</ref> | |||
| style="background: #F5F5F5; padding: 5px;" |[[Blurred vision|Blurry vision]], [[urinary incontinence]], [[fatigue]] | |||
|- | |||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Seizure]] | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
|style="background: #F5F5F5; padding: 5px text-align:center" |Previous history of [[seizures]] | |||
| style="background: #F5F5F5; padding: 5px;" | - | |||
| style="background: #F5F5F5; padding: 5px;" |Mass lesion | |||
| style="background: #F5F5F5; padding: 5px;" |Clinical assesment and [[EEG]] <ref name="pmid11385043">{{cite journal| author=Manford M| title=Assessment and investigation of possible epileptic seizures. | journal=J Neurol Neurosurg Psychiatry | year= 2001 | volume= 70 Suppl 2 | issue= | pages= II3-8 | pmid=11385043 | doi= | pmc=1765557 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11385043 }}</ref> | |||
| style="background: #F5F5F5; padding: 5px;" |[[Confusion]], [[apathy]], [[irritability]], | |||
|} | |} | ||
==References== | |||
{{Reflist|2}} | |||
{{reflist|2}} | |||
{{WH}} | |||
==Other Conditions causing headache== | ==Other Conditions causing headache== | ||
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{{WS}} | {{WS}} | ||
[[Category:Needs content]] | |||
[[Category:Emergency medicine]] | |||
[[Category:Endocrinology]] | |||
[[Category:Neurology]] | |||
[[Category:Obstetrics]] | |||
[[Category:Disease]] | |||
[[Category:Needs overview]] | [[Category:Needs overview]] | ||
[[Category:Migraine]] | [[Category:Migraine]] | ||
[[Category:Headaches]] | [[Category:Headaches]] | ||
[[Category:Head and neck]] | [[Category:Head and neck]] |
Latest revision as of 22:44, 29 July 2020
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 | |||||
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. | |
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 |
|
|
Head injury | Sudden |
|
|
CT scan without contrast |
|
|
Lymphocytic hypophysitis | Sudden |
|
|
Pituitary biopsy |
|
Migraine must be differentiated from other causes of headache,seizures and loss of consciousness.
Diseases | Symptoms | Physical Examination | Past medical history | Diagnostic tests | Other Findings | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Headache | ↓LOC | Motor weakness | Abnormal sensory | Motor Deficit | Sensory deficit | Speech difficulty | Gait abnormality | Cranial nerves | CT /MRI | CSF Findings | Gold standard test | |||
Meningitis | + | - | - | - | - | + | + | - | - | History of fever and malaise | - | ↑ Leukocytes,
↑ Protein ↓ Glucose |
CSF analysis[12] | Fever, neck |
Encephalitis | + | + | +/- | +/- | - | - | + | +/- | + | History of fever and malaise | + | ↑ Leukocytes, ↓ Glucose | CSF PCR | Fever, seizures, focal neurologic abnormalities |
Brain tumor[13] | + | - | - | - | + | + | + | - | + | Weight loss, fatigue | + | Cancer cells[14] | MRI | Cachexia, gradual progression of symptoms |
Hemorrhagic stroke | + | + | + | + | + | + | + | + | - | Hypertension | + | - | CT scan without contrast[15][16] | Neck stiffness |
Subdural hemorrhage | + | + | + | + | + | - | - | - | + | Trauma, fall | + | Xanthochromia[17] | CT scan without contrast[15][16] | Confusion, dizziness, nausea, vomiting |
Neurosyphilis[18][19] | + | - | + | + | + | + | - | + | - | STIs | + | ↑ Leukocytes and protein | CSF VDRL-specifc
CSF FTA-Ab -sensitive[20] |
Blindness, confusion, depression,
Abnormal gait |
Complex or atypical migraine | + | - | + | + | - | - | + | - | - | Family history of migraine | - | - | Clinical assesment | Presence of aura, nausea, vomiting |
Hypertensive encephalopathy | + | + | - | - | - | - | + | + | - | Hypertension | + | - | Clinical assesment | Delirium, cortical blindness, cerebral edema, seizure |
Wernicke’s encephalopathy | - | + | - | - | - | + | + | + | + | History of alcohal abuse | - | - | Clinical assesment and lab findings | Ophthalmoplegia, confusion |
CNS abscess | + | + | - | - | + | + | + | - | - | History of drug abuse, endocarditis, immunosupression | + | ↑ leukocytes, ↓ glucose and ↑ protien | MRI is more sensitive and specific | High grade fever, fatigue,nausea, vomiting |
Drug toxicity | - | + | - | + | + | + | - | + | - | - | - | - | Drug screen test | Lithium, Sedatives, phenytoin, carbamazepine |
Conversion disorder | + | + | + | + | + | + | + | + | History of emotional stress | - | - | Diagnosis of exclusion | Tremors, blindness, difficulty swallowing | |
Metabolic disturbances (electrolyte imbalance, hypoglycemia) | - | + | + | + | + | + | - | - | + | - | - | Hypoglycemia, hypo and hypernatremia, hypo and hyperkalemia | Depends on the cause | Confusion, seizure, palpitations, sweating, dizziness, hypoglycemia |
Multiple sclerosis exacerbation | - | - | + | + | - | + | + | + | + | History of relapses and remissions | + | ↑ CSF IgG levels
(monoclonal bands) |
Clinical assesment and MRI [21] | Blurry vision, urinary incontinence, fatigue |
Seizure | + | + | - | - | + | + | - | - | + | Previous history of seizures | - | Mass lesion | Clinical assesment and EEG [22] | Confusion, apathy, irritability, |
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.
- ↑ Carbonnelle E (2009). "[Laboratory diagnosis of bacterial meningitis: usefulness of various tests for the determination of the etiological agent]". Med Mal Infect. 39 (7–8): 581–605. doi:10.1016/j.medmal.2009.02.017. PMID 19398286.
- ↑ Morgenstern LB, Frankowski RF (1999). "Brain tumor masquerading as stroke". J Neurooncol. 44 (1): 47–52. PMID 10582668.
- ↑ Weston CL, Glantz MJ, Connor JR (2011). "Detection of cancer cells in the cerebrospinal fluid: current methods and future directions". Fluids Barriers CNS. 8 (1): 14. doi:10.1186/2045-8118-8-14. PMC 3059292. PMID 21371327.
- ↑ 15.0 15.1 Birenbaum D, Bancroft LW, Felsberg GJ (2011). "Imaging in acute stroke". West J Emerg Med. 12 (1): 67–76. PMC 3088377. PMID 21694755.
- ↑ 16.0 16.1 DeLaPaz RL, Wippold FJ, Cornelius RS, Amin-Hanjani S, Angtuaco EJ, Broderick DF; et al. (2011). "ACR Appropriateness Criteria® on cerebrovascular disease". J Am Coll Radiol. 8 (8): 532–8. doi:10.1016/j.jacr.2011.05.010. PMID 21807345.
- ↑ Lee MC, Heaney LM, Jacobson RL, Klassen AC (1975). "Cerebrospinal fluid in cerebral hemorrhage and infarction". Stroke. 6 (6): 638–41. PMID 1198628.
- ↑ Liu LL, Zheng WH, Tong ML, Liu GL, Zhang HL, Fu ZG; et al. (2012). "Ischemic stroke as a primary symptom of neurosyphilis among HIV-negative emergency patients". J Neurol Sci. 317 (1–2): 35–9. doi:10.1016/j.jns.2012.03.003. PMID 22482824.
- ↑ Berger JR, Dean D (2014). "Neurosyphilis". Handb Clin Neurol. 121: 1461–72. doi:10.1016/B978-0-7020-4088-7.00098-5. PMID 24365430.
- ↑ Ho EL, Marra CM (2012). "Treponemal tests for neurosyphilis--less accurate than what we thought?". Sex Transm Dis. 39 (4): 298–9. doi:10.1097/OLQ.0b013e31824ee574. PMC 3746559. PMID 22421697.
- ↑ Giang DW, Grow VM, Mooney C, Mushlin AI, Goodman AD, Mattson DH; et al. (1994). "Clinical diagnosis of multiple sclerosis. The impact of magnetic resonance imaging and ancillary testing. Rochester-Toronto Magnetic Resonance Study Group". Arch Neurol. 51 (1): 61–6. PMID 8274111.
- ↑ Manford M (2001). "Assessment and investigation of possible epileptic seizures". J Neurol Neurosurg Psychiatry. 70 Suppl 2: II3–8. PMC 1765557. PMID 11385043.