Differential diagnosis of Recurrent Benign Headache Syndrome
  Migraine Tension Headache Chronic Daily Headache
Age of onset 10-30 yo any age 30-40 yo
Duration 4-72 hours 30 min to 7 days constant
Frequency variable occasional to daily Daily
Time of day any time Worse in PM Constant
Quality pulsatile Dull aching, band like Variable
Location retro-orbital, temporal, hemicranium bilateral, bitemporal or occipital nuchal variable
Associated symptoms Nausea/vomiting, photophobia & phonophobia other symptoms rare May have history of Migraine or psychiatric illness. Analgesic abuse common

 

Clues to a specific headache diagnosis
Onset Descriptions Differential
Sudden onset severe headache Patient able to pinpoint the exact time of onset of headache Subarachnoid hemorrhage, Cluster headache
Onset after age 50 Most benign headache starts before the age of 50 Rule out tumor, Subdural hematoma
Side locked headache Seen in Migraine, cluster headache, less often in tension headache still need to rule out tumor
Associated symptoms
Fever, meningeal signs suspect infection: meningitis, abscess, endocarditis, meningeal carcinomatosis
Behavior or personality change Even if subtle change observed by family or coworkers. Need to rule out tumor, encephalitis, depression
Decreased vision in both eyes Suspect autoimmune disease, infection, optic chiasm lesion. TB, Fungal meningitis, Uveitis, pituitary tumor.
Abnormal or funny gait Suspect frontal lobe dysfunction, hydrocephalus, Tumor, SDH, hydrocephalus
Endocrine change Symptoms of hypothyroidism, galactorrhea, decreased libido: suspect pituitary tumor, carniopharyngioma
Constitutional symptoms Joint pain, Jaw claudication, loss of appetite, fatigue, anemia. Giant cell arteritis, autoimmune disease.


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