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Differential diagnosis of Recurrent Benign
Headache Syndrome
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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. |
Headache information center
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