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3 - Approach to History Taking and the Physical Examination

Published online by Cambridge University Press:  09 October 2017

Serena L. Orr
Affiliation:
Children’s Hospital of Eastern Ontario, Ottawa
Benjamin W. Friedman
Affiliation:
Albert Einstein College of Medicine, New York
David W. Dodick
Affiliation:
Mayo Clinic, Phoenix, AZ
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Summary

Abstract

The majority of patients presenting to the emergency department (ED) have non-life-threatening primary headaches such as migraine, tension-type, or cluster headache. It is important to differentiate this group from the smaller number of patients with a secondary headache disorder, which can be serious with potentially fatal outcomes.

A careful history and physical examination is the most important part of the evaluation of the patient presenting to the ED with headache. This helps to determine whether there is a significant risk for secondary headache and whether additional investigations are needed.

This chapter discusses how to approach adults who present to the ED with headache, with an emphasis on determining elements of the history indicative of an underlying secondary cause as well as important questions to ask patients presenting with a primary headache disorder. In addition, key elements of the general medical and neurological examination will be reviewed.

Type
Chapter
Information
Emergency Headache
Diagnosis and Management
, pp. 15 - 25
Publisher: Cambridge University Press
Print publication year: 2017

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References

1.Edmeads, J. Challenges in the diagnosis of acute headache. Headache. 1990;30:53740.Google Scholar
2.Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia. 2013;33(9):629808.Google Scholar
3.Pozzi, M, Roccatagliata, D, Sterzi, R. Drug abuse and intracranial hemorrhage. Neurol Sci. 2008;29(Suppl. 2):S269–70.Google Scholar
4.McGee, SM, McGee, DN, McGee, MB. Spontaneous intracranial hemorrhage related to methamphetamine abuse: autopsy findings and clinical correlation. Am J Forensic Med Pathol. 2004;25(4):334–7.Google Scholar
5.Cozzolino, M, Bianchi, C, Mariani, G, et al. Therapy and differential diagnosis of posterior reversible encephalopathy syndrome (PRES) during pregnancy and postpartum. Arch Gynecol Obstet. 2015 ;292(6):1217–23.Google Scholar
6.Coutinho, JM. Cerebral venous sinus thrombosis in women. Stroke. 2009;40(7):2356–61.Google Scholar
7.Rogers, LR. Cerebrovascular complications in cancer patients. Neurol Clin. 2003;21(1):167–92.Google Scholar
8.Berger, JR. Pearls: neurologic complications of HIV/AIDS. Semin Neurol. 2010;30(1):6670.Google Scholar
9.Sheikh, HU, Cho, TA Clinical aspects of headache in HIV. Headache 2014;54(5):939–45.Google Scholar
10.Dodick, D. Diagnosing headache: clinical clues and clinical rules. Adv Stud Med. 2003;3(2):8792.Google Scholar
11.Sobri, M, Lamont, AC, Alias, NA, Win, MN. Red flags in patients presenting with headache: clinical indications for neuroimaging. Br J Radiol. 2003; 76(908):532–5.Google Scholar
12.Dodick, D. Headache as a symptom of ominous disease: what are the warning signals? Postgrad Med. 1997;101(5):4650.Google Scholar
13.Ward, TN, Levin, M, Phillips, JM. Evaluation and management of headache in the emergency department. Med Clin North Am. 2001;85:971.Google Scholar
14.Stewart, WF, Wood, C, Reed, ML, et al. Cumulative lifetime migraine incidence in women and men. Cephalalgia. 2008;28:1170–8.Google Scholar
15.Swanson, JW, Yanagihara, T, Stang, PE, et al. Incidence of cluster headaches: a population-based study in Olmstead County, Minnesota. Neurology. 1994;44:433–7.Google Scholar
16.Bravo, TP. Headaches of the elderly. Curr Neurol Neurosci Rep. 2015;15(30):19.Google Scholar
17.Kahn, K, Finkel, A. It is a tumor: current review of headache and brain tumor. Curr Pain Headache Rep. 2014;18(6):421.Google Scholar
18.Schievink, WI, Deline, CR. Headache secondary to intracranial hypotension. Curr Pain Headache Rep. 2014;18:457.Google Scholar
19.Anderson, C, Mhurchu, N, Scott, D, et al. Triggers of subarachnoid hemorrhage: role of physical exertion, smoking, and alcohol in the Australasian Cooperative Reseach on Subarachnoid Hemorrhage Study (ACROSS). Stroke. 2003;34(7):1771–6.Google Scholar
20.Alvarez, R, Ramón, C, Pascual, J. Clues in the differential diagnosis of primary vs secondary cough, exercise, and sexual headaches. Headache. 2014;54(9):1560–2.Google Scholar
21.Debette, S, Germain, DP. Neurologic manifestations of inherited disorders of connective tissue. Handb Clin Neurol. 2014;119:565–76.Google Scholar
22.Ring, T, Spiegelhalter, D. Risk of intracranial aneurysm bleeding in autosomal-dominant polycystic kidney disease. Kidney Int. 2007;72(11):1400–2.Google Scholar
23.Zorbalar, N, Yesilaras, M, Aksay, E. Carbon monoxide poisoning in patients presenting to the emergency department with a headache in winter months. Emerg Med J. 2014;31(1):6670.Google Scholar
24.Adapted from Dodick, D. Diagnosing headache: clinical clues and clinical rules. Adv Stud Med. 2003;3(2):8792.Google Scholar
25.Stiell, IG, Wells, GA, Vandemheen, K, et al. The Canadian CT head rule for patients with minor head injury. Lancet. 2001;357(9266):1391–6.Google Scholar
26.Thomas, KE, Hasbun, R, Jekel, J, Quagliarello, VJ. The diagnostic accuracy of Kernig’s sign, Brudzinski’s sign, and nuchal rigidity in adults with suspected meningitis. Clin Infect Dis. 2002;35:4652.Google Scholar
27.Uchihara, T, Tsukagoshi, H. Jolt accentuation of headache: the most sensitive sign of CSF pleocytosis. Headache. 1991;31(3):167–71.Google Scholar
28.Nakao, JH, Jafri, FN, Shah, K, Newman, DH. Jolt accentuation of headache and other clinical signs: poor predictors of meningitis in adults. Am J Emerg Med. 2014;32(1):24–8.Google Scholar
29.Rosenfeld, RM, Piccirillo, JF, Chandrasekhar, SS, et al. Clinical practice guideline (update): adult sinusitis. Otolaryngol Head Neck Surg. 2015;152(Suppl. 2): S1–39.Google Scholar
31.Smetana, GW, Shmerling, RH. Does this patient have temporal arteritis? JAMA. 2002;287(1):92101.Google Scholar
32.Lama, DSC, Thama, CCY, Laia, JSM, Leung, DYL. Current approaches to the management of acute primary angle closure. Curr Opin Ophthalmol. 2007;18:146–51.Google Scholar
33.Lyrer, PA, Brandt, T, Metso, TM, et al. Clinical import of Horner syndrome in internal carotid and vertebral artery dissection. Neurology. 2014;82:1653–9.Google Scholar
34.Jacks, AS, Miller, NR. Spontaneous retinal venous pulsation: aetiology and significance. J Neurol Neurosurg Psychiatry. 2003;74:79.Google Scholar
35.Detsky, ME, McDonald, DR, Baerlocher, MO, et al. Does this patient with headache have a migraine or need neuroimaging? JAMA. 2006;296:1274–83.Google Scholar
36.Vertesi, A, Lever, JA, Molloy, DW, et al. Standardized mini-mental state examination: use and interpretation. Can Fam Physician. 2001;47:2018–23.Google Scholar
37.Teasdale, G, Jennett, B. Assessment of coma and impaired consciousness: a practical approach. Lancet. 1974;304(7872):81–4.Google Scholar
38.Coello, AF, Canals, AG, Gonzalez, JM, Martín, JJA. Cranial nerve injury after minor head trauma. J Neurosurg. 2010;113(3):547–55.Google Scholar
39.Lam, BL, Thompson, HS, Corbett, JJ. The prevalence of simple anisocoria. Am J Ophthalmol. 1987;104(1):6973.Google Scholar
40.Optic Neuritis Study Group. The clinical profile of optic neuritis: experience of the optic neuritis treatment trial. Arch Ophthalmol. 1991;109:1673–8.Google Scholar
41.Darcy, P, Moughty, AM. Pronator drift. N Engl J Med. 2013;369(16):e20.Google Scholar

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