RT Book, Section
A1 Kasper, Dennis L.
A1 Fauci, Anthony S.
A1 Hauser, Stephen L.
A1 Longo, Dan L.
A1 Jameson, J. Larry
A1 Loscalzo, Joseph
SR Print(0)
ID 1128782836
T1 Headache
T2 Harrison's Manual of Medicine, 19e
YR 2016
FD 2016
PB McGraw-Hill Education
PP New York, NY
SN 9780071828529
LK accessmedicine.mhmedical.com/content.aspx?aid=1128782836
RD 2024/04/19
AB APPROACH  TO  THE  PATIENT:  HeadacheAmong  the  most  common  reasons  that  pts  seek  medical  attention;  can  be  either  primary  or  secondary  (Table  49-1).  First  step—distinguish  serious  from  benign  etiologies.  Symptoms  that  raise  suspicion  for  a  serious  cause  are  listed  in  Table  49-2.  Intensity  of  head  pain  rarely  has  diagnostic  value;  most  pts  who  present  with  worst  headache  of  their  lives  have  migraine.  Headache  location  can  suggest  involvement  of  local  structures  (temporal  pain  in  giant  cell  arteritis,  facial  pain  in  sinusitis).  Ruptured  aneurysm  (instant  onset),  cluster  headache  (peak  over  3–5  min),  and  migraine  (pain  increases  over  minutes  to  hours)  differ  in  time  to  peak  intensity.  Provocation  by  environmental  factors  suggests  a  benign  cause.Complete  neurologic  examination  is  important  in  evaluation  of  headache.  If  examination  is  abnormal  or  if  serious  underlying  cause  is  suspected,  an  imaging  study  (CT  or  MRI)  is  indicated  as  a  first  step.  Lumbar  puncture  (LP)  is  required  when  meningitis  (stiff  neck,  fever)  or  subarachnoid  hemorrhage  (following  negative  imaging)  is  a  possibility.  The  psychological  state  of  the  pt  should  also  be  evaluated  because  a  relationship  exists  between  pain  and  depression.