Urgent evaluation of headache in adults without history of trauma
Urgent evaluation of headache in adults without history of trauma
This is an overview of our approach to the urgent evaluation of headache in an adult. It should be used in conjunction with other UpToDate content on headache.
CO-Hgb: carboxyhemoglobin; CO: carbon monoxide; CT: computed tomography; HA: headache; CNS: central nervous system; MRA: magnetic resonance angiography; MRI: magnetic resonance imaging; MRV: magnetic resonance venography; LP: lumbar puncture; SAH: subarachnoid hemorrhage; c/w: consistent with. * All patients with acute or subacute head trauma should have head CT scan; pregnant women >20 weeks gestation or women in early postpartum should be evaluated for preeclampsia. ΒΆ The main clinical features of these conditions are listed below:
Giant cell (temporal) arteritis typically affects people age >50 years and may be associated with systemic manifestations fever, fatigue, weight loss, jaw claudication, visual symptoms, particularly transient monocular visual loss and diplopia, or symptoms of polymyalgia rheumatic.
Acute angle-closure glaucoma may present with vision loss, headache, severe eye pain, light halos, nausea, and vomiting. Exam reveals a red eye, corneal cloudiness or edema, a shallow anterior chamber, and poorly reactive mid dilated pupil.
Optic neuritis typically presents with painful, monocular visual loss that evolves over several hours to a few days. One-third of patients have visible optic nerve inflammation (papillitis) on funduscopic examination. MRI of the brain and orbits with gadolinium contrast confirms the diagnosis in most cases.
Idiopathic intracranial hypertension (pseudotumor cerebri) typically affects obese women of child-bearing age. Characteristic features are headache, papilledema, vision loss or diplopia, elevated lumbar puncture opening pressure with normal cerebrospinal fluid composition. MRI with MR venography is the preferred study to exclude secondary causes of elevated intracranial pressure, particularly cerebral venous thrombosis.
Pheochromocytoma is a rare condition that may present with episodic headache, sweating, and tachycardia. Sustained or paroxysmal hypertension is the most common sign, but 5 to 15% of patients present with normal blood pressure.
Acute herpes zoster usually presents with a vesicular rash and acute painful neuritis. Prodromal pain may precede the rash by days to weeks. In unusual cases, pain may be related to herpes zoster without rash (zoster sine herpete).
Postherpetic neuralgia usually affects the thoracic, cervical, and trigeminal nerves. In most cases, the diagnosis is made when pain persists beyond four months in the same distribution as a preceding documented episode of acute herpes zoster.
Trigeminal neuralgia is defined by sudden, usually unilateral, severe, brief, stabbing or lancinating, recurrent episodes of pain in the distribution of one or more branches of the fifth cranial (trigeminal) nerve.
