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Headache Diagnostic Testing

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1. Migraine headache in children

in quality, of moderate or severe intensity, and is aggravated by routine physical activity. Nausea, vomiting, photophobia, and phonophobia are common accompanying symptoms. Headache Classification Committee of the International Headache Society (IHS). The international classification of headache disorders, 3rd edition (beta version). Cephalalgia. 2013 Jul;33(9):629-808. https://www.ichd-3.org/ http://www.ncbi.nlm.nih.gov/pubmed/23771276?tool=bestpractice.com Diagnostic criteria for children are broader (...) than those used for adults in relationship to both duration and localisation of pain. Many affected children do not fit the traditional diagnostic classifications that have been developed from practice in adults. Ryan S. Medicines for migraine. Arch Dis Child Educ Pract Ed. 2007 Apr;92(2):ep50-5. http://www.ncbi.nlm.nih.gov/pubmed/17430855?tool=bestpractice.com This should not exclude them from a trial of acute or prophylactic treatment, provided that alternative diagnoses have been carefully

2018 BMJ Best Practice

2. Cluster headache

from the episodic form. History and exam presence of risk factors repeated attacks of unilateral pain excruciating pain lacrimation, rhinorrhoea, and partial Horner's syndrome agitation nausea, vomiting photophobia, phonophobia migrainous aura male sex family history head injury cigarette smoking heavy drinking Diagnostic investigations brain CT scan or MRI erythrocyte sedimentation rate pituitary function tests polysomnogram ECG Treatment algorithm ACUTE ONGOING Contributors Authors Clinical (...) Cluster headache Cluster headache - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Cluster headache Last reviewed: February 2019 Last updated: July 2018 Summary Attack of severe pain localised to the unilateral orbital, supra-orbital, and/or temporal areas; lasts from 15 minutes to 3 hours. Occurs from once every other day to 8 times per day. Attacks occur at the same time period for several weeks (the cluster period

2018 BMJ Best Practice

3. Migraine headache in adults

to light sensitivity to noise aura vomiting unilateral throbbing sensation family history of migraine high caffeine intake exposure to change in barometric pressure female sex obesity habitual snoring stressful life events overuse of headache medications lack of sleep low socio-economic status allergies or asthma hypertension hypothyroidism diet Diagnostic investigations clinical diagnosis erythrocyte sedimentation rate (ESR) lumbar puncture (LP) cerebrospinal fluid (CSF) culture CT head MRI brain (...) Migraine headache in adults Migraine headache in adults - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Migraine headache in adults Last reviewed: February 2019 Last updated: October 2018 Summary Migraine is a chronic, genetically determined, episodic, neurological disorder that usually presents in early-to-mid life. Patients complain of intermittent headache and associated symptoms, such as visual disturbance

2018 BMJ Best Practice

4. Migraine headache in adults

to light sensitivity to noise aura vomiting unilateral throbbing sensation family history of migraine high caffeine intake exposure to change in barometric pressure female sex obesity habitual snoring stressful life events overuse of headache medications lack of sleep low socio-economic status allergies or asthma hypertension hypothyroidism diet Diagnostic investigations clinical diagnosis erythrocyte sedimentation rate (ESR) lumbar puncture (LP) cerebrospinal fluid (CSF) culture CT head MRI brain (...) Migraine headache in adults Migraine headache in adults - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Migraine headache in adults Last reviewed: February 2019 Last updated: October 2018 Summary Migraine is a chronic, genetically determined, episodic, neurological disorder that usually presents in early-to-mid life. Patients complain of intermittent headache and associated symptoms, such as visual disturbance

2018 BMJ Best Practice

5. Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Acute Headache

to the ED, the differential diagnosis is extensive and inclusive of multiple life- 107 threatening etiologies. 7-9 Additional clinical findings such as fever, severe back pain, or other factors may warrant 108 further additional diagnostic testing. 10 This clinical policy also excludes the specific discussion of acute headache 109 in the pregnant women and postpartum woman, for whom the list of differential diagnoses of acute headache is 110 further expanded. 111 This policy is an update of the 2008 (...) a normal head CT is a long-standing diagnostic 507 regimen that will occasionally reveal alternative diagnoses. If the LP is no longer performed, these 508 diagnoses may be missed, particularly in patients for whom other diagnoses remain in the 509 differential, eg, meningitis. 510 • The use of the recommendation could result in a rare missed SAH. 511 512 Key words/phrases for literature searches: headache, migraine, subarachnoid hemorrhage, brain 513 angiography, cerebral angiograph, computed

2019 American College of Emergency Physicians

6. 34m with fever, headache and myalgias

provider’s diagnosis [4:36] Interpreting the test of treatment [9:42] Keeping your instincts on a leash? [10:58] Case presentation, part 2 [12:33] Diagnostic schemas [14:30] Our discussant’s differential and the final diagnosis [17:46] Shira’s cognitive autopsy [23:02] Show Notes “ Diagnostic momentum ” refers to our conscious or unconscious tendency to avoid rethinking a diagnosis that has already been “assigned” to a patient. While most diagnoses made by doctors are correct, many are not. Since (...) it is often impractical to comprehensively question every assigned diagnosis, learning to recognize when these labels do not fit the patient is an essential skill. The test of treatment is a legitimate diagnostic tool, but like any test, it can produce false positive and false negative results. False positive: A doctor may misdiagnose angina if her patient’s chest pain improves with nitroglycerin, when in fact it remitted spontaneously. False negative: A patient with obstructive sleep apnea may complain

2019 Clinical Correlations

7. Headache

Summary of Literature Review Introduction/Background The cause or type of most headaches can be determined by procuring a careful history and performing a physical examination while focusing on the warning signals that prompt further diagnostic testing. In the absence of worrisome features in the history or examination, the task is then to diagnose the primary headache syndrome based on the clinical features. If atypical features are present or the patient does not respond to conventional therapy (...) to an aneurysm than to an AVM. In a combination of 3 series, as many as 165 of 350 patients (47%) presenting with thunderclap headache had acute SAH [53-55]. The key to SAH diagnosis is the noncontrast head CT [56]. Failure to obtain the head CT accounts for 73% of misdiagnosis [57]. If the CT scan is negative, a lumbar puncture should be performed to disclose additional instances of SAH [54,55]. Patients diagnosed with acute SAH require MRA, computed tomography angiography (CTA), and/or catheter angiography

2019 American College of Radiology

8. Monoclonal antibodies to prevent migraine headaches

into specific head and neck sites. Other drugs are used in migraine prevention but patient adherence and efficacy are issues. Anti-calcitonin gene-related peptide (anti-CGRP) monoclonal antibodies belong to a novel class of drugs that target CGRP — a potent vasodilator — which plays a role in pain and migraines. Four anti-CGRP monoclonal antibodies are currently in development for use in the prevention of episodic and chronic migraines: eptinezumab, erenumab, fremanezumab, and galcanezumab. They have (...) not been determined, these drugs will potentially have a significant budget impact because of the high cost of biologics and the prevalence of episodic and chronic migraines. Background A migraine is characterized as a headache, with at least two of the following pain attributes: moderate or severe, throbbing, localized to one area, and avoidance of routine physical activity because of the pain. 1,2 The headache must be accompanied by at least one of the following symptoms: nausea or vomiting

2018 CADTH - Issues in Emerging Health Technologies

9. Differences of Cluster Headache on the Basis of Sex in the Korean Cluster Headache Registry. (Abstract)

Headache Registry, a prospective, cross-sectional, multicenter headache registry that collected data from consecutive patients diagnosed with CH. Demographics and clinical characteristics were compared between the sexes.In total, 250 patients were enrolled in this study; 41 (16.4%) were women (male to female ratio 5.1:1). Mean age of onset did not differ between women and men (30.7 ± 15.5 vs 29.0 ± 11.1 years). The clinical features of CH in women and men were similar, with no differences in pain (...) severity, duration, and attack frequency. Among autonomic features, facial and forehead sweating was significantly rare in women (4.9%) compared to men with CH (33.0%). Headache-related disability assessed by Headache Impact Test-6 did not differ between the sexes; however, depression scale assessed by Patients Health Questionnaire-9 (11.0 ± 8.5 vs 7.0 ± 5.8, P = .009) and stress (Perceived Stress Scale 4, 7.5 ± 3.4 vs 6.4 ± 3.0, P = .045) were significantly higher in women with CH.Although decreasing

2019 Headache

10. CRACKCast E103 – Headache Disorders

on the IHSC (international headache society classification) Primary Secondary “Organic, identifiable, distinct pathologic process” Others: Migraine Cluster Tension H/A attributed to trauma or injury to the head or neck Cranial or cervical vascular disorder Nonvascular intracranial disorder A substance or its withdrawal Infection Disorder of homeostasis Headache or facial pain attributed to disorder of cranium, neck, Eyes, ears, nose, sinuses, teeth, mouth, or other facial or cranial structures PAINFUL (...) for diagnostic caution . A subset of otherwise typical patients have facial location of pain, which is called “facial migraine” in the literature; there is no evidence that these patients form a separate subgroup of migraine patients. In young children, photophobia and phonophobia may be inferred from their behaviour. Migraine attacks can be associated with cranial autonomic symptoms and symptoms of cutaneous allodynia.” from ICHD-3.org 2) Describe four unique presentations of migraine headache Retinal

2017 CandiEM

11. Headache ? Child

. Overview of diagnosis and management of paediatric headache. Part I: diagnosis. J Headache Pain. 2011;12(1):13-23. 19. American College of Radiology. ACR Appropriateness Criteria ® : Seizures — Child. Available at: https://acsearch.acr.org/docs/69441/Narrative/. Accessed December 4, 2017. 20. Mortimer AM, Bradley MD, Stoodley NG, Renowden SA. Thunderclap headache: diagnostic considerations and neuroimaging features. Clin Radiol. 2013;68(3):e101-113. 21. Bederson JB, Connolly ES, Jr., Batjer HH, et al (...) with syringohydromyelia) or headache worsened by the Valsalva ACR Appropriateness Criteria ® 8 Headache — Child maneuver are typical findings. Most literature agrees that occipital headache in children is rare and calls for diagnostic caution; however, isolated occipital and cervical pain are not characteristic symptoms of any headache group in the pediatric age group, and their presence or absence does not correspond to changes on conventional brain MRI [37]. Children with sickle cell anemia are a special subgroup

2017 American College of Radiology

12. Chronic migraine and chronic tension-type headache

) OR 2) Has changed to episodic migraine (defined as <15 headache days per month) for three consecutive months. Maximum of five treatment cycles. Action The committee checked for availability of a Medicare national coverage decision (NCD). Medicare does not have a NCD for treatment of migraines and chronic tension headaches. The committee discussed clinical guidelines identified for chronic migraine and chronic tension headaches treatment from the following organizations: ? Diagnosis and management (...) ), composed of eleven independent health care professionals, reviews all the information and renders a decision at an open public meeting. The Washington State HTCC determines how selected health technologies are covered by several state agencies (RCW 70.14.080-140). These technologies may include medical or surgical devices and procedures, medical equipment, and diagnostic tests. HTCC bases its decisions on evidence of the technology’s safety, efficacy, and cost effectiveness. Participating state

2017 Washington Health Care Authority

13. Headache Diagnostic Testing

Headache Diagnostic Testing Headache Diagnostic Testing Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Headache Diagnostic Testing (...) Headache Diagnostic Testing Aka: Headache Diagnostic Testing From Related Chapters II. Diagnostics or See See Focal neurologic symptoms or signs Progressive s Symptoms of increasing Indications to obtain head imaging prior to Suspected CNS mass Altered neurologic exa Venogram or the preferred MR Venogram Cerebral Venous Sinus Thrombosis (LP) ( or suspected) Do not delay antibiotics if is suspected (but attempt to get first if possible) LP indicated in with negative with opening pressure (e.g

2018 FP Notebook

14. Characteristics and diagnoses of acute headache in pregnant women – a retrospective cross-sectional study Full Text available with Trip Pro

Characteristics and diagnoses of acute headache in pregnant women – a retrospective cross-sectional study Acute headache is one of the most frequent neurological symptoms in pregnant women. The early diagnosis of underlying secondary conditions has a major influence on patient outcome, especially in emergency settings. However, at the time being no well-established guideline for diagnostic evaluation of acute headache during pregnancy exists. In this study, we aimed to characterize acute (...) headache in pregnant women concerning demographic, clinical, and diagnostic features, and to determine predictors of secondary headache.We analysed retrospectively the data of 151 pregnant women receiving neurological consultation due to acute headache at the Charité Berlin between 2010 and 2016. To assess risk factors for secondary headache in these patients we compared multiple anamnestic and clinical features of the primary and secondary headache group.57.6% of the patients were diagnosed

2017 The journal of headache and pain

15. Head-to-head comparison of the diagnostic performance of coronary computed tomography angiography and dobutamine-stress echocardiography in the evaluation of acute chest pain with normal ECG findings and negative troponin tests: A prospective multicenter (Abstract)

Head-to-head comparison of the diagnostic performance of coronary computed tomography angiography and dobutamine-stress echocardiography in the evaluation of acute chest pain with normal ECG findings and negative troponin tests: A prospective multicenter To perform a head-to-head comparison of coronary CT angiography (CCTA) and dobutamine-stress echocardiography (DSE) in patients presenting recent chest pain when troponin and ECG are negative.Two hundred seventeen patients with recent chest (...) -positive rates was 1.70 (95% CI 1.65-1.75) and 1.00 (95% CI 0.91-1.09), respectively, when non-contributive CCTA and DSE were both considered positive. Only one missed acute coronary syndrome was observed at six months.CCTA has higher diagnostic performance than DSE in the evaluation of patients with recent chest pain, normal ECG findings, and negative troponine to exclude coronary artery disease.Copyright © 2017. Published by Elsevier B.V.

2017 International journal of cardiology

16. Reduced Computed Tomography Use in the Emergency Department Evaluation of Headache Was Not Followed by Increased Death or Missed Diagnosis Full Text available with Trip Pro

Reduced Computed Tomography Use in the Emergency Department Evaluation of Headache Was Not Followed by Increased Death or Missed Diagnosis This study investigated whether a 9.6% decrease in the use of head computed tomography (HCT) for patients presenting to the emergency department (ED) with a chief complaint of headache was followed by an increase in proportions of death or missed intracranial diagnosis during the 22.5-month period following each index ED visit.We reviewed the electronic (...) to determine whether the condition was reasonably likely to have been related to the index ED visit's presentation, thereby representing a missed diagnosis.Of the 582 separate index ED visits sampled, we observed a total of nine deaths and 10 missed intracranial diagnoses. There was no difference in the proportion of death (p = 0.337) or missed intracranial diagnosis (p = 0.312) observed after a 9.6% reduction in HCT use. Among patients who subsequently had visits for headache or brain imaging, we found

2018 Western Journal of Emergency Medicine

17. Diagnosis and Management of Headache in Older Adults. Full Text available with Trip Pro

Diagnosis and Management of Headache in Older Adults. Headache is a common, disabling neurologic problem in all age groups, including older adults. In older adults, headache is most likely a primary disorder, such as tension-type headache or migraine; however, there is a higher risk of secondary causes, such as giant cell arteritis or intracranial lesions, than in younger adults. Thus, based on the headache history, clinical examination, and presence of headache red flags, a focused diagnostic (...) evaluation is recommended, ranging from blood tests to neuroimaging, depending on the headache characteristics. Regardless of the primary or secondary headache disorder diagnosis, treatment options may be limited in older patients and may need to be tailored to the presence of comorbid medical conditions. The purpose of this review is to provide an update on the management of headache in older adults, from diagnosis to treatment.Copyright © 2017 Mayo Foundation for Medical Education and Research

2018 Mayo Clinic Proceedings

18. Testing myWHI: Online Self-help Programs for Headaches

diagnosed with psychosis and/or schizophrenia, because a past or current diagnosis may likely interfere with the participants ability to fully participate in the study have participated in our recent three-armed pilot RCT (i.e., any participant who consented and was randomized) they complete less than 50% of daily entries (i.e., less than 14 daily entries) in an electronic headache dairy when they asked to use it for 4 weeks More than 15 headache days during the 4 weeks that they are asked to use (...) Testing myWHI: Online Self-help Programs for Headaches Testing myWHI: Online Self-help Programs for Headaches - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Testing myWHI: Online Self-help Programs

2018 Clinical Trials

19. Headache, Diagnosis and Treatment of

. Together, we aim to improve care and reduce costs for our patients, families and communities. e Guidelines Headache, Diagnosis and Treatment of REVISION DATE: JANUARY 2013 / ELEVENTH EDITION GUIDELINE SUMMARY Scope and Target Population Patients age 12 years and older who present with headache. For the purpose of this guideline, pain that primarily involves the back of the neck and only involves the head to a limited extent is not considered a headache. This guideline does not specifically address (...) have a treatment plan or report adherence to a treatment plan. Decrease the percentage of patients with migraine headache who are prescribed opiates and barbiturates for the treatment of migraines to less than 5%. Increase the percentage of patients with migraine headache who have appropriate acute treatment. Clinical Highlights Headache is diagnosed by history and physical examination with limited need for imaging or laboratory tests. Warning signs of possible disorder other than primary headache

2013 Institute for Clinical Systems Improvement

20. Real-world health plan claims analysis of differences in healthcare utilization and total cost in patients suffering from cluster headaches and those without headache-related conditions. (Abstract)

explores the impact of headache conditions on healthcare utilization.To assess differences in healthcare utilization and total cost in patients suffering from cluster headaches (CH) compared with patients without headache-related conditions.Medical and pharmacy claims data from 4 regional health plans were used to evaluate differences in healthcare utilization and cost in patients with a diagnosis code for CH (chronic, episodic, or unspecified) from International Classification of Diseases, Ninth (...) Revision, Clinical Modification or International Classification of Diseases, Tenth Revision, Clinical Modification compared with a control group of patients without headache-related conditions. Qualifying patients were aged at least 18 years and continuously eligible for their health plan for 3 consecutive years during the study period (January 1, 2009-December 31, 2015). The first date with a diagnosis of CH was considered the index date and the subsequent 3 years of claims data were used

2017 American Journal Of Managed Care

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