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Headache Diagnostic Testing

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1. 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

2. Field testing primary stabbing headache criteria according to the 3rd beta edition of International Classification of Headache Disorders: a clinic-based study (PubMed)

Field testing primary stabbing headache criteria according to the 3rd beta edition of International Classification of Headache Disorders: a clinic-based study The diagnostic criteria for primary stabbing headache (PSH) in the 3rd beta edition of International Classification of Headache Disorders (ICDH-3 beta) were recently revised. In the ICDH-3 beta, PSH is defined as short-lasting head pain spontaneous occurring as a single stab or series of stabs without autonomic symptoms and involving all (...) of pain.Data from 280 patients with headache with stabbing pain without apparent cause were collected, and 245 patients were followed up for 2 weeks. Secondary causes for stabbing headache were observed in 9 patients (herpes zoster in 7 patients and Bell's palsy in 2 patients) after 2 weeks. The remaining 236 patients fulfilled the diagnostic criteria for PSH according to ICHD-3 beta. Only 22 patients met the diagnostic criteria for PSH according to ICHD-2.All patients with headache with stabbing pain

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2016 The journal of headache and pain

3. Cluster headache

injection, lacrimation, rhinorrhoea, nasal stuffiness, eyelid and facial swelling, aural fullness, facial sweating, and redness. Most patients become very restless or agitated during an acute attack, unlike people with migraine who often report motion sensitivity during attacks. Ninety percent of patients will have episodic cluster headache, Bahra A, May A, Goadsby PJ. Cluster headache: a prospective clinical study with diagnostic implications. Neurology. 2002 Feb 12;58(3):354-61. http (...) ://www.ncbi.nlm.nih.gov/pubmed/11839832?tool=bestpractice.com which consists of attacks lasting from 7 days to 1 year (averaging from 2 weeks to 3 months), separated by remission periods lasting at least 1 month. The chronic form of cluster headache is seen in approximately 10% Bahra A, May A, Goadsby PJ. Cluster headache: a prospective clinical study with diagnostic implications. Neurology. 2002 Feb 12;58(3):354-61. http://www.ncbi.nlm.nih.gov/pubmed/11839832?tool=bestpractice.com and consists of attacks that occur

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. 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

6. 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 (...) hormonal changes alcohol and caffeine volume depletion overuse of analgesics sleep disturbance bright or flickering lights periodic syndromes Diagnostic investigations no initial test brain CT/MRI Treatment algorithm ACUTE ONGOING Contributors Authors Consultant Paediatrician Northampton General Hospital Northampton UK Disclosures NB declares that he has no competing interests. Peer reviewers Medical Director Mayo Clinic Pediatric Center Rochester MN Disclosures KM declares that he has no competing

2018 BMJ Best Practice

7. 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

8. 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 (...) contrast 5 ??? MRA head without and with IV contrast 4 O MRA head without IV contrast 4 Perform this procedure in selected cases when vascular disease suspected. O CTA head with IV contrast 4 ??? CT head with IV contrast 3 ??? Arteriography cervicocerebral 2 This procedure is not used as a primary diagnostic tool. ??? Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate *Relative Radiation Level ACR Appropriateness Criteria ® 2 Headache Clinical Condition

2019 American College of Radiology

9. 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 (...) increase unnecessary testing. 220 • Misapplication of the recommendation because of confusion with decision rule criteria for 221 inclusion may increase unnecessary diagnostic testing. 222 • In rare cases, potential SAH may be missed, resulting in neurologic morbidity or death. 223 224 225 Key words/phrases for literature searches: headache, primary headache, thunderclap headache, acute 226 headache, acute onset headache, acute primary headache, sudden acute headache, sudden onset headache, non- 227

2019 American College of Emergency Physicians

10. Use of routine complete blood count results to rule out anaplasmosis without the need for specific diagnostic testing. (PubMed)

Use of routine complete blood count results to rule out anaplasmosis without the need for specific diagnostic testing. Anaplasmosis presents with fever, headache, and laboratory abnormalities including leukopenia and thrombocytopenia. Polymerase chain reaction (PCR) is the preferred diagnostic but is overutilized. We determined if routine laboratory tests could exclude anaplasmosis, improving PCR utilization.Anaplasma PCR results from a 3-year period, with associated complete blood count (CBC (...) ) and liver function test (LFT) results, were retrospectively reviewed. PCR rejection criteria, based on white blood cell (WBC) and platelet (PLT) count, were developed and prospectively applied in a mock-stewardship program. If rejection criteria were met, a committee mock-refused PCR unless the patient was clinically unstable or immunocompromised.WBC and PLT counts were the most actionable routine tests for excluding anaplasmosis. Retrospective review demonstrated rejection criteria of WBC≥11,000/µL

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2019 Clinical Infectious Diseases

11. Monoclonal antibodies to prevent migraine headaches

III trials. All trials involved multiple testing centres and all were industry-sponsored (Table 3). The sample sizes ranged from 264 patients to 1,130 patients. The patient population included adult patients with a history of chronic migraine. Patients were randomized to receive either the treatment drug or placebo. The drugs were tested over a 12-week period. The primary outcome included the change in frequency of migraines or headaches. Table 3: Characteristics of Randomized, Double-Blind (...) ClinicalTrials.gov (NCT02614261) 44 Keller (2017) 30 REGAIN Multi-centre Eli Lilly Phase III 12 weeks N = 825 Patients 18- to 65-years-old with at least 15 migraine headaches days per month Galcanezumab 120 mg SC monthly c (n = 278) Galcanezumab 240 mg SC once monthly c (n = 277) Matching placebo (n = 558) Change from baseline in monthly migraine days over 12 weeks IV = intravenous; NR = not reported; SC = subcutaneous. a Doses of 10 mg and 30 mg were also tested in the trial. b Patients in this trial arm

2018 CADTH - Issues in Emerging Health Technologies

12. Reassurance after diagnostic testing with a low pretest probability of serious disease: systematic review and meta-analysis

Reassurance after diagnostic testing with a low pretest probability of serious disease: systematic review and meta-analysis Reassurance after diagnostic testing with a low pretest probability of serious disease: systematic review and meta-analysis Reassurance after diagnostic testing with a low pretest probability of serious disease: systematic review and meta-analysis Rolfe A, Burton C CRD summary This well-conducted review concluded that diagnostic tests, for symptoms with a low risk (...) of serious illness, did little to reassure patients, decrease their anxiety, or resolve their symptoms, but they could prevent some subsequent primary care visits. This conclusion reflects the results of the review and appears likely to be reliable. Authors' objectives To assess the impact of diagnostic tests in reassuring patients with a low probability of serious disease. Searching Six databases, including MEDLINE and PsycINFO, were searched for articles from inception to the end of 2011. Search terms

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2013 DARE.

13. Spontaneous Subarachnoid Hemorrhage: A Systematic Review and Meta-analysis Describing the Diagnostic Accuracy of History, Physical Examination, Imaging, and Lumbar Puncture With an Exploration of Test Thresholds

Spontaneous Subarachnoid Hemorrhage: A Systematic Review and Meta-analysis Describing the Diagnostic Accuracy of History, Physical Examination, Imaging, and Lumbar Puncture With an Exploration of Test Thresholds Spontaneous subarachnoid hemorrhage (SAH) is a rare, but serious etiology of headache. The diagnosis of SAH is especially challenging in alert, neurologically intact patients, as missed or delayed diagnosis can be catastrophic.The objective was to perform a diagnostic accuracy (...) to 23) and LR- was 0.21 (95% CI = 0.03 to 1.7). Using the pooled estimates of diagnostic accuracy and testing risks and benefits, we estimate that LP only benefits CT-negative patients when the pre-LP probability of SAH is on the order of 5%, which corresponds to a pre-CT probability greater than 20%.Less than one in 10 headache patients concerning for SAH are ultimately diagnosed with SAH in recent studies. While certain symptoms and signs increase or decrease the likelihood of SAH, no single

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2016 EvidenceUpdates

14. CRACKCast E103 – Headache Disorders

are unilateral location, pulsating quality, moderate or severe intensity, aggravation by routine physical activity and association with nausea and/or photophobia and phonophobia. Diagnostic criteria: A. At least five attacks 1 fulfilling criteria B-DB. Headache attacks lasting 4-72 hr (untreated or unsuccessfully treated) 2;3 C. Headache has at least two of the following four characteristics: 1. unilateral location 2. pulsating quality 3. moderate or severe pain intensity 4. Aggravation by or causing (...) , sensory or other central nervous system symptoms that usually develop gradually and are usually followed by headache and associated migraine symptoms. Diagnostic criteria: A.At least two attacks fulfilling criteria B and CB. One or more of the following fully reversible aura symptoms: 1. Visual“scintillating scotomas (bright rim around an area of visual loss), teichopsia (subjective visual image perceived with eyes open or closed), fortification spectra (zigzagged lines that slowly drift across

2017 CandiEM

15. Headache ? Child

with headache begins with acquiring a thorough medical history and performing a physical examination with measurement of vital signs, including blood pressure, a complete neurologic examination, and examination of the optic discs. Primary headaches, such as migraine or tension headaches that are typically chronic or recurrent, are the predominant type of headache in children. It is important to recognize that migraine headaches in young children may not meet the usual diagnostic criteria (eg (...) 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

16. Chronic migraine and chronic tension-type headache

), 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 (...) Chronic migraine and chronic tension-type headache Revised Final Chronic migraine and chronic tension-type headache: findings and decision Page 1 of 5 Health Technology Clinical Committee Findings and Decision Topic: Treatment of chronic migraine and chronic tension-type headache Meeting date: May 19, 2017 Final adoption: July 14, 2017 Revised: July 13, 2018 Meeting materials and transcript are available on the HTA website: www.hca.wa.gov/about-hca/health-technology-assessment/meetings

2017 Washington Health Care Authority

17. Health worker adherence to malaria treatment guidelines at outpatient health facilities in southern Malawi following implementation of universal access to diagnostic testing. (PubMed)

Health worker adherence to malaria treatment guidelines at outpatient health facilities in southern Malawi following implementation of universal access to diagnostic testing. Appropriate diagnosis and treatment are essential for reducing malaria mortality. A cross-sectional outpatient health facility (HF) survey was conducted in southern Malawi from January to March 2015 to determine appropriate malaria testing and treatment practices four years after implementation of a policy requiring (...) diagnostic confirmation before treatment.Enrolled patients were interviewed, examined and had their health booklet reviewed. Health workers (HWs) were asked about training, supervision and access to the 2013 national malaria treatment guidelines. HFs were assessed for malaria diagnostic and treatment capacity. Weighted descriptive analyses and logistic regression of patient, HW and HF characteristics related to testing and treatment were performed.An evaluation of 105 HFs, and interviews of 150 HWs

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2017 Malaria journal

18. Outbreak of travel-related pontiac fever among hotel guests illustrating the need for better diagnostic tests. (PubMed)

Outbreak of travel-related pontiac fever among hotel guests illustrating the need for better diagnostic tests. Pontiac fever (PF), a legionellosis with influenza-like symptoms and high attack rates, is rarely reported. Travel-related outbreaks can elude detection because infected persons are often widely removed geographically from the transmission source before illness onset. Thirty-one persons staying at an Illinois hotel during August 9 to 11, 2002, reported influenza-like symptoms to local (...) health departments within 24 to 48 hours of checkout. We investigated to identify the cause and source of illness to guide control measures.Hotel water samples were collected for culture. A telephone questionnaire detailing illness symptoms and exposures was administered to all who were guests at the hotel from August 9 to 15 (n = 380). A case was defined as onset of fever, headache, and myalgia in a guest in the 14 days following the hotel stay. Patient sera were tested by hemagglutination assay

2017 Journal of Travel Medicine

19. Diagnostic test accuracy of jolt accentuation for headache in acute meningitis in the emergency setting [Cochrane protocol]

Diagnostic test accuracy of jolt accentuation for headache in acute meningitis in the emergency setting [Cochrane protocol] Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites. Email salutation (e.g. "Dr Smith" or "Joanne") for correspondence (...) -Bonferroni correction for testing multiple subgroup analyses will be performed. If one or more subgroup analyses cannot be performed due to insufficient data, the p-value will be adjusted accordingly. ">Other Subgroup analysis or meta-regression are used to explore between-study heterogeneity and can provide insight into the relationship between study characteristics (e.g. species, sex or drug class or dose) and effect size. They should be considered hypothesis-generating. Ideally, a threshold describing

2017 PROSPERO

20. Clinimetric evaluation of diagnostic tests for headaches: a systematic review of the literature

Clinimetric evaluation of diagnostic tests for headaches: a systematic review of the literature Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites. Email salutation (e.g. "Dr Smith" or "Joanne") for correspondence: Organisation web address (...) models Example: Heterogeneity will be assessed using the (residual) I2 and adjusted R2 statistics. ">Heterogeneity For further guidance please refer to the and to pre-clinical meta-analysis. Example: Whenever a control group serves more than one experimental group, we will correct the total number of control animals in the meta-analysis by dividing the number of animals in the control group by the number of treatment groups served. Where applicable, Holm-Bonferroni correction for testing multiple

2017 PROSPERO

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