Diagnosis and Treatment of Headache. Diagnosis Algorithm.

[Migraine (See Migraine algorithm)]

[Tension-type (See Tension-type algorithm)]

[Cluster (See Cluster algorithm)]

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Source: Institute for Clinical Systems Improvement (ICSI). Diagnosis and treatment of headache. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2007 Jan. 72 p. Diagnosis and Treatment of Headache Diagnosis Algorithm Patient presents with complaint of a headache. A Detailed History *Characteristics of the headache. *Assess functional impairment. *Past medical history. *Family history of migraines. *Current medications (Rx and over-the-counter). *Social history. *Review of systems - to rule out systemic illness. Critical first steps: *Detailed history. *Focused physical examination. *Focused neurological examination. A Causes for concern: *Subacute and / or progressive headache over months. *New or different headache. *"Worst headache ever". *Any headache of maximum severity at onset. *Onset after the age of 50 years old. *Symptoms of systemic illness. *Seizures. *Any neurological signs. Causes for concern? A Consider secondary headache disorder. A Headaches other than primary headache. Out of guideline. Meets criteria for primary headache disorder? A Specialty consultation indicated? A Refer to headache specialist Perform diagnostic testing if indicated. A Diagnosis of primary headache confirmed? Findings consistent with secondary headache? A Determine secondary headache type. Out of guideline. Evaluate type of primary headache. Initiate patient education and lifestyle management. A A = Annotation Migraine (See Migraine algorithm) Tension-type (See Tension-type algorithm) Cluster (See Cluster algorithm) Chronic daily headache. A Sinus Headache. Migraine-associated symptoms are often misdiagnosed as "sinus headache" by patients and providers. This has led to the underdiagnosis and treatment of migraine. The International Headache Society (IHS) defines sinus headache by purulent nasal discharge, pathologic sinus finding by imaging,simultaneous onset of headache and sinusitis, and headache localized to specific facial and cranial areas of the sinuses. All copyrights are reserved by the Institute for Clinical Systems Improvement, Inc.