Clinical Evaluation of Acute,New Onset Headache [Mnemonic]

Clinical Evaluation of Acute, New Onset Headache :

• H: Headache Differential Diagnosis

  • New-onset and severe headache has a different differential diagnosis compared to recurrent headaches over many years. The probability of finding a potentially serious cause is considerably greater in new-onset and severe headache.

  E: Evaluation

  • A careful neurologic examination is an essential first step in the evaluation. Patients with an abnormal examination or a history of recent-onset headache should be evaluated by a computed tomography (CT) or magnetic resonance imaging (MRI) study of the brain.

  A: Additional Tests

  • In some circumstances, a lumbar puncture (LP) is also required, unless a benign etiology can be otherwise established. A general evaluation of acute headache might include cranial arteries by palpation; cervical spine by the effect of passive movement of the head and by imaging; the investigation of cardiovascular and renal status by blood pressure monitoring and urine examination; and eyes by funduscopy, intraocular pressure measurement, and refraction.

  D: Depression and Anxiety

  • The patient’s psychological state should also be evaluated because a relationship exists between head pain, depression, and anxiety. Medicines with antidepressant actions are also effective in the preventive treatment of both tension-type headache and migraine, but each symptom must be treated optimally.

  A: Activated Recurrent Headache Disorders

  • Underlying recurrent headache disorders may be activated by pain that follows otologic or endodontic surgical procedures. Thus, treatment of the headache is largely ineffective until the cause of the primary problem is addressed.

  C: Causes of Serious Headache

  • Serious causes to be considered include meningitis, subarachnoid hemorrhage, epidural or subdural hematoma, glaucoma, tumor, and purulent sinusitis. When worrisome symptoms and signs are present (Table 16-2), rapid diagnosis and management are critical.

  H: Headache and Brain Tumor

  • Brain tumor is a rare cause of headache and even less commonly a cause of severe pain. The vast majority of patients presenting with severe headache have a benign cause.

Mnemonic: ” HEADACHe“