Get answers to your Pediatric Headache and Hospitalist questions.
Many patients reported a delay of 1 - 6 years in the diagnosis of their headaches. Migraine-like symptoms (light and sound sensitivity, aura, nausea, vomiting) are major reasons for the frequent misdiagnosis by primary care doctors. In some cases, patients are inappropriately treated for other types of headaches or health conditions (including having sinus surgery).
Cluster headache is diagnosed by medical history, including the pattern of recurrent attacks, and by oyd typical symptoms (swollen eyelid, watery eye, runny nose). Keeping a headache diary to record a description of attacks can help the doctor make an accurate diagnosis. The patient should describe to the doctor:
Pain may be indicated by using a number system:
1 = Mild, barely noticeable
2 = Noticeable, but does not interfere with work or activities
3 = Distracts from work or activities
4 = Makes work or activities very difficult
5 = Incapacitating
To diagnose a chronic headache, the doctor will examine the head and neck and perform a neurologic examination, which includes a series of simple exercises to test strength, reflexes, coordination, and sensation. The doctor may also examine the eyes. The doctor may ask questions to test short-term memory and related aspects of mental function.
The doctor may order a computed tomography (CT) scan or magnetic resonance imaging (MRI) test of the head to check for brain abnormalities that may be causing the headaches.
As part of the diagnosis, a doctor should rule out other headaches and disorders. If the results of the history and physical examination suggest other or accompanying causes of headaches or serious complications, extensive imaging tests are performed.
Migraines. Cluster headaches are often misdiagnosed as migraines but they are quite different:
Nevertheless, in both cases, the headache suffers can be highly sensitive to light and noise, which may make it difficult to distinguish between them.
Other Headaches. Other headaches that resemble migraines include SUNCT (short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing) and chronic paroxysmal hemicrania, which are other primary headaches, and some secondary headaches notably trigeminal neuralgia (TN), temporal arteritis, and sinus headaches. Cluster symptoms, however, are usually precise enough to rule out these other types of headaches.
Tear in the Carotid Artery. A tear in the carotid artery (which leads to the brain) can cause pain that resembles a cluster headache. People with this condition may even respond to sumatriptan, a drug used to treat a cluster attack. Doctors should consider imaging tests for patients with a first episode of cluster headache in which this event is suspected.
Orbital Myositis. An unusual condition called orbital myositis, which produces swelling of the muscles around the eye, may mimic symptoms of cluster headache. This condition should be considered in patients who have unusual symptoms such as protrusion of the eyeball, painful eye movements, or pain that does not dissipate within 3 hours.
Headaches indicating a serious underlying problem, such as cerebrovascular disorder or malignant hypertension, are uncommon. (It should be emphasized that a headache is not a common symptom of a brain tumor.) People with existing chronic headaches, however, might miss a more serious condition believing it to be one of their usual headaches. Such patients should immediately call a doctor if the quality of a headache or accompanying symptoms has changed. Everyone should call a doctor for any of the following symptoms:
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