Differential Diagnosis for Migraines

In the evaluation of headaches, accurate and rapid diagnostic testing should be done to assist in establishing the basis for an effective treatment plan. The differential diagnosis would start with asking the patient about the headache history. A physical examination, laboratory tests and other diagnostic evaluations would follow to allow the physician to classify the headache as either primary or secondary for effective treatment (Lipton, 2011).

Tension-Type Headache, TTH is characterized by pain that is pressing and tightening whose intensity ranges for mild to moderate with no nausea (Bierman, 2011). Moreover, TTH is not intensified by physical activity although it may be accompanied by either sensitivity to noise or light. The headache lasts from 30 minutes to 7 days. New Daily Persistent Headache: The patient experiences unremitting daily headaches which get severe. Nausea, if present is normally mild although chances of photophobia and phonophobia may occur. Migraines: Headache is characterized by unilateral location, pulsating or throbbing quality, aggravation by physical activity, for instance walking, nausea or vomiting as well as photophobia and phonophobia.

The differential diagnosis of these types of headaches is crucial because each responds to different treatments. Migraines respond well to triptans. Daily prophylactic medication is recommended for severe attacks that are not responsive to abortive medication (Lipton, 2011). Drugs, such as beta blockers, propranolol, anticonvulsants divalproex sodium and topiramate may be administered. Moreover, educating patients about headache triggers, such as bright lights, weather changes, and stress is also important in its management.

Bierman (2011) asserts that it is crucial to ask the patient timing questions, such as the severity of the headache in a scale of 1-10, the duration the headache persists. Cause questions, such as aggravating, relieving, trigger, or predisposing factors as well as a family history of similar headaches. Moreover, response questions include the medication tried or used before. Grazzi and Usai (2011) note the tests a doctor may perform as; an eye examination, a physical examination of the head and neck to check for tenderness, a neurological examination to test for strength, coordination and mental function. Imaging test may also be performed in the form of CT-scans or magnetic resonance imaging.


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