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  • Updated 08.12.2023
  • Released 10.21.2004
  • Expires For CME 08.12.2026

Acute headache: diagnosis



Headache is a common chief complaint in acute settings. The diagnosis of acute headache can be challenging and should proceed in an orderly fashion. An important first step is to distinguish primary from secondary headache disorders. The approach is to seek “red flags” in the history and exam that suggest the possibility of secondary headache. If red flags are identified, the clinician must entertain potential secondary diagnoses and proceed with the appropriate diagnostic investigations. In the absence of secondary headache, the clinician diagnoses a primary headache disorder.

Key points

• Migraine is the most common diagnosis in the evaluation of acute headache.

• Secondary causes must be ruled out in all cases of acute headache presentation, mainly based on “red flags” uncovered in the history and physical/neurologic examination.

• A systematic approach to the headache, characterizing it in terms of duration, quality, location, and accompanying symptoms, speeds the diagnosis.

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