Headache, differential diagnosis

DDx

Classification of Headaches

Headache red flags.

The International Classification of Headache Disorders 3rd edition classifies headaches into primary and secondary headaches.

I. Primary Headaches (e.g., tension, migraine, cluster)

Primary headaches are headache syndromes not due to another cause. Primary headaches are often chronic and the diagnosis is established early in adulthood.

  1. Migraine
  2. Tension-type headache
  3. Cluster headaches
  4. Trigeminal autonomic cephalalgias ( other than cluster headaches )
  5. Other primary headache disorders
    -Primary cough headaches
    -Primary exercise headache
    -Primary headaches associated with sexual activity
    -Primary thunderclap headache / idiopathic thunderclap
    -Cold-Stimulus Headache
    -External pressure headache
    -Primary stabbing headache
    -Nummular headache
    -Hypnic headache
    -New Daily Persistent Headache

II. Secondary Headaches (e.g., those caused by infection or vascular disease, etc.)

Secondary headache syndromes are due to other causes (e.g. systemic illness or neurological abnormalities).

The VINDICATED MEN mnemonic works very well here.

5. Headache attributed to trauma or injury to the head and/or neck
6. Headache attributed to cranial or cervical vascular disorder
7. Headache attributed to non-vascular intracranial disorder
8. Headache attributed to a substance or its withdrawal
9. Headache attributed to infection
10. Headache attributed to disorder of homeostasis
11. Headache or facial pain attributed to disorder of the cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cervical structure
12. Headache attributed to psychiatric disorder

Secondary headaches, in detail

Neuropsychiatric
Neuralgias (e.g., trigeminal neuralgia)
Spontaneous intracranial hypotension
Pituitary apoplexy
Glaucoma
Drugs & Drug withdrawal
Medication overuse (Rebound headache) / Daily withdrawal headaches
Caffeine withdrawal headaches
Drug side effect
Toxic Exposures
Carbon monoxide
Vascular
Cerebral aneurysm
Subdural hematoma
Subarachnoid hemorrhage
Arterial dissections
Cerebral venous sinus thrombosis
Vasculitis
Temporal arteritis (Giant Cell arteritis)
Stroke
Reversible cerebral vasoconstriction syndrome
Acute severe hypertension
Preeclampsia
Infection
Meningitis/encephalitis/brain abscess
Human immunodeficiency virus
HSV encephalitis
Viral syndrome
Febrile illness
Herpes Zoster (also neurologic)
Sinusitis
Neoplasm
Pseudotumor cerebri (intracranial hypertension)
Brain tumor
Musculoskeletal head & Neck problems
Temporomandibular joint syndrome
Cervical arthritis
Cervicogenic headache
Occipital neuralgia
Trauma
Postconcussion syndrome
Domestic abuse
Spinal headache (after lumbar puncture)
Environmental
Allergy Headaches.
Sinus headaches

III. Painful cranial neuropathies, other facial pains, and other headaches

13. Painful cranial neuropathies and other facial pains
15. Other headache disorders

References
https://www.ncbi.nlm.nih.gov/pubmed/23771276
www.ichd-3.org
https://headaches.org/resources/the-complete-headache-chart/

print