COVID-19-associated headache differential diagnosis: Difference between revisions
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==Overview== | ==Overview== | ||
COVID-19-associated headache must be differentiated from other diseases that cause headache, such as [[migraine]], [[tension-type headache]], [[Cluster headache (patient information)|cluster headache]], [[seizure]], [[meningitis]], [[encephalitis]], [[neurosyphilis]], [[Subarachnoid hemorrhage|SAH]], [[subdural hematoma]], [[brain tumor]], [[hypertensive encephalopathy]], [[brain abscess]], [[multiple sclerosis]], [[hemorrhagic stroke]], [[Wernicke's encephalopathy|Wernickes encephalopathy]], and [[drug toxicity]] etc. | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
COVID-19-associated headache must be differentiated from other diseases that cause headache, such as [[migraine]], [[tension-type headache]], [[Cluster headache (patient information)|cluster headache]], [[seizure]], [[meningitis]], [[encephalitis]], [[neurosyphilis]], [[Subarachnoid hemorrhage|SAH]], [[subdural hematoma]], [[brain tumor]], [[hypertensive encephalopathy]], [[brain abscess]], [[multiple sclerosis]], [[hemorrhagic stroke]], [[Wernicke's encephalopathy|Wernickes encephalopathy]], and [[drug toxicity]] etc.<ref name="pmid145039852">{{cite journal |vauthors= |title=National guidelines for analysis of cerebrospinal fluid for bilirubin in suspected subarachnoid haemorrhage |journal=Ann. Clin. Biochem. |volume=40 |issue=Pt 5 |pages=481–8 |date=September 2003 |pmid=14503985 |doi=10.1258/000456303322326399 |url=}}</ref><ref name="pmid237177982">{{cite journal| author=Le Rhun E, Taillibert S, Chamberlain MC| title=Carcinomatous meningitis: Leptomeningeal metastases in solid tumors. | journal=Surg Neurol Int | year= 2013 | volume= 4 | issue= Suppl 4 | pages= S265-88 | pmid=23717798 | doi=10.4103/2152-7806.111304 | pmc=3656567 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23717798 }}</ref><ref name="pmid243266182">{{cite journal| author=Chow E, Troy SB| title=The differential diagnosis of hypoglycorrhachia in adult patients. | journal=Am J Med Sci | year= 2014 | volume= 348 | issue= 3 | pages= 186-90 | pmid=24326618 | doi=10.1097/MAJ.0000000000000217 | pmc=4065645 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24326618 }}</ref><ref name="pmid228800962">{{cite journal| author=Leen WG, Willemsen MA, Wevers RA, Verbeek MM| title=Cerebrospinal fluid glucose and lactate: age-specific reference values and implications for clinical practice. | journal=PLoS One | year= 2012 | volume= 7 | issue= 8 | pages= e42745 | pmid=22880096 | doi=10.1371/journal.pone.0042745 | pmc=3412827 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22880096 }}</ref><ref name="pmid106549482">{{cite journal| author=Negrini B, Kelleher KJ, Wald ER| title=Cerebrospinal fluid findings in aseptic versus bacterial meningitis. | journal=Pediatrics | year= 2000 | volume= 105 | issue= 2 | pages= 316-9 | pmid=10654948 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10654948 }}</ref><ref name="pmid206108192">{{cite journal| author=Brouwer MC, Tunkel AR, van de Beek D| title=Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis. | journal=Clin Microbiol Rev | year= 2010 | volume= 23 | issue= 3 | pages= 467-92 | pmid=20610819 | doi=10.1128/CMR.00070-09 | pmc=2901656 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20610819 }}</ref><ref name="pmid27692742">{{cite journal |vauthors=Vermeulen M, Hasan D, Blijenberg BG, Hijdra A, van Gijn J |title=Xanthochromia after subarachnoid haemorrhage needs no revisitation |journal=J. Neurol. Neurosurg. Psychiatry |volume=52 |issue=7 |pages=826–8 |date=July 1989 |pmid=2769274 |pmc=1031927 |doi=10.1136/jnnp.52.7.826 |url=}}</ref><ref name="pmid158850532">{{cite journal |vauthors=Wasay M, Mekan SF, Khelaeni B, Saeed Z, Hassan A, Cheema Z, Bakshi R |title=Extra temporal involvement in herpes simplex encephalitis |journal=Eur. J. Neurol. |volume=12 |issue=6 |pages=475–9 |date=June 2005 |pmid=15885053 |doi=10.1111/j.1468-1331.2005.00999.x |url=}}</ref><ref name="pmid171092902">{{cite journal |vauthors=Glaser CA, Honarmand S, Anderson LJ, Schnurr DP, Forghani B, Cossen CK, Schuster FL, Christie LJ, Tureen JH |title=Beyond viruses: clinical profiles and etiologies associated with encephalitis |journal=Clin. Infect. Dis. |volume=43 |issue=12 |pages=1565–77 |date=December 2006 |pmid=17109290 |doi=10.1086/509330 |url=}}</ref><ref name="pmid214901812">{{cite journal |vauthors=Meltzer EO, Hamilos DL |title=Rhinosinusitis diagnosis and management for the clinician: a synopsis of recent consensus guidelines |journal=Mayo Clin. Proc. |volume=86 |issue=5 |pages=427–43 |date=May 2011 |pmid=21490181 |pmc=3084646 |doi=10.4065/mcp.2010.0392 |url=}}</ref><ref name="pmid19410102">{{cite journal |vauthors=Rasmussen BK, Jensen R, Schroll M, Olesen J |title=Epidemiology of headache in a general population--a prevalence study |journal=J Clin Epidemiol |volume=44 |issue=11 |pages=1147–57 |date=1991 |pmid=1941010 |doi=10.1016/0895-4356(91)90147-2 |url=}}</ref><ref name="pmid154476952">{{cite journal |vauthors=Kelman L |title=The premonitory symptoms (prodrome): a tertiary care study of 893 migraineurs |journal=Headache |volume=44 |issue=9 |pages=865–72 |date=October 2004 |pmid=15447695 |doi=10.1111/j.1526-4610.2004.04168.x |url=}}</ref><ref name="pmid266433782">{{cite journal |vauthors=Laurell K, Artto V, Bendtsen L, Hagen K, Häggström J, Linde M, Söderström L, Tronvik E, Wessman M, Zwart JA, Kallela M |title=Premonitory symptoms in migraine: A cross-sectional study in 2714 persons |journal=Cephalalgia |volume=36 |issue=10 |pages=951–9 |date=September 2016 |pmid=26643378 |doi=10.1177/0333102415620251 |url=}}</ref><ref>{{cite web | author=Charlotte E. Grayson and The Cleveland Clinic Neuroscience Center | title=Cluster Headaches |url=http://www.webmd.com/content/article/46/1826_50688.htm | date=October 2004 | publisher=WebMD | accessdate=2006-09-22}}</ref><ref name="pmid78887472">{{cite journal |vauthors=Drummond PD |title=Sweating and vascular responses in the face: normal regulation and dysfunction in migraine, cluster headache and harlequin syndrome |journal=Clin. Auton. Res. |volume=4 |issue=5 |pages=273–85 |date=October 1994 |pmid=7888747 |doi=10.1007/BF01827433 |url=}}</ref><ref name="pmid166869022">{{cite journal |vauthors=Drummond PD |title=Mechanisms of autonomic disturbance in the face during and between attacks of cluster headache |journal=Cephalalgia |volume=26 |issue=6 |pages=633–41 |date=June 2006 |pmid=16686902 |doi=10.1111/j.1468-2982.2006.01106.x |url=}}</ref><ref name="pmid22454692">{{cite journal |vauthors=Ekbom K |title=Evaluation of clinical criteria for cluster headache with special reference to the classification of the International Headache Society |journal=Cephalalgia |volume=10 |issue=4 |pages=195–7 |date=August 1990 |pmid=2245469 |doi=10.1046/j.1468-2982.1990.1004195.x |url=}}</ref><ref name="pmid76977072">{{cite journal |vauthors=Sandrini G, Antonaci F, Pucci E, Bono G, Nappi G |title=Comparative study with EMG, pressure algometry and manual palpation in tension-type headache and migraine |journal=Cephalalgia |volume=14 |issue=6 |pages=451–7; discussion 394–5 |date=December 1994 |pmid=7697707 |doi=10.1046/j.1468-2982.1994.1406451.x |url=}}</ref><ref name="pmid75157932">{{cite journal |vauthors=Jensen R, Fuglsang-Frederiksen A |title=Quantitative surface EMG of pericranial muscles. Relation to age and sex in a general population |journal=Electroencephalogr Clin Neurophysiol |volume=93 |issue=3 |pages=175–83 |date=June 1994 |pmid=7515793 |doi=10.1016/0168-5597(94)90038-8 |url=}}</ref> | |||
( | {| class="wikitable" | ||
|+ | |||
! rowspan="2" |Disease | |||
! colspan="13" |History and Physical Examination | |||
! rowspan="2" |PMHx | |||
! colspan="3" |Diagnostic approach | |||
|- | |||
!Bilateral | |||
!Throbbing character | |||
!Autonomic symptoms | |||
!Fever | |||
!Photophobia | |||
!Aphasia | |||
!LOC | |||
!Aura | |||
!Nause/ | |||
Vomiting | |||
!Rash | |||
!Neck stiffness | |||
!Vision changes | |||
!Neurologic deficits | |||
!Labs and CSF findings | |||
!CT/MRI | |||
!Gold standard test | |||
|- | |||
|[[Migraine]] | |||
|<nowiki>-</nowiki> | |||
| + | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+</nowiki> | |||
|<nowiki>+</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
| + | |||
|<nowiki>-</nowiki> | |||
|Trigger factors, family hx | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|Clinical assesment | |||
|- | |||
|[[Tension-type headache|Tension-type headache (TTH)]] | |||
|<nowiki>+</nowiki> | |||
| - | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
| - | |||
|<nowiki>-</nowiki> | |||
|[[stress]], [[genetics]] | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|Clinical assesment | |||
|- | |||
|[[Cluster headache]] | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+</nowiki> | |||
|<nowiki>-</nowiki> | |||
|episodic history | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|Clinical assesment | |||
|- | |||
|[[Seizure]] | |||
|<nowiki>+</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>+</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|Hx of [[Seizure|seizures]] | |||
|prolactin level | |||
|<nowiki>+/- mass lesion</nowiki> | |||
|[[EEG]] <ref name="pmid11385043">{{cite journal| author=Manford M| title=Assessment and investigation of possible epileptic seizures. | journal=J Neurol Neurosurg Psychiatry | year= 2001 | volume= 70 Suppl 2 | issue= | pages= II3-8 | pmid=11385043 | doi= | pmc=1765557 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11385043 }}</ref> | |||
|- | |||
|[[Meningitis]] | |||
|<nowiki>+</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>+</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+</nowiki> | |||
|Hx of [[fever]], [[malaise]] | |||
|[[Leukocytosis|<math>\uparrow</math>WBC]] | |||
<math>\uparrow</math>Protein | |||
<math>\downarrow</math>glucose | |||
|<nowiki>+/-</nowiki> | |||
|[[CSF analysis]]<ref name="pmid19398286">{{cite journal| author=Carbonnelle E| title=[Laboratory diagnosis of bacterial meningitis: usefulness of various tests for the determination of the etiological agent]. | journal=Med Mal Infect | year= 2009 | volume= 39 | issue= 7-8 | pages= 581-605 | pmid=19398286 | doi=10.1016/j.medmal.2009.02.017 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19398286 }}</ref> | |||
|- | |||
|[[Encephalitis]] | |||
|<nowiki>+</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>+</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+</nowiki> | |||
|Hx of [[fever]], [[malaise]] | |||
|elevated WBC, low glucose | |||
|<nowiki>+</nowiki> | |||
|CSF PCR | |||
|- | |||
|[[Brain tumor]]<ref name="pmid10582668">{{cite journal| author=Morgenstern LB, Frankowski RF| title=Brain tumor masquerading as stroke. | journal=J Neurooncol | year= 1999 | volume= 44 | issue= 1 | pages= 47-52 | pmid=10582668 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10582668 }}</ref> | |||
|<nowiki>+</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|[[weight loss]], [[fatigue]] | |||
|neuromarkers, | |||
Cancer cells<ref name="pmid21371327">{{cite journal| author=Weston CL, Glantz MJ, Connor JR| title=Detection of cancer cells in the cerebrospinal fluid: current methods and future directions. | journal=Fluids Barriers CNS | year= 2011 | volume= 8 | issue= 1 | pages= 14 | pmid=21371327 | doi=10.1186/2045-8118-8-14 | pmc=3059292 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21371327 }}</ref> | |||
|<nowiki>+/- mass</nowiki> | |||
|[[MRI]] | |||
|- | |||
|[[Subdural hematoma|Subdural hemorrhage]] | |||
|<nowiki>-/+</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|[[Trauma]], [[fall]] | |||
|Xanthochromia | |||
|<nowiki>+</nowiki> | |||
|CT w/o contrast | |||
|- | |||
|[[Subarachnoid hemorrhage]] | |||
| -/+ | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|[[thunderclap headache]] | |||
|<math>\uparrow</math>opening pressure, xanthochromia | |||
|<nowiki>+</nowiki> | |||
|CT w/o contrast | |||
|- | |||
|[[Hypertensive encephalopathy]] | |||
|<nowiki>+</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|[[Hypertension]] | |||
|UA +/- | |||
|<nowiki>+/-</nowiki> | |||
|clinical assessment | |||
|- | |||
|[[Brain abscess|CNS abscess]] | |||
|<nowiki>-/+</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|History of [[drug abuse]], [[endocarditis]], [[immunosupression]] | |||
|'''↑''' [[Leukocytosis|leukocytes]], '''↓''' [[glucose]] and '''↑''' protien | |||
|<nowiki>+</nowiki> | |||
|[[MRI]] | |||
|- | |||
|[[Conversion disorder]] | |||
|<nowiki>-/+</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|History of [[emotional stress]] | |||
|<nowiki>-</nowiki> | |||
| - | |||
|Diagnosis of exclusion | |||
|- | |||
|[[Multiple sclerosis]] | |||
|<nowiki>-/+</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|History of relapses and remissions | |||
|'''↑''' [[CSF]] [[IgG]] levels | |||
(monoclonal bands) | |||
|<nowiki>+</nowiki> | |||
|[[MRI]] | |||
|- | |||
|[[Hemorrhagic stroke]] | |||
|<nowiki>-/+</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|[[Hypertension|HTN]] | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+</nowiki> | |||
|[[CT scan]] without contrast<ref name="pmid21694755">{{cite journal| author=Birenbaum D, Bancroft LW, Felsberg GJ| title=Imaging in acute stroke. | journal=West J Emerg Med | year= 2011 | volume= 12 | issue= 1 | pages= 67-76 | pmid=21694755 | doi= | pmc=3088377 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21694755 }}</ref><ref name="pmid21807345">{{cite journal| author=DeLaPaz RL, Wippold FJ, Cornelius RS, Amin-Hanjani S, Angtuaco EJ, Broderick DF et al.| title=ACR Appropriateness Criteria® on cerebrovascular disease. | journal=J Am Coll Radiol | year= 2011 | volume= 8 | issue= 8 | pages= 532-8 | pmid=21807345 | doi=10.1016/j.jacr.2011.05.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21807345 }}</ref> | |||
|- | |||
|[[Neurosyphilis]]<ref name="pmid22482824">{{cite journal| author=Liu LL, Zheng WH, Tong ML, Liu GL, Zhang HL, Fu ZG et al.| title=Ischemic stroke as a primary symptom of neurosyphilis among HIV-negative emergency patients. | journal=J Neurol Sci | year= 2012 | volume= 317 | issue= 1-2 | pages= 35-9 | pmid=22482824 | doi=10.1016/j.jns.2012.03.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22482824 }}</ref><ref name="pmid24365430">{{cite journal |vauthors=Berger JR, Dean D |title=Neurosyphilis |journal=Handb Clin Neurol |volume=121 |issue= |pages=1461–72 |year=2014 |pmid=24365430 |doi=10.1016/B978-0-7020-4088-7.00098-5 |url=}}</ref> | |||
|<nowiki>-/+</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|[[Sexually transmitted disease|STI]]<nowiki/>s | |||
|'''↑''' [[Leukocytes]] and [[protein]] | |||
|<nowiki>+</nowiki> | |||
|CSF [[VDRL]]-specifc | |||
CSF FTA-Ab -sensitive<ref name="pmid22421697">{{cite journal| author=Ho EL, Marra CM| title=Treponemal tests for neurosyphilis--less accurate than what we thought? | journal=Sex Transm Dis | year= 2012 | volume= 39 | issue= 4 | pages= 298-9 | pmid=22421697 | doi=10.1097/OLQ.0b013e31824ee574 | pmc=3746559 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22421697 }}</ref> | |||
|- | |||
|[[Wernicke's encephalopathy|Wernicke’s encephalopathy]] | |||
|<nowiki>-/+</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|History of alcohal abuse | |||
|blood ethanol levels | |||
|<nowiki>+/-</nowiki> | |||
|Clinical assesment and lab findings | |||
|- | |||
|[[Drug toxicity]] | |||
|<nowiki>-/+</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|Medication hx | |||
|Drug levels | |||
|<nowiki>-</nowiki> | |||
|Drug screen test | |||
|- | |||
|[[Metabolic disorder|Metabolic disturbances]] | |||
|<nowiki>-/+</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|Underlying [[CKD]], CLD | |||
|[[Hypoglycemia]], [[Hyponatremia|hypo]] and [[hypernatremia]], [[Hypokalemia|hypo]] and [[hyperkalemia]] | |||
|<nowiki>-</nowiki> | |||
|Cause dependent | |||
|- | |||
|[[Sinusitis]] | |||
|<nowiki>-/+</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+/-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|[[allergies]], seasonal | |||
|[[leukocytosis]] | |||
|<nowiki>+</nowiki> | |||
|[[CT-scans|CT]] | |||
|} | |||
</small></small> | |||
== References == | == References == | ||
{{reflist|2}} | {{reflist|2}} | ||
Latest revision as of 15:33, 20 July 2020
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
COVID-19-associated headache must be differentiated from other diseases that cause headache, such as migraine, tension-type headache, cluster headache, seizure, meningitis, encephalitis, neurosyphilis, SAH, subdural hematoma, brain tumor, hypertensive encephalopathy, brain abscess, multiple sclerosis, hemorrhagic stroke, Wernickes encephalopathy, and drug toxicity etc.
Differential Diagnosis
COVID-19-associated headache must be differentiated from other diseases that cause headache, such as migraine, tension-type headache, cluster headache, seizure, meningitis, encephalitis, neurosyphilis, SAH, subdural hematoma, brain tumor, hypertensive encephalopathy, brain abscess, multiple sclerosis, hemorrhagic stroke, Wernickes encephalopathy, and drug toxicity etc.[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]
| Disease | History and Physical Examination | PMHx | Diagnostic approach | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Bilateral | Throbbing character | Autonomic symptoms | Fever | Photophobia | Aphasia | LOC | Aura | Nause/
Vomiting |
Rash | Neck stiffness | Vision changes | Neurologic deficits | Labs and CSF findings | CT/MRI | Gold standard test | ||
| Migraine | - | + | - | - | + | - | - | + | + | - | - | + | - | Trigger factors, family hx | - | - | Clinical assesment |
| Tension-type headache (TTH) | + | - | - | - | - | - | - | - | - | - | - | - | - | stress, genetics | - | - | Clinical assesment |
| Cluster headache | - | - | + | - | - | - | - | - | - | - | - | + | - | episodic history | - | - | Clinical assesment |
| Seizure | + | - | - | - | - | +/- | + | +/- | - | - | - | - | +/- | Hx of seizures | prolactin level | +/- mass lesion | EEG [20] |
| Meningitis | + | - | - | + | +/- | +/- | - | - | +/- | +/- | + | - | + | Hx of fever, malaise | <math>\uparrow</math>WBC
<math>\uparrow</math>Protein <math>\downarrow</math>glucose |
+/- | CSF analysis[21] |
| Encephalitis | + | +/- | - | + | +/- | +/- | - | - | - | +/- | + | - | + | Hx of fever, malaise | elevated WBC, low glucose | + | CSF PCR |
| Brain tumor[22] | + | - | - | - | - | +/- | - | - | +/- | - | - | +/- | +/- | weight loss, fatigue | neuromarkers,
Cancer cells[23] |
+/- mass | MRI |
| Subdural hemorrhage | -/+ | +/- | - | - | - | +/- | - | - | - | - | - | +/- | +/- | Trauma, fall | Xanthochromia | + | CT w/o contrast |
| Subarachnoid hemorrhage | -/+ | +/- | - | - | +/- | +/- | - | - | - | - | +/- | +/- | +/- | thunderclap headache | <math>\uparrow</math>opening pressure, xanthochromia | + | CT w/o contrast |
| Hypertensive encephalopathy | + | +/- | - | - | +/- | - | - | - | - | - | - | +/- | - | Hypertension | UA +/- | +/- | clinical assessment |
| CNS abscess | -/+ | - | - | + | - | +/- | - | - | +/- | +/- | +/- | +/- | +/- | History of drug abuse, endocarditis, immunosupression | ↑ leukocytes, ↓ glucose and ↑ protien | + | MRI |
| Conversion disorder | -/+ | - | - | - | - | +/- | - | - | - | - | +/- | +/- | +/- | History of emotional stress | - | - | Diagnosis of exclusion |
| Multiple sclerosis | -/+ | - | - | - | - | - | - | - | - | - | - | + | +/- | History of relapses and remissions | ↑ CSF IgG levels
(monoclonal bands) |
+ | MRI |
| Hemorrhagic stroke | -/+ | +/- | - | - | - | +/- | - | - | - | - | - | +/- | +/- | HTN | - | + | CT scan without contrast[24][25] |
| Neurosyphilis[26][27] | -/+ | - | - | - | - | - | +/- | - | - | +/- | - | +/- | +/- | STIs | ↑ Leukocytes and protein | + | CSF VDRL-specifc
CSF FTA-Ab -sensitive[28] |
| Wernicke’s encephalopathy | -/+ | - | - | - | - | +/- | - | - | - | - | - | +/- | +/- | History of alcohal abuse | blood ethanol levels | +/- | Clinical assesment and lab findings |
| Drug toxicity | -/+ | - | - | +/- | - | - | +/- | - | +/- | - | +/- | +/- | +/- | Medication hx | Drug levels | - | Drug screen test |
| Metabolic disturbances | -/+ | - | - | - | - | - | - | - | +/- | - | - | +/- | +/- | Underlying CKD, CLD | Hypoglycemia, hypo and hypernatremia, hypo and hyperkalemia | - | Cause dependent |
| Sinusitis | -/+ | - | - | +/- | - | - | - | - | - | - | - | - | - | allergies, seasonal | leukocytosis | + | CT |
References
- ↑ "National guidelines for analysis of cerebrospinal fluid for bilirubin in suspected subarachnoid haemorrhage". Ann. Clin. Biochem. 40 (Pt 5): 481–8. September 2003. doi:10.1258/000456303322326399. PMID 14503985.
- ↑ Le Rhun E, Taillibert S, Chamberlain MC (2013). "Carcinomatous meningitis: Leptomeningeal metastases in solid tumors". Surg Neurol Int. 4 (Suppl 4): S265–88. doi:10.4103/2152-7806.111304. PMC 3656567. PMID 23717798.
- ↑ Chow E, Troy SB (2014). "The differential diagnosis of hypoglycorrhachia in adult patients". Am J Med Sci. 348 (3): 186–90. doi:10.1097/MAJ.0000000000000217. PMC 4065645. PMID 24326618.
- ↑ Leen WG, Willemsen MA, Wevers RA, Verbeek MM (2012). "Cerebrospinal fluid glucose and lactate: age-specific reference values and implications for clinical practice". PLoS One. 7 (8): e42745. doi:10.1371/journal.pone.0042745. PMC 3412827. PMID 22880096.
- ↑ Negrini B, Kelleher KJ, Wald ER (2000). "Cerebrospinal fluid findings in aseptic versus bacterial meningitis". Pediatrics. 105 (2): 316–9. PMID 10654948.
- ↑ Brouwer MC, Tunkel AR, van de Beek D (2010). "Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis". Clin Microbiol Rev. 23 (3): 467–92. doi:10.1128/CMR.00070-09. PMC 2901656. PMID 20610819.
- ↑ Vermeulen M, Hasan D, Blijenberg BG, Hijdra A, van Gijn J (July 1989). "Xanthochromia after subarachnoid haemorrhage needs no revisitation". J. Neurol. Neurosurg. Psychiatry. 52 (7): 826–8. doi:10.1136/jnnp.52.7.826. PMC 1031927. PMID 2769274.
- ↑ Wasay M, Mekan SF, Khelaeni B, Saeed Z, Hassan A, Cheema Z, Bakshi R (June 2005). "Extra temporal involvement in herpes simplex encephalitis". Eur. J. Neurol. 12 (6): 475–9. doi:10.1111/j.1468-1331.2005.00999.x. PMID 15885053.
- ↑ Glaser CA, Honarmand S, Anderson LJ, Schnurr DP, Forghani B, Cossen CK, Schuster FL, Christie LJ, Tureen JH (December 2006). "Beyond viruses: clinical profiles and etiologies associated with encephalitis". Clin. Infect. Dis. 43 (12): 1565–77. doi:10.1086/509330. PMID 17109290.
- ↑ Meltzer EO, Hamilos DL (May 2011). "Rhinosinusitis diagnosis and management for the clinician: a synopsis of recent consensus guidelines". Mayo Clin. Proc. 86 (5): 427–43. doi:10.4065/mcp.2010.0392. PMC 3084646. PMID 21490181.
- ↑ Rasmussen BK, Jensen R, Schroll M, Olesen J (1991). "Epidemiology of headache in a general population--a prevalence study". J Clin Epidemiol. 44 (11): 1147–57. doi:10.1016/0895-4356(91)90147-2. PMID 1941010.
- ↑ Kelman L (October 2004). "The premonitory symptoms (prodrome): a tertiary care study of 893 migraineurs". Headache. 44 (9): 865–72. doi:10.1111/j.1526-4610.2004.04168.x. PMID 15447695.
- ↑ Laurell K, Artto V, Bendtsen L, Hagen K, Häggström J, Linde M, Söderström L, Tronvik E, Wessman M, Zwart JA, Kallela M (September 2016). "Premonitory symptoms in migraine: A cross-sectional study in 2714 persons". Cephalalgia. 36 (10): 951–9. doi:10.1177/0333102415620251. PMID 26643378.
- ↑ Charlotte E. Grayson and The Cleveland Clinic Neuroscience Center (October 2004). "Cluster Headaches". WebMD. Retrieved 2006-09-22.
- ↑ Drummond PD (October 1994). "Sweating and vascular responses in the face: normal regulation and dysfunction in migraine, cluster headache and harlequin syndrome". Clin. Auton. Res. 4 (5): 273–85. doi:10.1007/BF01827433. PMID 7888747.
- ↑ Drummond PD (June 2006). "Mechanisms of autonomic disturbance in the face during and between attacks of cluster headache". Cephalalgia. 26 (6): 633–41. doi:10.1111/j.1468-2982.2006.01106.x. PMID 16686902.
- ↑ Ekbom K (August 1990). "Evaluation of clinical criteria for cluster headache with special reference to the classification of the International Headache Society". Cephalalgia. 10 (4): 195–7. doi:10.1046/j.1468-2982.1990.1004195.x. PMID 2245469.
- ↑ Sandrini G, Antonaci F, Pucci E, Bono G, Nappi G (December 1994). "Comparative study with EMG, pressure algometry and manual palpation in tension-type headache and migraine". Cephalalgia. 14 (6): 451–7, discussion 394–5. doi:10.1046/j.1468-2982.1994.1406451.x. PMID 7697707.
- ↑ Jensen R, Fuglsang-Frederiksen A (June 1994). "Quantitative surface EMG of pericranial muscles. Relation to age and sex in a general population". Electroencephalogr Clin Neurophysiol. 93 (3): 175–83. doi:10.1016/0168-5597(94)90038-8. PMID 7515793.
- ↑ Manford M (2001). "Assessment and investigation of possible epileptic seizures". J Neurol Neurosurg Psychiatry. 70 Suppl 2: II3–8. PMC 1765557. PMID 11385043.
- ↑ Carbonnelle E (2009). "[Laboratory diagnosis of bacterial meningitis: usefulness of various tests for the determination of the etiological agent]". Med Mal Infect. 39 (7–8): 581–605. doi:10.1016/j.medmal.2009.02.017. PMID 19398286.
- ↑ Morgenstern LB, Frankowski RF (1999). "Brain tumor masquerading as stroke". J Neurooncol. 44 (1): 47–52. PMID 10582668.
- ↑ Weston CL, Glantz MJ, Connor JR (2011). "Detection of cancer cells in the cerebrospinal fluid: current methods and future directions". Fluids Barriers CNS. 8 (1): 14. doi:10.1186/2045-8118-8-14. PMC 3059292. PMID 21371327.
- ↑ Birenbaum D, Bancroft LW, Felsberg GJ (2011). "Imaging in acute stroke". West J Emerg Med. 12 (1): 67–76. PMC 3088377. PMID 21694755.
- ↑ DeLaPaz RL, Wippold FJ, Cornelius RS, Amin-Hanjani S, Angtuaco EJ, Broderick DF; et al. (2011). "ACR Appropriateness Criteria® on cerebrovascular disease". J Am Coll Radiol. 8 (8): 532–8. doi:10.1016/j.jacr.2011.05.010. PMID 21807345.
- ↑ Liu LL, Zheng WH, Tong ML, Liu GL, Zhang HL, Fu ZG; et al. (2012). "Ischemic stroke as a primary symptom of neurosyphilis among HIV-negative emergency patients". J Neurol Sci. 317 (1–2): 35–9. doi:10.1016/j.jns.2012.03.003. PMID 22482824.
- ↑ Berger JR, Dean D (2014). "Neurosyphilis". Handb Clin Neurol. 121: 1461–72. doi:10.1016/B978-0-7020-4088-7.00098-5. PMID 24365430.
- ↑ Ho EL, Marra CM (2012). "Treponemal tests for neurosyphilis--less accurate than what we thought?". Sex Transm Dis. 39 (4): 298–9. doi:10.1097/OLQ.0b013e31824ee574. PMC 3746559. PMID 22421697.