Diseases » Headache-free migraine » Diagnosis

Diagnosis of Headache-free migraine

Headache-free migraine Diagnosis: Book Excerpts

• Ask the Following Questions - HEADACHE
• Differential Diagnosis - Aura
• Differential Diagnosis - Headache
• Differential Diagnosis - Abdominal Bruit
• Differential Diagnosis - Abdominal Guarding
• Differential Diagnosis - Headache
• Approach to the Diagnosis - HEADACHE
• History and physical examination - Aura
• History and physical examination - Headache
• History and physical examination - Abdominal rigidity [Abdominal muscle spasm, involuntary guarding]
• Diagnosis - Headache
• Diagnosis - West Nile encephalitis
• History and physical examination - Aura
• History and physical examination - Headache
• History and physical examination - Abdominal rigidity [Abdominal muscle spasm, involuntary guarding]
• History - Headache
• Differential Overview - Headache
• Diagnosis - Headache
• Diagnosis - West Nile encephalitis
• History - Aura
• History
  - Headache
• Clinical Features and Diagnosis - Headache
• History and physical examination - Aura
• History and physical examination - Headache
• History and physical examination - Abdominal rigidity [Abdominal muscle spasm, involuntary guarding]
• Approach to the Diagnosis - HEADACHES
• Headache and Migraine - DIAGNOSIS - Headache and Migraine

Diagnostic Tests for Headache-free migraine: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about diagnostis of Headache-free migraine.

HEADACHE: Ask the Following Questions:
(Algorithmic Diagnosis of Symptoms and Signs)

1. Is there a history of drug, caffeine, or alcohol ingestion? The hangover headache is well known and should not present a problem in diagnosis. Caffeine withdrawal headaches are also common because of the large amount of caffeine consumed in coffee, various soft drinks, and chocolate. Drugs that may induce headache include the nonsteroidal anti-inflammatory drugs such as indomethacin (Indocin®) and the anti-hypertensives such as clonidine, aspirin, quinidine, and bromides.
2. Is there a history of trauma? Trauma may cause concussion and postconcussion headaches, intracranial neoplasms such as subdural hematoma, and cervical sprain, all of which can induce headaches.
3. Is the headache acute or chronic? An acute onset of a headache can be a serious problem. It should be taken seriously because it may mean a subarachnoid hemorrhage or meningitis. This can be easily confirmed by checking for nuchal rigidity. Whenever there is an acute onset of a headache this must be done. Chronic headaches, on the other hand, are most likely due either to migraine if they occur in exacerbations or remissions, or to tension headaches if they are fairly constant, mild, and chronic. The headache of a brain tumor is rarely severe and is rarely the presenting symptom of a brain tumor. Headaches that occur in clusters almost daily for 6 to 8 weeks with interruptions of several months must make one consider cluster headaches. Unilateral headaches in the elderly with acute onset should make one think of temporal arteritis.
4. Is there nuchal rigidity? The presence of nuchal rigidity should make one think of a subarachnoid hemorrhage or meningitis, but it may also be due to cerebral hemorrhage or cerebral abscess.
5. Is there fever? If the headache is associated with fever, the possibility of acute sinusitis should be considered, and the sinuses should be transilluminated. Other sources for the fever should be looked for, and meningitis or encephalitis should be considered.
6. Is there papilledema or are there focal neurologic signs? With acute headache and focal neurologic signs and/or papilledema, one should consider cerebral abscess or cerebral hemorrhage. With a chronic headache and papilledema or focal neurologic signs, one should consider a space-occupying lesion such as a primary brain tumor or metastatic neoplasm.
7. Do the sinuses transilluminate well? A sinus transilluminator should be in the armamentarium of every physician who expects to diagnose headache. If the sinuses fail to transilluminate, one should consider acute sinusitis as the diagnosis.
8. Is there tenderness of the superficial temporal artery? The presence of a tender superficial temporal artery should make one think of temporal arteritis, particularly in the elderly, but it may also be related to a long-standing migraine attack.
9. Is the headache relieved by superficial temporal artery compression? Relief of the headache on superficial temporal artery compression should suggest classical or common migraine. If one can relieve the headache by compression of the occipital artery, occipital migraine should be considered. When there is no relief on compression of the superficial temporal artery, one should consider tension headaches, occipital neuralgia, cervical spondylosis, and cluster headaches as the cause.

DIAGNOSTIC WORKUP

Routine diagnostic tests include a CBC to rule out severe anemia, a sedimentation rate to rule out temporal arteritis, a chemistry panel to rule out liver and kidney disease, a VDRL test to rule out central nervous system syphilis, an x-ray of the sinuses to rule out sinusitis, and an x-ray of the cervical spine to exclude cervical spondylosis. A chest x-ray should also be done to rule out the possibility of metastatic neoplasm. A tonometry study may be done if glaucoma is suspected.

If there are focal neurologic signs, referral should be made to a neurologist or neurosurgeon as soon as possible. If one is not readily available, a CT scan or MRI may be done, the CT scan being the preferred procedure if the expense is a consideration.

If there is nuchal rigidity, a CT scan should be done to rule out a space-occupying lesion before proceeding with a spinal tap. If the CT scan is negative, a spinal tap can be done, and this will ascertain whether there is intracranial bleeding or meningitis. It is usually best to refer the patient to a neurologist or neurosurgeon if there is nuchal rigidity.

If the headaches are chronic and episodic, and there are no focal neurologic signs, papilledema, or nuchal rigidity, an imaging study can be postponed for a while until the response to treatment is evaluated. However, if the response to treatment is poor, one should not hesitate to order a CT scan or MRI.

Difficult cases of headache should also be studied with 24-hr blood pressure monitoring, a 24-hr urine for catecholamines, and lumbar puncture to diagnose central nervous system lues. Histamine phosphate 0.5 cc subcutaneously may help diagnose cluster headaches. Response to beta-blockers may help diagnose migraine. Cerebral angiography may be necessary to diagnose aneurysms and arteriovenous malformations. Patients with chronic headache unresponsive to therapy should be referred to a psychiatrist.

 

» READ BOOK EXCERPT ONLINE »

Source: Algorithmic Diagnosis of Symptoms and Signs, 2003

Aura: Differential Diagnosis
(In a Page: Signs and Symptoms)

• Epilepsy
  –Recurrent seizures
  –Strong family history
• Migraine with aura
  –Usually visual aura (e.g., scotoma, flashing lights) lasting less than 60 minutes
  –Usually fully reversible with rare migrainous infarction (like CVA)
  –Migraine headache follows aura within 60 minutes and lasts 4–72 hours; however, aura may occur without headache
  • Partial seizure
    –60% of patients with focal seizures have an accompanying aura
    –Aura symptoms are associated with the brain area where they originate (e.g., occipital lobe seizure results in seeing lights)
    –Simple partial seizures result in focal tonic-clonic motor activity without loss of consciousness
    –Complex partial seizures progress to decreased consciousness and unresponsiveness
  • Tonic-clonic (grand mal seizure) seizures result in an abrupt loss of consciousness followed by stiffness (tonic); the patient then starts jerking (clonic) for an additional 2–3 minutes; rare aura
  • Pituitary adenoma or other underlying pathology that predisposes to migraines, seizures, or altered sensations (taste, smell)
  • Hallucinations (not actually an aura)
  • Physiologic nonepileptic seizures
    –Usually due to an underlying physiologic cause (e.g., fever, hypoglycemia, hypo- or hyperthyroidism, renal failure, cerebral anoxia)
  • Absence seizures (petit mal seizure) only rarely have an aura

  Workup and Diagnosis

  • History is very important
    –Type of aura (any of five senses)
    –Loss of consciousness
    –Associated activities and triggers (e.g., stress, medications, exertion, trauma, foods)
    –Postaura symptoms (e.g., headache, loss of consciousness, seizure)
    –History or family history of seizures or migraines
    –Review past medical history for head injury, stroke, dementia, intracranial infection, and alcohol or drug abuse
    –Full head, neck, and neurologic exam (look for one-sided features that suggest pathology on opposite side of brain)
    –Examine for trauma following loss of consciousness
  • Initial tests may include glucose, electrolytes, calcium, magnesium, CBC, BUN/creatinine, and toxicology screen
  • EEG may be indicated if seizure activity is suspected
    (provocative EEG with triggers gives higher yield)
    –Normal EEG does not rule out epilepsy
    –May be abnormal in migraines
  • MRI to rule out cerebral pathology
  • CT if physiologic seizure or trauma is involved (not indicated in patients with migraine and normal neurologic exam unless pattern of migraine has changed)

» READ BOOK EXCERPT ONLINE »

Source: In a Page: Signs and Symptoms, 2004

Headache: Differential Diagnosis
(In a Page: Signs and Symptoms)

• Tension-type headache
  –Most common cause of headache
  –Diffuse, bilateral, band-like pain
  –Lasts for hours to days
  –May occur on a fairly regular basis
• Migraine headache
  –Throbbing unilateral or bilateral pain
  –May last for days
  –May have preceding aura (flashing light)
  –Triggers include foods, drugs, or stress
• Meningitis
  –May present with fever, photophobia, neck stiffness, nausea/vomiting, papilledema
  –Brudzinski's sign: Neck pain upon passive flexion of neck
  –Kernig's sign: Neck pain and involuntary flexion upon passive extension of knee with hips flexed
• Head trauma
• Medications
• Carbon monoxide exposure
• Sinusitis
• Temporomandibular joint syndrome or dental pain
• Withdrawal from alcohol, barbiturates, caffeine, or other substance
• Temporal arteritis
  –Pain/tenderness over temporal area/jaw
  –Occurs uniquely in patients over 50
  –Blindness may occur
• Mass lesions (e.g., tumor, hematoma)
  –Daily, progressive headache
  –May awaken from sleep
  –Focal neurologic signs
• Subarachnoid hemorrhage
  –Sudden onset of “worst headache of my life”
  –Neck stiffness
  –Loss of consciousness
• Cluster headache
  –Severe, unilateral pain
  –Lasts minutes to hours
  –Occurs daily for months, then remits for months or even years
• Glaucoma
  –Retro-orbital pain
• Chronic daily headache or rebound headache (e.g., secondary to chronic analgesic use)
• Benign intracranial hypertension

Workup and Diagnosis

• History and physical exam often make the diagnosis
  –History should focus on onset, duration, frequency, possible triggers, severity, quality (e.g., throbbing, band-like), accompanying symptoms (e.g., aura, photophobia, visual changes, nausea/vomiting, lacrimation, nasal congestion), constitutional symptoms (e.g., weight loss, fever), medications, and dietary history
  –Is this first and/or worst headache of life?
  –Exam should include a complete neurologic exam, visual/retinal exam, head/neck, and gait exam

• Possible serious etiologies and need for further workup are suggested by the following red flags: Constitutional symptoms, new headache in a patient over 50, sudden onset, awakening from sleep, mental status changes, focal neurologic signs, visual/motor/balance disturbance, papilledema
• CT will identify hemorrhage and mass lesions and rule out increased intracranial pressure
• MRI will identify posterior fossa tumors
• Lumbar puncture is indicated if CT is normal but still suspect hemorrhage, infection, or tumor
• Serologies for bacterial, viral, and other causes of meningitis or encephalitis
• Elevated ESR suggests temporal arteritis or infection
• Carboxyhemoglobin measurement if history suggests carbon monoxide poisoning

» READ BOOK EXCERPT ONLINE »

Source: In a Page: Signs and Symptoms, 2004

Abdominal Bruit: Differential Diagnosis
(In a Page: Signs and Symptoms)

• Abdominal aortic aneurysm
• Hepatocellular carcinoma (hepatoma)
• Cirrhosis
• Liver hemangioma
• Arteriovenous malformation
• Renal artery stenosis
• Celiac artery stenosis
• Superior mesenteric artery stenosis
• Tricuspid regurgitation
• Turbulence of the splenic artery
• Hepatic venous hum
  –High-pitched continuous murmur that decreases with forced held expiration
• Cruveilhier-Baumgarten murmur
  –High-pitched venous hum of portal hypertension that becomes louder with forced expiration
• Abdominal friction rub
  –Associated with hepatoma, cholangiocarcinoma, liver metastases, inflammatory processes
• Takayasu's arteritis

Workup and Diagnosis

• History and physical exam with focus on abdominal exam (may have palpable thrill), cardiac exam, four extremity pulses, and blood pressure
• Ultrasound is often the initial test and is diagnostic for AAA, liver metastases, and liver and spleen sizes
• Abdominal CT will demonstrate abdominal pathology and is useful to better delineate anatomy
• Arterial Doppler ultrasound
• Angiography is diagnostic for stenosis
• Measuring renal vein renin levels following a captopril challenge is diagnostic for renal artery stenosis
• Radionuclide nephrograms or IV urography will demonstrate differences in perfusion of kidneys with stenotic artery
• Echocardiogram may be indicated to evaluate for valvular dysfunction
• Laboratory studies may include a lipid panel to evaluate for arteriosclerosis; CBC and ESR if inflammatory processes are suspected; liver function tests to evaluate for liver dysfunction; and electrolytes and renal function tests if renal artery stenosis is suspected

» READ BOOK EXCERPT ONLINE »

Source: In a Page: Signs and Symptoms, 2004

Abdominal Guarding: Differential Diagnosis
(In a Page: Signs and Symptoms)

• Appendicitis
• Pancreatitis
• Diverticulitis
• Abdominal wall strain/injury
• Pelvic inflammatory disease
• Ectopic pregnancy
• Bowel obstruction
• Ileus
• Pneumonia
• Dyspepsia
• Nephrolithiasis
• Peptic ulcer disease
• Abdominal aortic aneurysm
• Anxiety
• Malingering
• Spontaneous bacterial peritonitis (SBP)
• Mesenteric ischemia
• GERD
• Ovarian cyst
• Hepatic or splenic contusion/laceration
• Pneumoperitoneum secondary to trauma
• Urinary tract infection/pyelonephritis
• Zoster
  –Skin lesions may not be visible until another day or two
• Insect toxins (e.g., black widow spider)
• Abscess (e.g., iliopsoas)
• Incarcerated hernia
• Abdominal migraine
• Intussusception
• Volvulus

Workup and Diagnosis

• History and physical examination
• Initial laboratory studies may include CBC, electrolytes, BUN/creatinine, glucose, liver function tests, amylase/lipase, β-hCG, urinalysis, and urine culture
• CT scan is often indicated to diagnose appendicitis, diverticulitis, aneurysm, organ contusion or lacerations, and bowel obstruction
• Abdominal, pelvic, and/or transvaginal ultrasound may be diagnostic for appendicitis, aneurysm, peritonitis, ectopic pregnancy, ovarian cysts, and fluid/blood secondary to trauma
• Plain KUB X-rays may reveal bowel gas pattern and nephrolithiasis
• Paracentesis is diagnostic for spontaneous bacterial peritonitis and may provide symptomatic relief
• Empiric trial of medications may be useful for diagnosis and treatment of GERD/dyspepsia (H2 blocker or proton pump inhibitor), zoster (acyclovir), anxiety (lorazepam), and abdominal wall strain (NSAIDs)
• Cervical cultures to diagnose pelvic inflammatory disease
• Helicobacter pylori testing and upper GI endoscopy may be indicated for suspected cases of peptic ulcer disease

» READ BOOK EXCERPT ONLINE »

Source: In a Page: Signs and Symptoms, 2004

Headache: Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)

Migraine
–Recurring headache with throbbing, pulsating pain; nausea and vomiting; photophobia, phonophobia
–Family history of migraine
–Improvement with rest/sleep
–Without aura (common migraine) 85%
–With aura (classic migraine) 15%
–Frequently bilateral pain in children
–Aura usually develops over 5 minutes and is most commonly visual
–Migraine is an episodic disorder
–Chronic daily headache is not migraine

• Tension headache
• Pseudotumor cerebri
  –Elevated ICP with no masses or abnormalities in CSF or labs
• Cluster headache
  –Unilateral nonthrobbing, periorbital pain
  –May have ipsilateral conjectival injection, lacrimation, rhinorrhea
• Subarachnoid hemorrhage
  –Sudden paroxysmal headache
  –Meningeal signs
  –An emergency requiring CT and LP
• Increased intracranial pressure
  –Tumor, abscess, hydrocephalus, hemorrhage
• Sinusitis, otitis
• Dental disease
• Systemic infection
• TMJ disease
• Postconcussive syndrome
• Trigeminal neuralgia
• Mitochondrial disorders
• Venous sinus thrombosis
• Meningitis/encephalitis
• CSF leak, post-lumbar puncture
• Hypertensive crisis
• Trauma
• Arteriovenous malformation
• Stroke
• Toxins and medication
  –Nitrites, cocaine, interferon, CO
• Fever
• Anemia

Workup and Diagnosis

• History
  –Duration (recurrent, progressive), frequency
  –Time of onset and duration
  –Location and nature of pain, warning (aura)
  –Factors that alleviate or exacerbate symptoms (e.g., stress)
  –Nausea, vomiting, photophobia, phonophobia
  –Family history, response to treatment
• Physical exam
  –Vital signs (temperature, blood pressure)
  –Height, weight, head circumference
  –Funduscopy (to rule out papilledema)
• Neuroimaging (CT, MRI) is required for certain symptoms
  –Short history of headache (<6 months) or age <5–6 years
  –Worsening headaches, no response to treatment
  –Deterioration in cognitive or motor function
  –Short stature, macrocephaly
  –Awakening at night or early morning
  –Repeated morning vomiting
  –Exacerbation by position change or cough
  –Focal neurologic symptoms during headache
  –Cluster headache in prepubertal children and adolescent girls
  –Systemic symptoms: Fatigue, weight loss
  –Abnormal neurological exam
  • Lumbar puncture with opening pressure
    –Subarachnoid hemorrhage, pseudotumor, or meningitis
  >>

» READ BOOK EXCERPT ONLINE »

Source: In A Page: Pediatric Signs and Symptoms, 2007

HEADACHE: Approach to the Diagnosis
(Differential Diagnosis in Primary Care)

The patient presenting with a history of headaches is an exciting diagnostic challenge. If one approaches the challenge simply on the basis of what is common, the patient most likely has migraine or muscle traction headache. But, wait a minute! Shouldn’t we look for serious conditions such as brain tumor, meningitis, or subarachnoid hemorrhage to avoid a serious mistake and a malpractice suit? First, check for nuchal rigidity to rule out meningitis and subarachnoid headache. Next, do a careful neurologic examination to rule out a brain tumor or other space-occupying lesion. These steps are particularly important in a patient is experiencing his or her first serious headache. If there is nuchal rigidity or focal neurologic signs, it is wise to immediately refer the patient to a neurologist or neurosurgeon for further workup and possible hospitalization. The specialist will probably order a CT scan of the brain and follow that with a spinal tap if a subarachnoid hemorrhage or meningitis is suspected. It is clear that a CT scan should be done prior to a spinal tap if there are focal neurologic signs or papilledema. One other condition that must be considered in acute headache particularly in the elderly is temporal arteritis. A sedimentation rate will usually be positive but a neurology consult is axiomatic so that steroids can be started immediately.

In the patient with chronic or recurring headaches and no neurologic findings, it is wise to see the patient during the attack. Migraine and histamine headaches can be diagnosed by the response to sumatriptan by mouth or injection. If the headaches are due to chronic allergic or infectious rhinitis, relief can be had by spraying the turbinates with phenylephrine. Muscle traction headaches will often be relieved by occipital nerve blocks supporting the diagnosis. Compression of the superficial temporal artery will often relieve migraine temporarily supporting that diagnosis. Compression of the jugular veins will often give relief to post spinal tap headaches.

If the patient is seen between headaches, certain prophylactic measures may help establish the diagnosis. For migraine, β-blockers may be prescribed and if the headaches are prevented, there is good support for the diagnosis. A course of corticosteroids may be initiated in patients with histamine (cluster) headaches to help establish the diagnosis. Muscle relaxants and/or tricyclic drugs may be given to help diagnose muscle contraction headaches.

The diagnostic workup of chronic headaches might include a CT scan of the brain, x-rays of the sinuses, x-rays of the cervical spine and routine blood work. Certainly if headache persists after careful follow up, these need to be done.

» READ BOOK EXCERPT ONLINE »

Source: Differential Diagnosis in Primary Care, 2007

Aura: History and physical examination
(Handbook of Signs & Symptoms (Third Edition))

Obtain a thorough history of the patient’s headaches or seizure history, asking him to describe any sensory or motor phenomena that precede each headache or seizure. Find out how long each headache or seizure typically lasts. Does anything make it worse, such as bright lights, noise, or caffeine? Does anything make it better? Ask the patient about drugs he takes for pain relief.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Headache: History and physical examination
(Handbook of Signs & Symptoms (Third Edition))

If the patient reports a headache, ask him to describe its characteristics and location. How often does he get a headache? How long does a typical headache last? Try to identify precipitating factors, such as certain foods or exposure to bright lights. Ask what helps to relieve the headache. Is the patient under stress? Has he had trouble sleeping?

Take a drug and alcohol history, and ask about head trauma within the past 4 weeks. Has the patient recently experienced nausea, vomiting, photophobia, or visual changes? Does he feel drowsy, confused, or dizzy? Has he recently developed seizures or does he have a history of seizures?

Begin the physical examination by evaluating the patient’s level of consciousness (LOC). Then check his vital signs. Be alert for signs of increased ICP — a widened pulse pressure, bradycardia, an altered respiratory pattern, and increased blood pressure. Check pupil size and response to light, and note any neck stiffness.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Abdominal rigidity [Abdominal muscle spasm, involuntary guarding]: History and physical examination
(Handbook of Signs & Symptoms (Third Edition))

If the patient’s condition allows further assessment, take a brief history. Find out when the abdominal rigidity began. Is it associated with abdominal pain? If so, did the pain begin at the same time? Determine whether the abdominal rigidity is localized or generalized. Is it always present? Has its site changed or remained constant? Next, ask about aggravating or alleviating factors, such as position changes, coughing, vomiting, elimination, and walking.

Explore other signs and symptoms. Inspect the abdomen for peristaltic waves, which may be visible in very thin patients. Also, check for a visibly distended bowel loop. Next, auscultate bowel sounds. Perform light palpation to locate the rigidity and determine its severity. Avoid deep palpation, which may exacerbate abdominal pain. Finally, check for poor skin turgor and dry mucous membranes, which indicate dehydration.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Headache: Diagnosis
(Professional Guide to Diseases (Eighth Edition))

Diagnosis requires a history of recurrent headaches and physical examination of the head and neck. Such examination includes percussion, auscultation for bruits, inspection for signs of infection, and palpation for defects, crepitus, or tender spots (especially after trauma). Firm diagnosis also requires a complete neurologic examination, assessment for other systemic diseases — such as hypertension — and a psychosocial evaluation, when such factors are suspected.

Diagnostic tests include cervical spine and sinus X-rays, EEG, computed tomography scan — performed before lumbar puncture to rule out increased intracranial pressure (ICP) — or magnetic resonance imaging. A lumbar puncture isn’t done if there’s evidence of increased ICP or if a brain tumor is suspected because rapidly reducing pressure by removing spinal fluid can cause brain herniation.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

West Nile encephalitis: Diagnosis
(Professional Guide to Diseases (Eighth Edition))

The immunoglobulin (Ig) M antibody capture enzyme-linked immunosorbent assay (MAC-ELISA) is the test of choice for rapid definitive diagnosis. The major advantage of MAC-ELISA laboratory analysis is the high probability of accurate diagnosis of WNV infection when performed with acute serum or cerebrospinal fluid specimens obtained while the patient is still hospitalized.

A new diagnostic test, the WNV MAC-ELISA, was recently approved by the Food and Drug Administration. This test detects levels of IgM antibodies in a patient's ser-um and is intended for use in patients with clinical symptoms consistent with viral encephalitis.

Other conditions to consider include St. Louis encephalitis, which is symptomatically similar.

Encephalitis can be caused by numerous viral and bacterial infections; all data must be examined to determine a definitive diagnosis.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Aura: History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))

After providing emergency care, obtain a thorough history of the patient’s headaches or seizures, asking him to describe any sensory or motor phenomena that precede each headache or seizure. Find out how long each headache or seizure typically lasts. Does anything make it worse, such as bright lights, noise, or caffeine? Does anything make it better? Ask the patient about drugs he takes for pain relief.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Headache: History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))

If the patient reports a headache, ask him to describe its characteristics and location. How often does he get a headache? How long does a typical headache last? Try to identify precipitating factors, such as eating certain foods or exposure to bright lights. Ask what helps to relieve the headache. Is the patient under stress? Has he had trouble sleeping?

Take a drug and alcohol history, and ask about head trauma within the last 4 weeks. Has the patient recently experienced nausea, vomiting, photophobia, or visual changes? Does he feel drowsy, confused, or dizzy? Has he recently developed seizures, or does he have a history of seizures?

Begin the physical examination by evaluating the patient’s level of consciousness (LOC). Then check his vital signs. Be alert for signs of increased ICP—widened pulse pressure, bradycardia, altered respiratory pattern, and increased blood pressure. Check pupil size and response to light, and note any neck stiffness. (See Differential diagnosis: Headache, pages 392 and 393.)

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Abdominal rigidity [Abdominal muscle spasm, involuntary guarding]: History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))

If the patient’s condition allows further assessment, take a brief history. Find out when the abdominal rigidity began. Is it associated with abdominal pain? If so, did the pain begin at the same time? Determine whether the rigidity is localized or generalized. Is it always present? Has its location changed or remained constant? Next, ask about aggravating or alleviating factors, such as position changes, coughing, vomiting, elimination, and walking.

Then explore other signs and symptoms. Inspect the abdomen for peristaltic waves, which may be visible in very thin patients. Also check for a visibly distended bowel loop. Next, auscultate bowel sounds. Perform light palpation to locate the rigidity and to determine its severity. Avoid deep palpation, which may exacerbate abdominal pain. Finally, check for poor skin turgor and dry mucous membranes, which indicate dehydration.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Headache: History
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)

A. Characteristics of the headache. What is the type of pain, its location, its duration, and its intensity? What symptoms precede or accompany the pain? Does anything trigger the headache or make the pain better or worse? Tell about a typical headache from beginning to end.

 1. Migraine food triggers include alcohol, aged cheese, chocolate, and aspartame.

 2. Approximately 20% to 30% of migraineurs will report an aura, typically visual in nature.

3. Patients with cluster headache report unilateral temporal headache, occurring generally once daily, usually in the evening and associated with ipsilateral nasal stuffiness and conjunctival injection.

4. Chronic daily headache (CDH) patients will describe headaches at least 10 to 15 days/month and usually report heavy use of relief drugs.

 5. Red flags that might suggest intracranial pathology (section I.B) include a loss of consciousness, persistent visual loss, seizures, staggering, or hearing loss.

 B. Chronology of the headache. Most primary headaches recur periodically for years, with only subtle changes over time. If the headache is getting worse, the cause might be psychosocial stressors, medication overuse, or evolving intracranial pathology (Table 2.5). Ask women whether the headache seems related to the menses. Past and current medication use and how they affect the headache can be important clues to headache severity and how the patient may respond to treatment.

 C. Family history. Migraine headaches often exhibit a familial pattern; the causes of secondary headaches generally do not. Tension headache can represent a family pattern of reacting to stress.

D. Psychosocial aspects of the headache. What does the patient believe is the cause of the headache? What life events might be playing a role? How does the patient’s family react to the headache? Ask: “If you did not have the headache, how would your life be different?” The key to management of recurrent primary headaches often lies in the responses to these questions, which can reveal unanticipated stressors, secondary gain, or family discord.

E. Other information. Important data include use of tobacco, alcohol, or coffee; response to exercise; a history of head trauma; or exposure to toxic fumes or chemicals. Have there been symptoms of fever, or fatigue? Ask about depression, which is often seen in migraineurs.

Physical examination

 A. Focused physical examination (PE). This should include vital signs (notably blood pressure) and an examination of the scalp; eyes, including funduscopic examination; ears; nose; paranasal sinuses; throat; and neck. A screening neurologic examination, including cranial nerves, coordination (finger-to-nose test), and deep tendon reflexes, is sufficient in most instances. In the migraineur, the examination findings should be all normal in the absence of a current headache; a positive finding warrants further testing (section IV).

B. Additional PE. Other PE maneuvers are appropriate if the medical history suggests specific secondary headache causes: palpation of the superficial temporal arteries (temporal arteritis), audiometry (acoustic neuroma), transillumination of the paranasal sinuses (“sinus headache”), or checking for nuchal rigidity plus Kernig’s and Brudzinski’s signs (meningeal irritation).

» READ BOOK EXCERPT ONLINE »

Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000

Headache: Differential Overview
(Field Guide to Bedside Diagnosis)

❑ Migraine

❑ Tension

❑ Acute sinusitis

❑ Acute glaucoma

❑ Postconcussive

❑ Cluster

❑ Meningitis

❑ Drugs

❑ Hypoglycemia

❑ Benign exertional headache

❑ Temporomandibular joint inflammation

❑ Subdural hematoma

❑ Subarachnoid hemorrhage

❑ Acute epidural hematoma

❑ Lumbar puncture

❑ Brain tumor

❑ Headache in HIV

❑ Pseudotumor cerebri

❑ Hypertensive encephalopathy

❑ Carbon monoxide intoxication

❑ Giant cell arteritis

❑ Psychogenic

❑ Brain abscess

❑ Encephalitis

❑ Arteriovenous malformations

❑ Cavernous sinus thrombosis

❑ Pituitary apoplexy

❑ Carotid artery dissection

Diagnostic Approach

Red flags to serious causes include: Sudden onset of “the worst headache of my life,” especially in a non—headache-prone person; headache different from previous headaches; headache precipitated by position change, cough, or exertion; a history of trauma or fever; abnormal mental status or other neurological findings; a headache that disturbs sleep or is present immediately on awakening; immune deficiency such as HIV.

The time course helps in diagnosing headache. A “thunderclap” headache of a ruptured aneurysm peaks instantly. Cluster headache peaks over 3 to
5 minutes, remains at maximum for 45 minutes, and then gradually recedes. Migraine builds over hours, lasts hours to days, and is improved with sleep.

In evaluating patients with recurrent migraine, it is critical to ascertain whether the present headache differs from prior migraines and whether fever is present or spontaneous retinal venous pulsations are abnormally absent. These should prompt a search for alternative causes. If fever is present with headache, rule out meningitis.

Raised intracranial pressure should be suspected with blurred vision upon bending the head forward, headache upon awakening that improves with sitting up, double vision, loss of coordination and balance, or daily
progressive headache with nausea. Pain originating above the tentorium is referred to the frontal, temporal, or parietal region. Pain from the posterior fossa and below is referred to the occiput. Pain from the posterior sagittal and transverse sinuses may be referred to the eye or forehead.

Lumbar puncture, subdural hematoma, or benign intracranial hypertension can cause orthostatic headache. Occipital headache radiating to the vertex and forehead is usually a result of cervical spondylosis but can also be caused by basal subarachnoid hemorrhage, posterior fossa tumor, or meningitis.

» READ BOOK EXCERPT ONLINE »

Source: Field Guide to Bedside Diagnosis, 2007

Headache: Diagnosis
(Handbook of Diseases)

An accurate diagnosis requires a history of recurrent headaches and physical examination of the head and neck. Such examination includes percussion, auscultation for bruits, inspection for signs of infection, and palpation for defects, crepitus, and tender spots (especially after trauma).

A firm diagnosis also requires a complete neurologic examination, assessment for other systemic diseases (such as hypertension), and a psychosocial evaluation (when such factors are suspected).

Most patients may be diagnosed by a thorough history and physical examination. Magnetic resonance imaging, computed tomography scans, lumbar puncture, and serology may be beneficial. Neurologic deficits, such as stroke or brain tumors; metabolic processes, such as thyroid disease or diabetes; and an aneurysm must be ruled out if the headache is explosive and “the worst” in their lives.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Diseases, 2003

West Nile encephalitis: Diagnosis
(Handbook of Diseases)

The immunoglobulin M antibody capture–enzyme-linked immunosorbent assay is the test of choice for rapid definitive diagnosis. It has a high probability of accurate diagnosis of WNV infection when performed with acute serum or cerebrospinal fluid specimens obtained while the patient is hospitalized.

Encephalitis can also be caused by numerous viral and bacterial infections, so data must be carefully examined to determine a definitive diagnosis. St. Louis encephalitis, which is symptomatically similar to West Nile encephalitis, should be considered.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Diseases, 2003

Aura: History
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Obtain a thorough history of the patient’s headaches or seizure history, asking him to describe any sensory or motor phenomena that precede each headache or seizure. Find out how long each headache or seizure typically lasts. Does anything make it worse, such as bright lights, noise, or caffeine? Does anything make it better? Ask the patient about drugs he takes for pain relief.

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Headache: History

(Signs & Symptoms: A 2-in-1 Reference for Nurses)

If the patient reports a headache, ask him to describe its characteristics and location. How often does he get a headache? How long does a typical headache last? Try to identify precipitating factors, such as certain foods or exposure to bright lights. Ask what helps to relieve the headache. Is the patient under stress? Has he had trouble sleeping?

Take a drug and alcohol history, and ask about head trauma within the last 4 weeks. Has the patient recently experienced nausea, vomiting, photophobia, or visual changes? Does he feel drowsy, confused, or dizzy? Has he recently developed seizures, or does he have a history of seizures?

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Headache: Clinical Features and Diagnosis
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)

Tension-Type Headache

Most commontype of headache in adolescence but also occurs in childhood.

Usually dull in character, diffuse,and bilateral and may last hours or days.

Nausea and vomiting are unusual.

Precipitating factors include emotionalstress and fatigue.

Vascular Headache

Migraine Headache

Vascularheadaches that are periodic, throbbing, and usually unilateral.

Generalized headaches are more commonthan unilateral headaches in children.

Positive family history is found inmany cases.

Typical clinical features and positivefamily history are diagnostic.

Migraine with Aura (Classic Migraine)

Migraineheadaches that occur with aura are called classic migraine.

Not only does aura precede headache,but it can persist with headache. May consist of visual (scotomata,flashing lights, blurring), sensory (numbness, paresthesias), ormotor (mild aphasia) phenomena.

Headache usually lasts for a few hoursbut can persist for 1–2 days. Interrupts normal activity,and most children wish to lie down in quiet place until it goesaway. Noise, light, and activity make headache worse.

Migraine without Aura (Common Migraine)

Migraineheadaches that occur without aura are called common migraines.

In childhood they are more common thanclassic migraines.

Headache is bifrontal or bitemporaland is often associated with nausea, vomiting, and abdominal pain.

Positive family history for migraineis important diagnostic clue.

Complicated Migraine

Associationof migraine episode with transient neurologic disturbance.

Deficits are usually benign but mustbe distinguished from serious intracranial pathology; thus, headCT or MRI is often necessary.

Hemiplegic Migraine

Hemisensoryloss or hemiparesis followed by headache on contralateral side characterizeshemiplegic migraine, which can be familial.

Hemiplegia may persist after headacheresolves and lasts hours to days. Can recur and alternate from sideto side. Permanent deficit rarely occurs.

Ophthalmoplegic Migraine

Associationof recurrent, unilateral, periorbital headaches associated withthird nerve palsy is known as ophthalmoplegic migraine.

Headache may precede, accompany, orfollow ophthalmoplegia. Eyes appear "down and out," withdeficits in elevation and adduction. There also may be ptosis andmydriasis.

Headache may last a few hours, butophthalmoplegia can persist for days to weeks.

Basilar Artery Migraine

Often beginswith visual disturbance consisting of blurred vision, scotomata,or transient loss of vision. Nausea, vomiting, ataxia, vertigo,paresthesias, hemiparesis, quadraparesis, and impaired consciousnessalso can occur.

Occipital headache may precede, accompany,or follow neurologic deficits. Episode lasts usually 10–30mins.

Recurrent attacks with absence of residualneurologic deficits is general pattern.

Confusional Migraine

Headacheusually precedes episodes of confusion that last a few hours upto 1 day. Impaired memory and restless or combative behavior sometimesoccur.

There is often family history of migraineheadache.

Diagnosis is usually made retrospectively.

Migraine Variants

Migrainevariants refer to transient episodic neurologic dysfunction in individuals withmigraine or who later develop migraine.

Cyclic vomiting is episodic occurrenceof unexplained nausea, vomiting, and abdominal pain that may occur ± headache.

Paroxysmal torticollis consists ofrecurrent episodes of torticollis, which are associated with nausea,vomiting, and headache that may last from hours to days.

Benign paroxysmal vertigo is suddenonset of vertigo, lasting a few minutes, and usually occurring inchildren 2–6 yrs of age. Children are frightened and unableto stand but do not lose consciousness.

Cluster Headache

Form ofvascular headache that may be transmitted as autosomal-dominanttrait in some cases.

Onset is usually in children >10yrs of age.

Headaches are intense, unilateral,and periorbital in location. Occur 2–10 times/day,lasting from 10 mins to a few hours, and never switch sides.

Headaches are usually episodic, occurringfor 1–3 mos at a time with remissions that last monthsto years.

Systemic Infection

Any systemic infection, usually viral orbacterial, may produce fever and headache.

Hypoxia

Can cause vasodilatation of cerebral arteriesand produce headache. Frequent causes include high altitude, carbonmonoxide poisoning, and chronic lung disease (most commonly cysticfibrosis).

Systemic Hypertension

When severe, may cause headache, which canbe dull or throbbing. BP should be measured in anyone who complainsof persistent severe headache.

Connective Tissue Diseases

Systemic lupus erythematosus may cause cerebralvasculitis and headache.

Head Trauma

Minor headtrauma can produce bruising, soft-tissue swelling, and mild headache. Whiplashinjuries produce neck pain, stiffness, and often occipital headache.

Concussion-associated headache generallylasts for a few days.

Postconcussion syndrome is unusualin childhood but may last for months or years. Besides headache,dizziness, irritability, insomnia, memory loss, and learning difficultiesalso may occur.

Headache Due to Disorders of Head and Neck Structures

Headache often occurs with various disordersinvolving head and neck region. History, physical exam, and appropriateradiographs are usually diagnostic.

Head and Neck Disorders

Other causesof cranial headache include osteomyelitis of skull and cervicalspine disorders (congenital anomalies, fracture, bone tumor, juvenilerheumatoid arthritis).

See section Head Trauma.

Ear, Eye, and Sinus Disorders

Acute otitismedia can produce headache, but earache and fever are major manifestations.

Hyperopia and astigmatism are occasionallyassociated with sustained contraction of extraocular, frontal, andtemporal muscles, which can cause frontal headache.

Acute glaucoma is characterized byincrease in intraocular pressure and steady pain in eye region,which may radiate to forehead.

Eye strain is another cause of ocularpain and headache.

In young children, headache from sinusdisease is uncommon. In older children, acute and chronic sinusitiscan cause frontal headache along with tenderness over involved sinus.Maxillary and ethmoid sinuses are most commonly involved. Pain isusually dull, aching, and nonthrobbing.

Mouth and Jaw Disorders

Dental caries, malocclusion, and temporomandibularjoint dysfunction sometimes cause pain in frontal and temporal areasas well as jaw pain.

Intracranial Infections

Headachewith meningitis or encephalitis is usually acute, constant, generalized,and associated with fever.

Brain abscess may produce headacheif abscess is large enough to cause traction and displacement ofintracranial structures. Associated findings include fever, vomiting,seizures, papilledema, hemiparesis, and alteration in consciousness.CT and MRI are usually diagnostic.

See Chap.3, Alteration in Consciousness.

Traction Headache

Pain-sensitive intracranial structures includecerebral and dural arteries and large cerebral veins and venoussinuses. Traction on these structures produces headache.

Brain Tumor

Headachesin children with brain tumors may be throbbing or nonthrobbing.

Although pain-free intervals sometimesoccur, these headaches are usually persistent and become more intense.

Also common for these headaches toawaken children from sleep and to occur upon awakening in morning.

Vomiting, lassitude, visual disturbance,ataxia, seizures, personality change, neck stiffness, papilledema,and alteration in consciousness can be manifestations of brain tumor.

Response to analgesics is unreliableindicator for presence of tumor.

CT or MRI locate and define extentof tumor. Histologic diagnosis is definitive.

Table25.1 lists common brain tumors and their locations.

» READ BOOK EXCERPT ONLINE »

Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006

Aura: History and physical examination
(Nursing: Interpreting Signs and Symptoms)

Obtain a thorough history of the patient's headache or seizure history, asking him to describe any sensory or motor phenomena that precede each headache or seizure. Find out how long each headache or seizure typically lasts. Does anything make it worse, such as bright lights, noise, or caffeine? Does anything make it better? Ask the patient about drugs he takes for pain relief.

Then perform a complete neurologic examination.

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007

Headache: History and physical examination
(Nursing: Interpreting Signs and Symptoms)

If the patient reports a headache, ask him to describe its characteristics and location. How often does he get a headache? How long does a typical headache last? Does he have a history of high blood pressure? Try to identify precipitating factors, such as certain foods or exposure to bright lights. Ask what helps to relieve the headache. Does he experience stress at work or at home? Has he had trouble sleeping?

Take a drug and alcohol history, and ask about head trauma within the past 4 weeks. Has the patient recently experienced nausea, vomiting, photophobia, or vision changes? Does he feel drowsy, confused, or dizzy? Has he recently developed seizures or does he have a history of seizures?

Begin the physical examination by evaluating the patient's level of consciousness (LOC). Then check his vital signs. Be alert for signs of increased ICP—a widened pulse pressure, bradycardia, an altered respiratory pattern, and increased blood pressure. Check pupil size and response to light, and note any neck stiffness.

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007

Abdominal rigidity [Abdominal muscle spasm, involuntary guarding]: History and physical examination
(Nursing: Interpreting Signs and Symptoms)

If the patient's condition allows further assessment, take a brief history. Find out when the abdominal rigidity began. Is it associated with abdominal pain? If so, did the pain begin at the same time? Determine whether the abdominal rigidity is localized or generalized. Is it always present? Has its site changed or remained constant? Next, ask about aggravating or alleviating factors, such as position changes, coughing, vomiting, elimination, and walking.

Explore other signs and symptoms. Inspect the abdomen for peristaltic waves, which may be visible in very thin patients. Check for a visibly distended bowel loop or pulsations. Next, auscultate bowel sounds. Perform light palpation to locate the rigidity and determine its severity. Avoid deep palpation, which may exacerbate abdominal pain. Finally, check for poor skin turgor and dry mucous membranes, which indicate dehydration.

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007

HEADACHES: Approach to the Diagnosis
(Differential Diagnosis in Primary Care)

The patient presenting with a history of headaches is an exciting diagnostic challenge. If one approaches the challenge simply on the basis of what is common, the patient most likely has migraine or muscle traction headache. But, wait a minute! Shouldn’t we look for serious conditions such as brain tumor, meningitis, or subarachnoid hemorrhage to avoid a serious mistake and a malpractice suit? First, check for nuchal rigidity to rule out meningitis and subarachnoid headache. Next, do a careful neurologic examination to rule out a brain tumor or other space-occupying lesion. These steps are particularly important in a patient who is experiencing his or her first serious headache. If there is nuchal rigidity or focal neurologic signs, it is wise to immediately refer the patient to a neurologist or neurosurgeon for further workup and possible hospitalization. The specialist will probably order a CT scan of the brain and follow that with a spinal tap if a subarachnoid hemorrhage or meningitis is suspected. It is clear that a CT scan should be done prior to a spinal tap if there are focal neurologic signs or papilledema. One other condition that must be considered in acute headache (particularly in elderly persons) is temporal arteritis. A sedimentation rate will usually be positive, but a neurology consult is axiomatic so that steroids can be started immediately. In the patient with chronic or recurring headaches and no neurologic findings, it is wise to see the patient during the attack. Migraine and histamine headaches can be diagnosed by the response to sumatriptan by mouth or injection. If the headaches are due to chronic allergic or infectious rhinitis, relief can be had by spraying the turbinates with phenylephrine. Muscle traction headaches will often be relieved by occipital nerve blocks supporting the diagnosis. Compression of the superficial temporal artery will often relieve migraine temporarily supporting that diagnosis. Compression of the jugular veins will often give relief to patients with post spinal tap headaches. If the patient is seen between headaches, certain prophylactic measures may help establish the diagnosis. For migraine, β -blockers may be prescribed; if the headaches are prevented, there is good support for the diagnosis. A course of corticosteroids may be initiated in patients with histamine (cluster) headaches to help establish the diagnosis. Muscle relaxants and/or tricyclic drugs may be given to help diagnose muscle contraction headaches. The diagnostic workup of chronic headaches might include a CT scan of the brain, x-rays of the sinuses, x-rays of the cervical spine, and routine blood work. Certainly if headache persists after careful follow-up, these need to be done.

» READ BOOK EXCERPT ONLINE »

Source: Differential Diagnosis in Primary Care, 2007

Headache and Migraine: Headache and Migraine - DIAGNOSIS
(The 5-Minute Pediatric Consult)

Migraine in children can be divided into 3 groups:

• Migraine without aura: Most cases. Mood changes or withdrawal from activity, sensitivity to light and sound
• Migraine with aura: Migraine with visual spots, colors, image distortions, visual scotoma, vertigo, blurry vision, paresthesias
  • Basilar-type migraine (now classified as a migraine with aura): Vertigo, diplopia, ataxia, visual field deficits
• Migraine variants:
  • Vertigo, hemiplegic migraine
  • Alice in Wonderland syndrome: Distortions of vision, space, and/or time (e.g., micropsia, metamorphopsia, sensory hallucinations)
  • Confusional migraine: Impaired sensorium, agitation, and lethargy; may progress to stupor
  • Benign paroxysmal vertigo, cyclic vomiting, and abdominal migraine may also be pediatric migraine variants.

» READ BOOK EXCERPT ONLINE »

Source: The 5-Minute Pediatric Consult, 2008

 » Next page: Signs of Headache-free migraine

Rate This Website

What do you think about the features of this website? Take our user survey and have your say:

Website User Survey

Medical Tools & Articles:

Next articles:

• Signs of Headache-free migraine
• Misdiagnosis of Headache-free migraine
• Misdiagnosis of Underlying Causes of Headache-free migraine
• Inheritance and Genetics of Headache-free migraine
• Treatments for Headache-free migraine

Tools & Services:

• Bookmark this page
• Take a survey relating to Headache-free migraine
• Symptom Search
• Symptom Checker
• Medical Dictionary
• Give your feedback

Medical Articles:

• Disease & Treatments Search
• Misdiagnosis Center
• Full list of interesting articles

Forums & Message Boards

• Ask or answer a question at the Boards:
• I cannot get a diagnosis. Please help.
• Tell us your medical story.
• Share your misdiagnosis story.
• What is the best treatment for my condition?
• See all the Boards.

Enter your search terms Submit search form
Search The Web Search wrongdiagnosis.com

homepage | back to top

Common Health Mistakes

Choose ... Alzheimers & Dementia Asthma Child ADHD ADHD in Adults Allergy Hypertension Bipolar Breast Cancer Celiac Disease Crohns Disease Colon Cancer Contraception Diabetes Cancer Depression Erectile Disorder Cholesterol COPD GERD Heartburn/Reflux Metabolic Syndrome Migraine/Headache Multiple Sclerosis Obesity Osteoporosis Overactive Bladder Psoriasis Sexual Disorder Sleep Disorders Smoking The Pill Ulcerative Colitis All Common Mistakes

Symptom
Checker

Choose... Fever Rash Pain Headache Fatigue Cough Other symptoms

Search Specialists by State and City

Choose... GENERAL PRACTICE CARDIAC HEALTH WOMEN'S HEALTH CANCER CARE RADIOLOGY MENTAL HEALTH PATHOLOGY EAR, NOSE, THROAT MEDICINE GENETICS NEUROLOGY DIALYSIS CARE SURGERY ORTHOPEDICS/SPORTS MEDICINE CHILDREN'S HEALTH OTHER SPECIALTIES