10. What should be asked when you see a patient with headache ??
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15. DIAGNOSIS AND TESTING Red flag Primary headache? Secondary headache Diagnostic testing Detailed history and physical examination Atypical features No Yes
The cause or type of most headaches can be determined by a careful history and physical examination. The clinical imperative is to recognize the warning signals, which should raise red flags and prompt further diagnostic testing. In the absence of worrisome features in the history or examination, the task is then to diagnose the primary syndrome based upon the clinical features. If there are atypical features or a lack of response to conventional therapy, the diagnosis should be questioned and the possibility of a secondary headache disorder revisited. Since migraine and TTH account for over 90% of the primary headache disorders in clinical practice, this discussion will focus on their clinical features, the warning signals of serious secondary headaches, and the role of diagnostic testing in the evaluation of headache.
In both males and females, the prevalence distribution of migraine is an inverted U-shape curve. Prevalence rises through early adult life and then falls after middle life. The second important point to emphasize on this slide is that, at all post-pubertal ages, migraine is substantially more common in women than in men. The prevalence of migraine varies as a function of age. Migraine is a disorder that is most prevalent between the ages of 25 and 55. Part of the reason the condition has such a big impact in the workplace is that it affects people during their peak productive years. Lipton RB, Stewart WF. Migraine in the United States: a review of epidemiology and health care use. Neurology. 1993;43(suppl 3):S6-S10.
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