Headache Diagnostic Testing

Aka: Headache Diagnostic Testing

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II. Labs

  1. Suspected Giant Cell Arteritis (Temporal Arteritis)
    1. C-Reactive Protein
    2. Erythrocyte Sedimentation Rate
  2. Suspected Carbon Monoxide Poisoning
    1. Carbon Monoxide Level
  3. Pregnancy Induced Hypertension or Preeclampsia
    1. See Pregnancy Induced Hypertension

III. Imaging

  1. Head CT or Head MRI
    1. See Neuroimaging in Headache
    2. See Organic Headache
    3. New Sudden Severe Headache (Thunderclap Headache)
    4. Focal neurologic symptoms or signs
    5. Progressive Headaches
    6. Symptoms of increasing Intracranial Pressure
    7. Pituitary Apoplexy (MRI)
    8. Indications to obtain head imaging prior to Lumbar Puncture
      1. Suspected Increased Intracranial Pressure
      2. CNS Mass
      3. Headache in HIV (new type of Headache for patient)
      4. Altered Neurologic Exam
  2. Head CT Venogram or the preferred MR Venogram
    1. Cerebral Venous Sinus Thrombosis
  3. Head and Neck CT Angiography or MR Angiography
    1. Cervical Artery Dissection
  4. Avoid XRay C-Spine
    1. Rarely useful in Headache Evaluation

IV. Diagnostics

  1. Lumbar Puncture (LP)
    1. Fever (Meningitis or Encephalitis suspected)
      1. Do not delay Antibiotics if Bacterial Meningitis is suspected (but attempt to get Lumbar Puncture first if possible)
    2. Subarachnoid Hemorrhage
      1. LP indicated in Thunderclap Headache with negative CT Head (esp. when CT Head >6 hours from onset)
  2. Lumbar Puncture with opening pressure
    1. Increased Intracranial Pressure (e.g. Pseudotumor Cerebri)
    2. Cerebral Venous Sinus Thrombosis (opening pressure)
    3. Idiopathic Intracranial Pressure (similar to Spinal Headache)
  3. Electroencephalogram (EEG)
    1. Rarely useful in Headache Evaluation

V. References

  1. Tabatabai (2021) Emerg Med Clin North Am 39(1): 67-85 [PubMed]

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