I have a headache.

I have a headache and, of course, my natural instinct is to run a differential in my head – an unfortunate side effect of PA school. Since headaches are a common patient complaint I thought I’d share my thought process…

Is it primary or secondary? (Note: Primary HA are non-life threatening.)

Primary = migraines, cluster, or tension

Secondary = think VOMIT

V = vascular (SAH, subdural hematoma, epidural hematoma, intraparenchymal hemorrhage, temporal arteritis)

O = other causes (malignant HTN, pseudomotor cerebri, post-LP, pheochromocytoma)

M = medication (drug related – nitrates, ETOH withdrawal, chronic analgesic use/abuse)

I = infection (meningitis, encephalitis, cerebral abscess, sinusitis, herpes zoster, fever)

T = tumor

Great Article and DDx Chart on Headaches (includes tests/treatments): 

Pitfalls in Management of Headaches in the Emergency Department

I may even add an “S”to the end – it will stand for studying student. I think I’m going to live.

Source: Step Up to Medicine  2^nd Ed.