Question

A 40-year-old man presents with complaints of headache.
How will you approach a patient presenting with headache?

Hint:

When evaluating headaches, always rule out red flags that suggest a secondary cause, such as sudden onset or neurological symptoms.

Answer 1

Step 1: Detailed History.
A thorough history should include the onset, duration, and characteristics of the headache (e.g., location, intensity, associated symptoms). The physician should also ask about any triggers, prior episodes, and family history of headaches. Additionally, it is crucial to assess for any red flags that suggest secondary causes (e.g., sudden onset, neurological deficits, trauma).

Step 2: Physical Examination.
Physical examination should focus on neurological signs. Check for signs of increased intracranial pressure, such as papilledema, or signs of systemic infection that might suggest secondary causes. Examination should also include palpation of the head and neck for muscle tension or signs of sinusitis.

Step 3: Diagnostic Testing.
Based on the clinical suspicion, diagnostic tests such as brain imaging (CT or MRI), lumbar puncture, or blood tests may be indicated to rule out secondary causes, particularly if there are red flags or if the headache is not typical of a primary headache.

Step 4: Management Plan.
The management plan will depend on the type of headache. For tension headaches, over-the-counter pain relievers may be sufficient. Migraines may require specific medications such as triptans, while cluster headaches often require oxygen therapy and specific abortive medications. For secondary headaches, the underlying cause must be treated.

Step 5: Conclusion.
A systematic approach that includes a detailed history, physical examination, and appropriate diagnostic testing is essential in evaluating and managing patients with headaches. Management should be tailored to the type and cause of the headache.