Headache (cont.)
How are secondary headaches diagnosed?
If there is time, the diagnosis of secondary headache begins with a complete
patient
history followed by a physical examination and laboratory and radiology tests as
appropriate.
However, some patients present in crisis with a decreased level of
consciousness or unstable vital signs. In these situations, the health care
practitioner may decide to treat a specific cause without waiting for tests to
confirm the diagnosis.
For example, in patients with headache, fever, stiff neck, and confusion that
suggest meningitis. Since meningitis can be rapidly fatal, antibiotic
therapy may be started before blood tests and a lumbar puncture are performed to
confirm the diagnosis.
What are the exams and tests for secondary headaches?
The patient history and physical examination provide the best means for
determining the cause of secondary headaches. Therefore, it is extremely
important that patients with severe headaches seek medical care and give their
health care practitioner an opportunity to assess their condition. Tests that may be
useful in making the diagnosis of the underlying disease causing headaches
include:
- blood tests,
- computerized tomography (CT Scan),
- magnetic resonance
imaging (MRI) scans of the head, and
- lumbar puncture.
Specific tests will depend
upon what potential issues the health care practitioner and patient want to address.
Blood tests
Blood tests provide helpful information in association with the history and
physical examination in pursuing a diagnosis. For example, an infection or
inflammation in the body may cause a rise in the white blood cell count, the
erythrocyte sedimentation rate (ESR) or
C-reactive protein (CRP). Blood tests
can also assess electrolyte disturbances, and a variety of organ functions like
liver, kidney, and
thyroid.
Computerized tomography of the head
Computerized tomography is able to detect bleeding, swelling, and tumor. It
can also show evidence of previous stroke. With intravenous contrast injection,
it can also be used to look at the arteries of the brain.
Magnetic resonance imaging (MRI) of the head
MRI is able to better look at the anatomy of the brain, meninges (the layers
that cover the brain and the spinal cord). While it is more precise, the time to
perform the scan is significantly longer than for computerized tomography. This
type of scan is not available at all hospitals.
Lumbar puncture
Cerebro-spinal fluid, the fluid that surrounds the brain and spinal cord, can
be obtained with a needle that is inserted into the spine in the lower back.
Examination of the fluid can reveal infection (such as meningitis due to
bacteria, a virus, or tuberculosis) or blood from hemorrhage. In almost all
cases, computerized tomography is done prior to
lumbar puncture to make certain
there is no bleeding, swelling, or tumor in the brain.
Next: When should patients with headache seek medical care? »
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