​Symptoms and Signs – Differential Diagnosis of Headache and Facial Pain
VASCULAR HEADACHES
• Migraine
• Migraine with headaches and inconspicuous neurologic features
Migraine without aura (“common migraine”)
• Migraine with headaches and conspicuous neurologic features With transient neurologic symptoms: migraine with typical aura (“classic migraine”), sensory, basilar, and
hemiplegic migraine With prolonged or permanent neurologic features
(“complicated migraine”): ophthalmoplegic migraine, migrainous infarction
• Migraine without headaches but with conspicuous neurologic features (“migraine equivalents”)
Abdominal migraine
Benign paroxysmal vertigo of childhood
• Migraine aura without headache (“isolated auras,” transient
migrainous accompaniments)
• Cluster headaches
• Episodic cluster headache (“cyclic cluster headaches”)
• Chronic cluster headaches
• Chronic paroxysmal hemicrania
• Other vascular headaches
• Headaches of reactive vasodilation (fever, drug induced,
postictal, hypoglycemia, hypoxia, hypercapnia,
hyperthyroidism)
• Headaches associated with arterial hypertension Chronic severe hypertension (diastolic >120 mm Hg)
Paroxysmal severe hypertension (pheochromocytoma, some coital headaches)
• Headaches caused by cranial arteritis
Giant cell arteritis (“temporal arteritis”)
Other vasculitides
HEADACHES ASSOCIATED WITH DEMONSTRABLE
MUSCLE SPASM
• Headache caused by posturally induced or paralesional muscle spasm
• Headaches of sustained or impaired posture (e.g., prolonged close work, driving)
• Headaches associated with cervical spondylosis and other diseases of cervical spine
• Myofascial pain dysfunction syndrome (headache or facial pain associated with disorders of teeth, jaws, and related structures, or “temporomandibular joint [TMJ] syndrome”)
• Headaches caused by psychophysiologic muscle contraction (“muscle contraction headaches,” or tension type of headache associated with disorder of pericranial muscles)
HEADACHES AND FACIAL PAIN WITHOUT DEMONSTRABLE PHYSICAL SUBSTRATE
• Headaches of uncertain etiology: “tension headaches” (tension type of headache unassociated with disorder of pericranial muscles)
• Some forms of post-traumatic headache
• Psychogenic headaches (e.g., hypochondriacal, conversional, delusional, malingering)
• Facial pain of uncertain etiology (“atypical facial pain”)
COMBINED TENSION-MIGRAINE HEADACHES
• Episodic migraine superimposed on chronic tension headaches
• Chronic daily headaches: associated with analgesic or ergotamine overuse (“rebound headaches”)
• Not associated with drug overuse
HEADACHES AND HEAD PAINS CAUSED BY DISEASES OF EYES, EARS, NOSE, SINUSES, TEETH, OR SKULL HEADACHES CAUSED BY MENINGEAL INFLAMMATION
• Subarachnoid hemorrhage
• Meningitis and meningoencephalitis
• Others (e.g., meningeal carcinomatosis)
HEADACHES ASSOCIATED WITH ALTERED INTRACRANIAL PRESSURE (“TRACTION HEADACHES”)
Increased Intracranial Pressure
• Intracranial mass lesions (e.g., neoplasm, hematoma, abscess)
• Hydrocephalus
• Benign intracranial hypertension
• Venous sinus thrombosis
Decreased Intracranial Pressure
• Post–lumbar puncture headaches
• Spontaneous hypoliquorrheic headaches
HEADACHES AND HEAD PAINS CAUSED BY CRANIAL NEURALGIAS
Presumed Irritation of Superficial Nerves
• Occipital neuralgia
• Supraorbital neuralgia
Presumed Irritation of Intracranial Nerves
• Trigeminal neuralgia (“tic douloureux”)
• Glossopharyngeal neuralgia