Clinical evaluation of Secondary causes of headaches

(Neurology 2019;92:134 & JAMA 2021;325:1874)

• Hx: onset (sudden vs. gradual), quality, evolution (progressive), severity, location, duration, triggers, alleviating factors, positional, hormonal (menstruation), preceding trauma, assoc. sx (visual Δs, “floaters,” N/V, photophobia, focal neuro sx), meds (new, analgesics), substance abuse (opioids, caffeine), personal/family hx of HA; neoplasm, preg
• General and neurologic exam (including funduscopic exam, visual fields). Headache diary.
• warning signs of headache
• Imaging: CT or MRI; consider CTA (beading in vasculitis/RCVS/vasospasm), CTV/MRV
• LP if ? SAH (✓ for xanthochromia), idiopathic intracranial HTN (✓opening press); image first!