jmnies's version from 2017-02-14 04:20


Question Answer
TensionUsually bilateral; frontotemporal, occipital, Scalp tenderness; occasional phono/photophobia
MigraineUsually unilateral (~70%); “throbbing” (+/-) phono/photophobia (+/-) N/V, visual/sensory auras
ClusterUsually retro-orbital; occurs at similar time each day (+) lacrimation, rhinorrhea, ptosis, miosis
Important attributes to investigateChronological pattern, Severity, Change in symptoms
Associated symptomsN/V Neurologic signs Change in vision/motor/speech Facial pain Worse with valsalva (coughing, sneezing, etc.) Worse with position changes
Past Medical HistoryBe sure to ask about a history head trauma, tension or migraine headaches, sinusitis, hypertension
Family HistoryImportant to ask about family history of brain tumors/cancers, migraines and aneurysms.
Cushing’s syndromeIncreased cortisol production Round, “moon” face with red cheeks +/- excessive hair growth
Nephrotic syndromeEdematous, pale face
MyxedemaSevere hypothyroidism Edematous, especially around the eyes Dry skin; eyebrows thin, dry and coarse
AcromegalyIncreased growth hormone production Enlargement of bone and soft tissue Prominent bones: forehead, nose and jaw Prominent soft tissues: nose, lips and ears
Parkinson diseaseDecreased facial mobility blunts expression “Mask-like” stare
Parotid gland enlargement (Chronic, bilateral, asymptomatic)Obesity, diabetes, cirrhosis
Parotid gland enlargement (Gradual, unilateral)Suggests neoplasm
Parotid gland enlargement (Acute)Mumps
Primary headacheNeuronal dysfunction, possibly of brainstem origin, involving low serotonin, spreading cortical depression and trigemino-vascular activation. Types: with aura; without aura; variants.
Timing of primary headachesprimary is rapid, tension is gradual, cluster abrupt

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