Approach to Headaches - Differential Diagnosis Algorithm



Red flags (PHANTOMS):

 • Pattern change, progressively worse, papilledema

 • Horner syndrome, history of cancer, HIV, or lyme

 • Altered mental status, analgesics refractory

 • Neurological deficits

 • Temporal artery tenderness, triggered by cough, exertion, or sexual intercourse

 • Onset > 50 yr, onset (thunderclap) of worst headache

 • Meningeal signs, mid-dilated pupil (AACG)

 • Systemic symptoms and signs (e.g., fever, myalgia), seizures



Life/sight-threatening conditions:

 • Stroke, carotid dissection

 • Cerebral venous thrombosis

 • Hemorrhage

 • Hypertensive encephalopathy

 • Space-occupying brain lesion

 • CNS infection (e.g., meningitis)

 • Temporal arteritis

 • Acute angle closure glaucoma (AACG)

 • Benign intracranial hypertension



Matthew Ho, MD PhD @MatthewHoMD



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