II. Diagnostics

  1. Head CT or Head MRI
    1. See Neuroimaging in Headache
    2. See Organic Headache
    3. Focal neurologic symptoms or signs
    4. Progressive Headaches
    5. Symptoms of increasing Intracranial Pressure
    6. Indications to obtain head imaging prior to Lumbar Puncture
      1. Suspected Increased Intracranial Pressure
      2. CNS mass
      3. Headache in HIV
      4. Altered neurologic exa
  2. Head CT Venogram or the preferred MR Venogram
    1. Cerebral Venous Sinus Thrombosis
  3. Lumbar Puncture (LP)
    1. Fever (Meningitis or Encephalitis suspected)
      1. Do not delay antibiotics if Bacterial Meningitis is suspected (but attempt to get Lumbar Puncture first if possible)
    2. Subarachnoid Hemorrhage
      1. LP indicated in Thunderclap Headache with negative CT Head
  4. Lumbar Puncture with opening pressure
    1. Increased Intracranial Pressure (e.g. Pseudotumor Cerebri)
    2. Cerebral venous sinus thrombosis (opening pressure)
    3. Idiopathic Intracranial Pressure (similar to Spinal Headache)
  5. XRay C-Spine
    1. Rarely useful in Headache Evaluation
  6. Electroencephalogram (EEG)
    1. Rarely useful in Headache Evaluation

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