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Causes of migraines nearly impossible to determine
- Headaches, especially pulsating headaches behind the eyes that occur early in the morning
- Visual disturbances
- Nausea and vomiting
Headache - Causes for Concern
The physician should be especially concerned if the patient has any of the following (Silberstein, 1992; Edmeads, 1988):
- a new-onset headache in a patient over the age of 50;
- a sudden-onset headache;
- a headache that is subacute in onset and gets progressively worse over days or weeks;
- a headache associated with fever, nausea, and vomiting that cannot be explained by a systemic illness;
- a headache associated with focal neurologic symptoms or signs, such as papilledema, changes in consciousness or cognition (such as difficulty in reading, writing, or thinking), or a stiff neck (other than the typical aura of migraine);
- no obvious identifiable headache etiology; and
- a new-onset headache in a patient with cancer or human immunodeficiency virus.
General rules for headache classification
- If the patient has more than one headache disorder, all should be diagnosed in the order of importance indicated by the patient.
- To make a diagnosis, all letter headings of a set of diagnostic criteria must be fulfilled.
- After each diagnosis, add estimated number of headache days per year in brackets.
- Diagnostic criteria given at the one- or two-digit level must generally be met by the subforms, but exceptions and/or more specific criteria are listed under the subforms.