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Occipital headache differential diagnosis

The Differential Diagnosis of Headache

Occipital neuralgia is a headache disorder characterized by shooting neuropathic pain secondary to greater or lesser occipital nerve pathology. The diagnosis should be considered in a patient presenting with the following: Unilateral or bilateral pain originating at the skull bas Unfortunately, the main differential diagnosis, occipital migraine, can have similar symptoms and can be ameliorated with occipital local anesthetic injections 1. Fronto-orbital pain may also be present due to connections between cervical nerves and the trigeminal nerve in the trigeminal spinal nuclei 7 Occipital Neuralgia is a condition in which the occipital nerves, the nerves that run through the scalp, are injured or inflamed. This causes headaches that feel like severe piercing, throbbing or shock-like pain in the upper neck, back of the head or behind the ears The differential diagnosis depends on the clinical picture and includes: Headache not associated with an underlying condition - primary headache: Migraine. Tension-type headache. Trigeminal... Migraine. Tension-type headache. Trigeminal autonomic cephalgias for example cluster headache and.

Occipital Headaches: Signs, Causes & Treatments National

  1. Although her clinical presentation was most concerning for occipital neuralgia, the differential diagnosis included migraine, cervicogenic headache, Arnold-Chiari malformation, posterior fossa or cervical mass, and vascular lesions. Brain and cervical spine MRIs were ordered and showed no evidence of intracranial or cervical spinal cord lesions
  2. Differential Diagnosis [edit | edit source] It is important to differentiate from serious pathology such as: Vascular Pathologies of the Neck; Intracranial Pathology; Cervical Instability; Cervical Myelopathy; Occipital neuralgia; It is also important to differentiate from other types of headache
  3. utes, and often consists of lancinating pain that directly results from the pathology of one of these nerves. It is paramount that physicians understand the differential diagnosis for this condition and specific diagnostic criteria. There are multipl
  4. utes of standing, and is associated with neck stiffness, tinnitus, hyperacusia, photophobia, and nausea; may be history of recent lumbar puncture or back/neck trauma; may be associated with Marfan's Syndrome, Ehlers-Danlos syndrome, neurofibromatosis, or polycystic kidney diseas
  5. Electroencephalography (EEG) is of limited use in the routine evaluation of headache in children. If the headache is associated with alteration of consciousness or abnormal involuntary movement,..
  6. Spontaneous intracranial hypotension, although considered a rare phenomenon, is still essential as a differential diagnosis for a patient presenting with a positional headache. The patient has been to numerous different physicians and naturopathic doctors with little success
  7. Classification of Headaches Headache red flags. The International Classification of Headache Disorders 3rd edition classifies headaches into primary and secondary headaches. I. Primary Headaches (e.g., tension, migraine, cluster) Primary headaches are headache syndromes not due to another cause. Primary headaches are often chronic and the diagnosis is established early in adulthood

Headache Classification Committee of the International Headache Society. Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Cephalalgia. 1988;8 Suppl 7:1-96. Biondi DM. Cervicogenic headache: a review of diagnostic and treatment strategies. J Am Osteopath Assoc. 2005;105(4 Suppl 2):16S-22S Diagnosis. Dr. Halker Singh says occipital neuralgia is defined as pain over the back of the head, neck and scalp, which is known as the occipital head region. It is characterized by a sharp, shooting pain that can be triggered by things like turning your head or pushing on the affected area *The ICHD-3 classification notes that migraine headache in children and adolescents (aged under 18 years) is more often bilateral than is the case in adults; unilateral pain usually emerges in late adolescence or early adult life. Migraine headache is usually frontotemporal. Occipital headache in children is rare and calls for diagnostic caution PDPH is classically fronto-occipital and is often associated with neck stiffness. Sometimes Diagnosis Symptoms of a postural headache and a history of dural puncture are usually sufficient to make a diagnosis. If in doubt, additional investigations such as MRI may be needed to about the possible differential diagnosis and management plan

Differential Diagnosis of Headaches (Definition, Types) - DD

  1. Specifically, ON can be described as bilateral or unilateral, typically accompanied by paresthesia around the occipital nerve [1]. During the initial, mild stage, this headache is commonly treated.
  2. Common treatments include blockade of the greater occipital nerve, the lesser occipital nerve, and the stellate ganglion. The differential diagnosis includes a migraine, hemicrania continua, spondylosis of the cervical spine, and tension-type headache. A cervicogenic headache is a rare chronic headache in people who are 30 to 44 years old 9)
  3. The differential diagnosis between migraine and the occipital epilepsies is reviewed. It is concluded that elementary visual hallucinations, blindness or both, alone or followed by headache and vomiting of symptomatic occipital epilepsy are identical to those of idiopathic occipital epilepsy
  4. Headache + intractable vomiting; New-onset headache in patients with: Age > 50yrs; Malignancy; HIV; Neurological deficits (other than migraine with aura) Consider CXR. 50% of patients with pneumococcal meningitis have evidence of pneumonia on CXR; Management Non-specific Headache. If known, treat specific headache type; avoid opioid medications if at all possibl
  5. Tension headaches are due to tight muscles in your shoulders, neck, scalp and jaw. They are often related to stress, depression or anxiety. You are more likely to get tension headaches if you work too much, don't get enough sleep, miss meals, or use alcohol. Other common types of headaches include migraines, cluster headaches, and sinus headaches
  6. Differential Diagnosis Occipital neuralgia is an infrequent cause of headaches and rarely occurs in the absence of trauma to the greater and lesser occipital nerves. More often, the patient with headaches involving the occipital region is in fact suffering from tension-type headaches

Tiny Tip: STAB as a Tool for Diagnosing Occipital

It is necessary to rule out the other forms of headache in differential diagnosis, first of all migraine and tension headache because of their great similarity with CH. The following is used in the treatment of the CH: medical therapy, acupuncture, neural therapy, local botulinum toxin injection, cervical epidural corticosteroid injection. Occipital neuralgia is a painful condition that affects the posterior aspect of the head and can be difficult to distinguish from other common forms of headaches. This article reviews the anatomy, pathophysiology, clinical presentation, differential diagnosis, diagnostic testing, and management approaches for occipital neuralgia Basic TCM Treatment Protocols for Headaches. Acupuncture rocks when it comes to headaches! - Cold or warm packs may also help relieve the pain. - Ginger, peppermint oil or rosemary are also a great addition, as well as magnesium rich foods such as almonds, spinach and avocados. Occipital (Gb 20, Bl 10, Bl 60) Differential Diagnosis. The differential diagnosis for ON includes any disorder which similarly presents with a headache or facial pain. Because connections are possible between the occipital nerves and cranial nerves VIII, IX, and X, patients can sometimes present with confusing symptoms, such as vision impairment, dizziness, or sinus congestion The differential diagnosis for occipital neuralgia includes any disorder which similarly presents with a headache or facial pain. Because connections are possible between the occipital nerves and cranial nerves VIII, IX, and X, patients can sometimes present with confusing symptoms, such as vision impairment, dizziness, or sinus congestion 6)

Occipital neuralgia Radiology Reference Article

Differential diagnosis and incidence of postpartum headaches. Patients complain of a frontal or occipital headache, characterized by its postural component. The severity increases on sitting or standing, coughing or straining, and improves on lying down Occipital neuralgia is a type of headache that causes symptoms of burning, aching, and throbbing pain in the back of the head and neck. Causes can include infection, irritation, or trauma to the occipital nerves. Treatment of occipital neuralgia depends upon the underlying cause

Occipitalneuralgia

Differential Diagnosis. It is very important to be able to distinguish occipital neuralgia from the occipital referral of pain from the atlantoaxial or upper zygapophyseal joints or tender trigger points in neck muscles or their insertions. Occipital neuralgia can produce symptoms indistinguishable from a cervicogenic headache An important differential diagnosis of both early‐ and late‐onset childhood epilepsy with occipital spikes is basilar migraine. Basilar migraine shares many features of both syndromes, including visual loss or disturbance, brain stem symptoms, loss of consciousness and headache ( Panayiotopoulos, 1999 b ) A thorough history and physical examination of the neck and occipital region coupled with appropriate diagnostic testing can help to provide an accurate diagnosis of the pain generator or generators. The following review will examine the differential diagnosis and outline a diagnostic approach for potentially confusing cervical pain syndromes.

Occipital Neuralgia - Causes, Symptoms, Diagnosis and

Headache Emergencies: Diagnosis and Management The differential diagnosis of headache plus focal findings is broad and work-up should be guided by the patients' profile of other risk factors. Symptom-atic malignancy is usually visualized on routine noncontrast head computed tomog- Document Viewer Differential Diagnosis of Common Neurological Symptoms. that all of their symptoms can be attributable to CMI. The most common symptom of CMI is posterior occipital headache (often triggered or worsened by valsalva). Other predominant symptoms include: neck pain, dizziness, fatigue, memory and concentration difficulty, parasthesias. Spasms In The Neck? It Could Be An Occipital Headache. It is common for many sufferers to confuse an occipital headache with any kind of chronic headaches or migraine.Typically, occipital headache, referred to as occipital neuralgia, arises from the neck, more specifically the base of the skull and spreads to the area behind the eyes and the back, front and side of the head INTRODUCTION. Neck pain and cervical muscle tenderness are common and prominent symptoms of primary headache disorders [].Conversely, it is plausible that head pain can be referred from bony structures or soft tissues of the neck, a condition called cervicogenic headache [].Nevertheless, there has been debate regarding the existence of cervicogenic headache as a distinct clinical disorder, as.

Scenario: Headache - diagnosis Diagnosis Headache

diagnosis can involve cervical facet joints, cervical disc dis-ease, cervical fractures, infection, rheumatoid arthritis, and Occipital Neuralgia & Cervicogenic Headache Occipital neuralgia and cervicogenic headache have similar anatomy and treatment. By Andrew C. Young, MD Case 1. Occipital Neuralgia Case Presentatio Differential Diagnosis: Headache due to invasion of pathogenic wind into the channels and collaterals. a) Headache due to wind-cold evil manifested as headache with stiff nape and back, chilliness, general aching, stuffy nose with watery discharge. Occipital Headaches a) Acute headaches here are due to invasion of external wind tightening. Since neuralgia due to pinching of the nerve can be confused with migraine (hemicrania) or a headache of a different etiology, differential diagnosis is of particular importance. The differential diagnosis includes tumors, infections (inflammation of the brain, arachnoiditis), myofascial syndrome, congenital anomalies, etc

Occipital Headache vs Occipital Neuralgia [edit Tend to resemble migraines or tension type headaches. Diagnosis is made based on the relationship between headache onset and head / neck trauma. Cordett T. Vertebral artery testing and differential diagnosis in dizzy patients. Physical Therapy and Rehabilitation. 2014; 1(1): 3 Taking a headache history is an important skill that is often assessed in OSCEs. This guide provides a structured approach to taking a headache history in an OSCE setting. The vast majority of headaches are not life-threatening, with tension headache and migraine being the most common diagnoses

Occipital Neuralgia & Cervicogenic Headache - Practical

  1. Differential diagnosis of Cervicogenic Headaches can be recognised using the following criteria: There is evidence of a lesion or disorder to either the cervical spine or soft tissues in the neck The headache developed in relation to the onset of the above disorde
  2. ation and diagnostic blocks remain the standard for diagnosis. Multiple treatment options exist, including rehabilitative measures.
  3. 387 Cervicogenic Headache: Clinical Presentation, Diagnostic Criteria, and Differential Diagnosis Fabio Antonaci, MD, PhD,* Torbjorn A. Fredriksen, MD, PhD
  4. Headache is a pain related to irritation and/or inflammation of intracranial or extracranial structures with pain receptors (e.g., meninges. , cranial nerves, blood vessels). Primary headache. : a headache that is not caused by another underlying condition. [2
  5. Occipital Neuralgia - Symptoms, Diagnosis, and Treatment Key Points: Occipital neuralgia may be a cause of head pain originating in the occipital region (back of the head). 1. Pain is episodic, brief, severe, and shock-like. It originates from the occipital region and radiates along the course of the occipital nerves. 2

Differential diagnosis summary that will come in handy for clinical exam ISCE in fourth year. ddx of headache acute chronic subarachnoid haemorrhage subdura Occipital neuralgia is a condition in which the nerves that run from the top of the spinal cord up through the scalp, called the occipital nerves, are inflamed or injured. You might feel pain in.

Cervicogenic Headache - Physiopedi

  1. Traditional Diagnosis and Treatment of Occipital Neuralgia Upon suspicion that occipital neuralgia is the cause of a patient's headache, one must be careful to confirm the diagnosis; in fact, occipital neuralgia is one of the most over-diagnosed headache conditions. 4 Definitive diagnosis is made with an occipital nerve block using lidocaine.
  2. Cervicogenic Headache: Clinical Presentation, Diagnostic Criteria, and Differential Diagnosis Fabio Antonaci, MD, PhD,* Torbjorn A. Fredriksen, MD, PhD, and Ottar Sjaastad, MD, PhD Address Cervicogenic headache has been defined, in principle, * Service of Neurophysiopathology, Department of Neurological as a unilateral headache without sideshift
  3. Migraine is a primary headache disorder characterized by recurrent attacks. Approximately 44.5 million U.S. adults (18% to 26% of women and 6% to 9% of men) have experienced a migraine, according.

Occipital neuralgia - Wikipedi

Occipital pain is a common complaint amongst patients with headache, and the differential can include many primary headache disorders such as cervicogenic headache or migraine. Occipital neuralgia is an uncommon cause of occipital pain characterized by paroxysmal lancinating pain in the distribution of the greater, lesser or third occipital nerves. Greater occipital nerve blockade with. Occipital pain is a common complaint amongst patients with headache, and the differential can include many primary headache disorders such as cervicogenic headache or migraine. Occipital neuralgia is an uncommon cause of occipital pain characterized by paroxysmal lancinating pain in the distribution of the greater, lesser or third occipital nerves Differential Diagnoses. Next in Headaches Guide. Finding Relief From Headaches; Diagnosis of a headache takes several things into account, including when episodes occur, what symptoms you experience, how they respond to treatments you've tried, your overall health profile, and more. By performing a detailed history and physical exam, and.

While a patient presenting with headache can have more than 300 differential diagnoses, individuals suffering from subdural hematoma will have fewer similar clinical presentations to consider. 5 Differential diagnoses for subdural hematoma, requiring neuroimaging studies include epidural hematoma/intracranial hematomas, cerebrovascular insults. Differential Diagnosis Of Occipital Headache S Can Dizzy Make Migraine headaches are usually characterized by severe pain on one or both sides of the head an Migraine and stroke may present similar symptoms including visual disturbances speech problems and weakness down one side Aprill C, Axinn MJ, Bogduk N. Occipital headaches stemming from the lateral atlanto-axial (C1-2) joint. Cephalalgia 2002; 22:15. Barnsley L, Lord S, Bogduk N. Comparative local anaesthetic blocks in the diagnosis of cervical zygapophysial joint pain Occipital neuralgia (ON) is a relatively rare primary headache disorder. The cause of occipital neuralgia is unknown, however, entrapment and irritation of the nerves have been proposed. When conservative measures are ineffective, occipital nerve blocks are a convenient and relatively benign tool for diagnosis and management of occipital neuralgia

Among other cranial neuropathies, occipital neuralgia is also known to occur in patients with multiple sclerosis. Differential diagnosis. The conditions most easily mistaken with ON for other headache and facial pain disorders include migraine, cluster headache, tension headache, and hemicrania continua Differential diagnosis of trigeminal neuralgia Trigeminal Neuralgia (TN) is distinct from other craniofacial neuralgias by its strict distribution the intermedius branch of the facial nerve or occipital nerves. The unique paroxysmal character of TN and evidence of trigger zones or (short-lasting unilateral neuralgiform headache attacks. Headache remains the most common cause of neurological consultation in clinical practice 1,2 for which correct diagnosis and treatment are mandatory. The International Headache Society (IHS) produced an International Classification of Headache Disorders of which the third edition was published this year. 3 This process involved working groups investigating primary headache disorders and. Occipital neuralgia is a distinct type of headache characterized by piercing, throbbing, or electric-shock-like chronic pain in the upper neck, back of the head, and behind the ears, usually on one side of the head. Typically, the pain of occipital neuralgia begins in the neck and then spreads upwards

Diagnosis. The diagnosis of migraine is based on patient history. International Headache Society diagnostic criteria are that patients must have had at least 5 headache attacks that lasted 4-72 hours (untreated or unsuccessfully treated) and that the headache must have had at least 2 of the following characteristics Vertebral artery dissection (VAD) sometimes has no specific symptoms and is difficult to differentiate from other forms of headache. A woman in her thirties had a severe, throbbing left-sided headache. A migraine without aura was suspected and zolmitriptan was administered, which alleviated the symptoms. The woman was consequently deemed to have a migraine without aura Regardless, her diagnosis of occipital headaches due to CMI was delayed by 2.5 yrs because of two separate conditions with overlapping symptoms. As first-line providers for those with concussions, physiatrists must be aware of CMI as a potential underlying cause of persistent symptoms unresponsive to typical management

Acute headache is defined as a recent onset of headache with no prior history of similar episodes. Establishing whether any neurologic symptoms accompany this headache is very important. The differential diagnosis of acute headache includes systemic infection, trauma, CNS infection, and first episode of migraine Cervicogenic headache is a secondary form of headache that occurs from the upper cervical spine and atlanto-occipital joint. A CGH is a frequent source of chronic headache and is frequently misdiagnosed .Cervicogenic headache is among the most common problem affecting four times more women as compared to males and is considered by some painful feeling in the head , neck ,temporal area, frontal. Occipital neuralgia (ON) is a painful condition affecting the posterior head in the distributions of the greater occipital nerve (GON), lesser occipital nerve (LON), third occipital nerve (TON), or a combination of the three. It is paroxysmal, lasting from seconds to minutes, and often consists of lancinating pain that directly results from the pathology of one of these nerves. It is paramount. Postictal headache does not show preference for those with a family history of migraine. Most of the patients are misdiagnosed as having migraine with aura, basilar migraine, acephalgic migraine, or migralepsy simply because physicians are not properly informed of differential diagnostic criteria. As a result, treatment may be delayed for years

Post-dural-puncture headache (PDPH) is a complication of puncture of the dura mater (one of the membranes around the brain and spinal cord). The headache is severe and described as searing and spreading like hot metal, involving the back and front of the head and spreading to the neck and shoulders, sometimes involving neck stiffness.It is exacerbated by movement and sitting or standing and. Differential Diagnosis of. Descrizione del post: A 48 year-old male with hypertension and hyperlipidemia presents with headache. Notes onset of symptoms 8 hours prior to presentation, reaching maximal severity within seconds. Headache improved with over-the-counter analgesics. On examination, there are no neurological deficits, neck is supple What vertebrae causes headaches? In the case of cervicogenic headache, the cause is a disorder of the cervical spine and its component bone, disc and/or soft tissue elements. Numerous pain-sensitive structures exist in the cervical (upper neck) and occipital (back of head) regions Differential diagnosis: Subarachnoid hemorrhage, venous thrombosis, Chronic migraine is a complication of migraines, and is a headache that fulfills diagnostic criteria for migraine headache and occurs for a greater time interval. Specifically, greater or equal to 15 days/month for longer than 3 months. Occipital nerve stimulation,. Tables of differential diagnosis are detailed in references 3 and 4). More important, in clinical practice, occipital seizures of visual symptoms associated with headache are often erroneously identified as migraine with significant diagnostic and therapeutic adverse effects ( 3 , 4 )

Not better accounted for by another ICHD-3 diagnosis. Differential Diagnosis: Because occipital pain is a common symptom of many headache disorders, it is important that your doctor rule out other explanations for occipital pain before settling on a diagnosis List the emergent differential diagnoses for pediatric headache; nighttime awakening from headache, occipital headache, hearing problems, diplopia or if they have been happening for a few weeks or months and are increasing in frequency and severity. Differential Diagnosis. Emergent conditions, though uncommon, MUST be excluded prior to.

Diagnostic criteria: A. Headache fulfilling criteria for 7.2 Headache attributed to low cerebrospinal fluid (CSF) pressure , and criterion C below B. Absence of a procedure or trauma known to be able to cause CSF leakage C. Headache has developed in temporal relation to occurrence of low CSF pressure or CSF leakage, or has led to its discovery D.D DIFFERENTIAL DIAGNOSIS. Migraine is typically manifest by episodic disabling headache, though it is more than just head pain. Differential diagnosis is from tension type headache (TTH), with which migraine is co-morbid (this differential is also discussed from the other perspective elsewhere in this supplement) Cervicogenic headache and migraine: differential diagnosis and therapy Cervicogenic headache (CH) is a syndrome of referred pain that originates in the neck structure. Despite the apparent simplicity of its determination, there is still no consensus on diagnostic criteria for cervicogenic headache amongst physicians of various specialties

occipital nerve stimulation or greater occipital nerve injection; Differential diagnosis. Once the typical episodic and recurrent nature of the headaches becomes apparent and the stereotyped pattern of signs and symptoms evident the diagnosis can usually be made with a high degree of certainty Bigal ME and Lipton RB. Tension-type headache: Classification and diagnosis. Curr Pain Headache Rep. 2005;9:423- 9. Bogduk N. An anatomical basis for the neck-tongue syndrome. J Neurol Neurosurg Psych 1981; 44:202-208. Buenaver LF, Edwards RR, Smith MT, Gramling SE, Haythornthwaite JA The Primary Headaches PART I Primary headaches are disorders by themselves. They are caused by independent pathomechanisms and not by other disorders. Examples are migraine, tension-type headache or cluster-headache The Secondary Headaches PART II Secondary headaches develop as a secondary symptom due to another disorder that is known to cause headache

The most useful features for resolving the differential diagnosis are the duration, location and severity of the headache. A headache of sudden onset; Subarachnoid haemorrhage - aka thunderclap headache, described as extremely sudden severe pain at the back of the head The distinctive headache of the Occipital Condyle associated with the palsy, which narrows the differential Syndrome: a report of four cases. Headache 1998; 38: 308- diagnosis to tumoral or inflammatory affections in the 11. occipital condyle region. The most common cause is 6 Kim ED, Grayhack JT Occipital Neuralgia Differential Diagnosis. The nature of symptoms makes diagnosing the condition quite difficult in some cases. A battery of Occipital Neuralgia tests is then needed to differentiate the condition from other similar diseases like. Cluster headaches; Foramen Magnum Tumors; Herniated Cervical Intervertebral Dis Secondary cervicogenic headache, in particular, is amenable to diagnosis and treatment without imaging, sub-specialist referral, or the use of medications that tend to reduce symptoms rather than treat the disorder. An osteopathic approach, including osteopathic manipulative treatment, may be well suited for both the evaluation and treatment of.

Differential diagnosis for headache. STUDY. PLAY. Symptoms of tension headache. Recurrent or chronic. Usually dull, non-throbbing, low intensity, persistent. May last days. Severity increases as day progresses and declines at night. Rarely awakens from sleep. Location of tension headaches. Occipital, suboccipital, bilateral. Pain of tension. A positional headache is a type of headache that gets worse when you change position. The pain is more severe when you're standing and goes away when you're lying down. Learn more about causes. Cervicogenic headaches may respond to exercise and manual techniques whereas other headache disorders require medical review. Because physiotherapists often encounter headaches in clinical practice, it is important that you can make a differential diagnosis between different types of headaches and detect any red flag signs and symptoms particular system and look for differential diagnosis. It should be • Headache 58 • Cerebral Blood Flow 59 xviii Differential Diagnosis in Clinical Medicine • Occipital Lobe-testing 70 • Temporal Lobe-testing 70 • Neurological Causes for Syncope 7

MEDICATION-OVERUSE HEADACHE Diagnostic criteria: • A. Headache occurring on 15 days per month in a patient with a pre-existing headache disorder • B. Regular overuse for >3 months of one or more drugs that can be taken for acute and/or symptomatic treatment of headache 1.Regular intake of ergotamine on 10 days per month for >3 months. 2 Pain differential diagnosis for crrection management Occipital Neuralgia A paroxysmal stabbing pain in the distribution of the greater or lesser occipital nerves. It may be caused by trauma, Palpation below the superior nuchal line may reveal a tender spot . Treatment has included occipital nerve block, neurolysis, C2 dorsal root.

Approach to neck painOccipital Neuralgia Causes Symptoms Cure And TreatmentHeadache Clinic: Precision Headache Clinic

4. Differential diagnosis The typical case with the full-blown syndrome (5 Hs) is not difficult to diagnose, but in some cases of pheochromocytoma, the symptoms are very subtle or absent except for severe headache. The most important point is to include pheochromocytoma in the differential diagnosis of a case with episodic headache Headache Online Medical Reference - from definition and diagnosis through risk factors and treatments. Authored by Robert S. Kunkel of the Cleveland Clinic. The primary headache syndromes are migraine, tension-type, and cluster headaches. Migraine and cluster headaches are episodic and recurring conditions. Tension-type headache is usually episodic but like migraine, it can become chronic Headaches associated with focal signs and symptoms require a thorough work-up to exclude mass lesions, ischemic or hemorrhagic stroke, a vascular pathologic condi-tion, or infection. The differential diagnosis of headache plus focal findings is broad and work-up should be guided by the patients' profile of other risk factors. Symptom Possible seizures in stroke patients The differential diagnosis of transient neurologic dysfunction is broad, and the elderly population that is at highest risk of stroke and transient ischemic attack (TIA) is also at risk of many conditions that can mimic seizures.3 Syncope Syncope may not be benign in this population