Which features of a secondary headache disorder should be considered in the differential diagnosis of migraine headache?

Updated: Oct 21, 2019
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Helmi L Lutsep, MD  more...
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Migraine may also may simulate or be simulated by secondary headache disorders or coexist with a secondary headache disorder. Any of the following features suggest a secondary headache disorder and warrant further investigation:

  • The first or worst headache of the patient's life, especially if rapid in onset

  • A change in frequency, severity, or clinical features of the attack

  • New progressive headache that persists for days

  • Precipitation of headache with Valsalva maneuvers (ie, coughing, sneezing, bearing down)

  • The presence of associated neurologic signs or symptoms (eg, diplopia, loss of sensation, weakness, ataxia)

  • Onset of headaches after the age of 55 years

  • Headache developing after head injury or major trauma

  • Persistent, 1-sided throbbing headaches

  • Headache accompanied by stiff neck or fever

  • Atypical history or unusual character that does not fulfill the criteria for migraine

  • Inadequate response to optimal therapy

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