Headache is one of the highly tested cases on USMLE step 2 CS since it is very common. Asking the right questions is the key to make the correct diagnosis. Are you having trouble remembering all the important questions to ask during your patient encounter? Then try this Headache Mnemonic for USMLE Step 2 CS.
PHYSICAL EXAMINATION Headache Mnemonic
NOTE: Make sure to wash your hands or wear gloves before you start physical examination. Make sure to ask for permission before you start each physical exam. Make sure to use proper draping and don’t forget to tie back patient’s gown. Make sure to explain each physical examination in layman’s term to your patient. Do NOT repeat painful maneuvers.
- HEENT: Palpation of the Sinuses & Temporomandibular joints, Funduscopic exam, Nose, Mouth, Teeth & Throat
- Neck Examination: Inspection, palpation
- Cardiovascular exam: Auscultation
- Pulmonary exam: Auscultation
- Neurology exam: CN 2-12, Muscle strength, DTRs, Kernig’s sign & Brudzinski sign
DIFFERENTIAL DIAGNOSIS Headache Mnemonic
- Migraine headache: Migraines are more common in women and typically appear as a unilateral headache. They are often associated with aura, nausea, vomiting, and photophobia. A positive family history makes the diagnosis even more likely.
- Tension headache: Often associated with stress but is usually bilateral and squeezing. It lasts from hours to days and worsens as the day progresses. Tension headaches are often associated with stress and sleep deprivation.
- Cluster headache: Involves unilateral periorbital pain, often accompanied by ipsilateral nasal congestion, rhinorrhea, lacrimation, redness of the eye, and/or Horner’s syndrome. Episodes of daily pain occur in clusters and often awaken patients at night.
- Pseudotumor cerebri: Headaches may be focal but are usually accompanied by diplopia and other visual symptoms. The physical exam should reveal papilledema but may be normal during the first few days after the onset of illness.
- Sinusitis: It is a rare cause of headache, however it should be considered in patients with recent upper respiratory infections who continue to have sinus tenderness on physical exam.
- Meningitis: is an inflammation of the membranes (meninges) surrounding the brain and spinal cord.
- Temporal arteritis (Giant cell arteritis): It causes inflammation that damages medium and large sized arteries. The name stems from the fact that some of the affected arteries provide blood to the head, including the temples.
- Subarachnoid hemorrhage: Is a life threatening type of stroke caused by bleeding in the space between the brain and the surrounding membrane, which is known as the subarachnoid space.
- Intracranial mass
DIAGNOSTIC WORKUP Headache Mnemonic
- CBC: look for sign of infection or inflammation. Mild normocytic anemia and thrombocytosis may also be seen in temporal arteritis.
- ESR: Will be elevated in malignant and infectious causes.
- CT of head or Brain MRI: Generally reserved for patients with acute severe headache, chronic unexplained headache, or abnormalities on neurologic exam. MRI provides greater anatomic detail, but CT is preferred to rule out acute bleeds.
- Lumbar puncture: To look for elevated opening pressure in pseudotumor. This should always be done after initial Head CT has ruled out any intracranial masses.
- CT of Sinuses: To rule out sinusitis
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