Neurology – Headache: By Fiona Costello M.D.


There are literally hundreds of different
headache types. The key thing is to differentiate a primary
headache, like tension or migraine, from secondary causes, which include life-threatening causes
like neoplasms, intracranial bleeds or giant cell arteritis. The American Headache Society has created
the SNOOP framework to help us remember the symptoms and signs of a secondary cause of
the headache. Primary headaches are usually recurrent and
are not caused by underlying disease or structural problems. Secondary headaches, in contrast,
may be due to underlying processes such as infections, trauma, vascular disorders, and
tumors. Now – like a detective, here is how I “SNOOP
it” when I look for clues of a secondary headache! S in SNOOP refers to Systemic symptoms and
Secondary risk factors. For instance a 20 pound weight loss in an elderly patient means
that giant cell arteritis needs to be ruled out with an ESR and C reactive protein. N refers to neurologic signs like cranial
nerve palsies or paralysis. Imaging needs to be ordered to rule out intracranial pathology. O refers to onset. If the onset is sudden,
imaging may be needed to rule out a ruptured aneurysm. O also refers to older onset. If the patient
is over 50 this can be a cause for concern. Lastly, P stands for previous headache history.
If there are changes in a pre-existing pattern in the headache, this too is worrisome.

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