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Headaches: Making the Diagnosis

Casey Parker, MD
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No me gusta!

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Does your patient’s headache need neuroimaging?

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Kelly A. -

Dr. Parker = fantastic. Great episode.

Michael B. -

Very good review. Also, having a rather humble primary care physician in the field presenting (vs a neurologist) is what makes the podcast unique.

Heidi J., MD -

Exactly Michael B! While consultants are invaluable to our practice, their perspective is going to be different than that of a front line primary care doc.

Mohammed A. -

I'm gonna challenge your assertion that hypertension causes headache, do you have any good to cite?

Casey P. -

Hi Mohammed
Fair comment - this is probably one of the oldest myths in modern medicine - that plain old hypertension can cause headaches. I completely agree that this is nonsense.
There are a number of articles that have well and truly busted this myth - in fact it is more likely that the antihypertensive meds are causing the headaches than the actual BP.

However, there are certainly cases of severe acute hypertension presenting with headaches - usually in the context of a sudden endocrinopathy or pregnancy-related BP disturbance - headache is certainly a symptom of pre-eclampsia .
I have put out some feelers and most of the smart docs I know have seen patients with rare problems like phaeochromocytoma, Cushings, thyroid storms or other odd hypertension-causing diseases present with a headache as a primary symptom.

So - I agree it is a rare thing. Everyday primary HT in the GP offices is very / extremely unlikely to cause a headache. However - my advice is that we ought to check the BP in pots with a headache - as it will make you think twice and investigate for these rarer diagnoses if it is 250/180!
Personally I have seen a young woman with headache, followed by a seizure in ED - she had severe HT and turned out to have undiagnosed Graves disease with severe hyperthyroidism. So it definitely happens - just not often.

Thanks for the comment
Casey

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My Anxieties Have Anxieties Full episode audio for MD edition 204:13 min - 96 MB - M4AHippo Primary Care RAP December 2014 Summary 787 KB - PDF

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