Approach to Headaches - Differential Diagnosis Algorithm Red flags (PHANTOMS): • Pattern change, progressively worse, papilledema • Horner syndrome, history of cancer, HIV, or lyme • Altered mental status, analgesics refractory • Neurological deficits • Temporal artery tenderness, triggered by cough, exertion, or sexual intercourse • Onset > 50 yr, onset (thunderclap) of worst headache • Meningeal signs, mid-dilated pupil (AACG) • Systemic symptoms and signs (e.g., fever, myalgia), seizures Life/sight-threatening conditions: • Stroke, carotid dissection • Cerebral venous thrombosis • Hemorrhage • Hypertensive encephalopathy • Space-occupying brain lesion • CNS infection (e.g., meningitis) • Temporal arteritis • Acute angle closure glaucoma (AACG) • Benign intracranial hypertension Matthew Ho, MD PhD @MatthewHoMD #Headache #Differential #Diagnosis #Algorithm #neurology #PHANTOMS #mnemonic
