A sedimentation rate to rule out temporal arteritis, a chemistry panel to rule out liver and kidney disease, a VDRL test to rule out central nervous system syphilis, an x-ray of the sinuses to rule out Routine diagnostic tests include a CBC to rule out severe anemia, sinusitis, and an x-ray of the cervical spine to exclude cervical spondylosis. To rule out the possibility of metastatic neoplasm A chest x-ray should also be done. A tonometry study may be done if glaucoma is suspected.
Referral should be made to a neurologist or neurosurgeon as soon as possible If there are main neurologic signs,. A CT scan or MRI may be done If one is not readily available, , the CT scan being the preferred procedure if the expense is a consideration.
If there is nuchal rigidity, a CT scan should be done to rule out a space-occupying lesion before proceeding with a spinal tap. A spinal tap can be done, and this will ascertain whether there is intracranial bleeding or meningitis if the CT scan is negative,. It is usually best to refer the patient to a neurologist or neurosurgeon if there is nuchal rigidity.
If the headaches are chronic and episodic, and there are no focal neurologic signs, until the response to treatment is evaluated papilledema, or nuchal rigidity, an imaging study can be postponed for a while. However, if the response to treatment is poor, one should not hesitate to order a CT scan or MRI.
With 24-hr blood pressure monitoring Difficult cases of headache should also be studied, a 24-hr urine for catecholamines, and lumbar puncture to diagnose central nervous system lues. Histamine phosphate 0.5 cc subcutaneously may help diagnose cluster headaches. May help diagnose migraine the Response to beta-blockers. Cerebral angiography may be necessary to diagnose aneurysms and arteriovenous malformations. Patients with chronic headache unresponsive to therapy should be referred to a psychiatrist.
