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Side-locked headaches: an algorithm-based approach.

Sanjay Prakash1,2, Chaturbhuj Rathore3

  • 1Department of Neurology, Smt. B. K. Shah Medical institute and research Centre, Sumandeep Vidyapeeth, Piparia, Waghodia, Vadodara, 391760, Gujarat, India. drprakashs@yahoo.co.in.

The Journal of Headache and Pain
|October 23, 2016
PubMed
Summary
This summary is machine-generated.

Unilateral hemicranial pain diagnosis is complex, with primary headaches common but secondary causes requiring urgent exclusion. This review offers an algorithmic approach to differentiate side-locked headaches for accurate diagnosis and management.

Keywords:
Cluster headacheHemicrania continuaNeuralgiasParoxysmal hemicraniaSide-locked headacheTrigeminal autonomic cephalagiasUnilateral headache

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Area of Science:

  • Neurology
  • Pain Medicine
  • Diagnostic Algorithms

Background:

  • Unilateral hemicranial pain presents a diagnostic challenge due to numerous overlapping primary and secondary causes.
  • Patients often consult various specialists, leading to diagnostic ambiguity and inconsistent management approaches.
  • Side-locked headache is a critical symptom necessitating prompt evaluation to rule out serious underlying conditions.

Purpose of the Study:

  • To review the differential diagnoses of strictly unilateral hemicranial pain.
  • To propose an algorithm-based approach for the systematic evaluation of side-locked headaches.
  • To guide clinicians in differentiating primary from secondary causes of hemicranial pain.

Main Methods:

  • Comprehensive review of existing literature on unilateral hemicranial pain.
  • Development of a structured diagnostic algorithm prioritizing the exclusion of secondary headaches.
  • Emphasis on detailed history taking and physical examination to guide investigations.

Main Results:

  • Approximately two-thirds of patients with side-locked headaches have primary disorders, while one-third have secondary headaches or neuralgias.
  • Overlapping presentations between primary headaches and secondary pathologies are common.
  • A systematic, algorithm-driven approach is crucial for accurate diagnosis.

Conclusions:

  • Side-locked headache serves as a red flag, mandating the exclusion of secondary causes first.
  • Comprehensive clinical evaluation and targeted investigations are essential for diagnosing secondary hemicranial pain.
  • The proposed algorithm aids in differentiating primary and secondary side-locked headaches, improving diagnostic accuracy.