Neurology – Headache: By Fiona Costello M.D.

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Neurology – Headache
Whiteboard Animation Transcript
with Fiona Costello, MD
https://medskl.com/Module/Index/headache

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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