• Diagnosing Headache


    When it comes to patients who complain of headache, “first or worst” are significant red flags that require an immediate and thorough workup, Lynn K. Gordon, MD, PhD, said at Neuro-Ophthalmology Subspecialty Day.

    SNOOP. For a fast, focused examination, Dr. Gordon suggested using the SNOOP mnemonic. Positive SNOOP findings mean that “you’ve got to work the patient up,” Dr. Gordon said. The mnemonic is as follows.

    S = Is there evidence of a systemic or secondary disorder?

    N = Are any neurologic symptoms or signs present?

    O = Is the onset sudden or abrupt?

    O = Is the patient older?

    P = Does the patient have a history of previous headache?

    Three critical questions. Headache patients also should be asked the following questions, Dr. Gordon said: 1) Are you nauseated? 2) Is the headache interfering with your life? That is, have you missed a day of work or been unable to do something you want to do? 3) Do you have photophobia or phonophobia? Patients who answer in the affirmative to 2 of these 3 questions most likely have migraine.

    Although tension headaches “are the most common [type of headache], these patients don’t come to the doctor. They’re at home, taking their Advil. Of those who do seek help, 75% have migraines,” Dr. Gordon said. Ophthalmologists need to be able to provide an accurate diagnosis, she said, “and if you refer, refer to someone who is interested in headache.”—Jean Shaw

    Dr. Gordon has no financial disclosures.