Diagnosis
Most headaches can be diagnosed by the clinical history alone. If the symptoms described by the person sound dangerous, further testing with neuroimaging or lumbar puncture may be necessary. Electroencephalography (EEG) is not useful for headache diagnosis.The first step to diagnosing a headache is to determine if the headache is old or new. A "new headache" can be a headache that has started recently, or a chronic headache that has changed character. For example, if a person has chronic weekly headaches with pressure on both sides of his head, and then develops a sudden severe throbbing headache on one side of his head, they have a new headache. Red flags
It can be challenging to differentiate between low-risk, benign headaches and high-risk, dangerous headaches since symptoms are often similar. Headaches that are possibly dangerous require further lab tests and imaging to diagnose.The American College for Emergency Physicians published criteria for low-risk headaches. They are as follows:
age younger than 30 years
features typical of primary headache
history of similar headache
no abnormal findings on neurologic exam
no concerning change in normal headache pattern
no high-risk comorbid conditions (for example, HIV)
no new concerning history or physical examination findingsA number of characteristics make it more likely that the headache is due to potentially dangerous secondary causes which may be life-threatening or cause long-term damage. These "red flag" symptoms mean that a headache warrants further investigation with neuroimaging and lab tests.In general, people complaining of their "first" or "worst" headache warrant imaging and further workup.
Granular myringitis is a long term condition in which there is inflammation of the tympanic membrane in the ear and formation of granulation tissue within the tympanic membrane. It is a type of otitis externa.Without treatment it can lead to narrowing of the ear canal. A number of treatment options exist including putting vinegar in the ear, using antibiotic drops, and surgery. == References ==