What is the next step in the diagnostic investigation?

From the Guidelines

The next step in the diagnostic investigation should be to determine whether further diagnostic testing is needed to establish a diagnosis or formulate a disposition plan, based on the patient's presentation and initial evaluation [ 1 ].

Key Considerations

• The initial assessment should focus on identifying potentially life-threatening conditions, such as ACS, acute aortic syndromes, and PE [ 1 ].
• A thorough physical examination and detailed medical history should be conducted to help identify the underlying cause of the patient's symptoms.
• Laboratory tests, such as complete blood count, blood chemistry, and urinalysis, may be ordered to further evaluate the patient's condition.
• Imaging studies, like X-rays, CT scans, or MRI scans, may be necessary to further assess the patient's condition.
• Consulting a specialist, such as a cardiologist, neurologist, or gastroenterologist, may be recommended depending on the patient's symptoms and initial test results [ 1 ].
• A hypothetico-deductive diagnostic approach may be used in complex cases, including those with fibrotic HP, to estimate the likelihood of the diagnosis and choose an appropriate diagnostic test [ 1 ].
• The diagnostic approach should be patient-centered and multidisciplinary, taking into account the patient's symptoms, medical history, and test results [ 1 ].
• The diagnostic certainty required should guide the diagnostic approach, with patients without a confident diagnosis having a provisional diagnosis that may change as additional data become available [ 1 ].

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Diagnostic Investigation Steps

The next step in the diagnostic investigation typically involves a combination of history taking, physical examination, and laboratory investigations.

• The history and neurologic and general physical examinations usually permit a definitive diagnosis 2.
• Certain historical and examination findings increase the likelihood of a secondary headache disorder and the need for diagnostic testing, such as recent head or neck injury, a new or worsening headache, and neurologic findings or symptoms 2.
• Diagnostic studies include neuroimaging, cerebrospinal fluid (CSF) examination, and blood tests, which are selected depending on the patient's history and findings 2.

Role of History Taking and Physical Examination

• Most diagnoses are made from the medical history, with the physical examination and laboratory investigation playing a supporting role in excluding certain diagnostic possibilities and increasing confidence in the diagnosis 3, 4.
• A thorough patient history is fundamental for accurate diagnosis and effective management of health conditions, and should be taken in a structured but flexible manner 5.
• The physical examination is a valuable tool in the outpatient setting, and can help narrow down or establish a diagnosis when used in conjunction with a thorough history 6.

Selection of Diagnostic Tests

• The choice of diagnostic test depends on the patient's history and findings, with magnetic resonance imaging (MRI) brain scan being the diagnostic test of choice for most patients 2.
• Computed tomography (CT) of the brain is usually obtained in the setting of trauma or abrupt onset of headache, while CSF examination is useful in diagnosing subarachnoid bleeding, infection, and high and low CSF pressure syndromes 2.