SNOOP Dog Headache

Tiny Tips: “SNOOP MEETS Pregnancy” Headache mnemonic

In Medical Concepts, Tiny Tips by Sean PatrickLeave a Comment

Many must-not-miss diagnoses manifest as a secondary headache. Though the DDx list is quite large, the pertinent questions that must be asked on history can be remembered using the mnemonic “SNOOP MEETS Pregnancy”1,2 Below you’ll find the cues associated with each letter, the symptoms they are associated with, and the differential diagnosis for some of those symptoms.

Systemic symptoms = fever, night sweats, weight loss, loss of appetite, protracted vomiting

  • DDx: Meningitis, Encephalitis, Systemic infection, Lyme disease, Collagen vascular disease

Neurologic symptoms = focal neurologic signs (classically CN6), confusion, impaired alertness or consciousness, seizures

  • DDx: Mass lesion, Stroke, Vascular malformation, Collagen vascular disease, Carotid or vertebral artery dissection, Acute angle closure glaucoma, Venous sinus thrombosis

Onset sudden or abrupt

  • DDx: SAH, Pituitary bleed, Hemorrhage into mass, CNS infection, Acute angle closure glaucoma, Hypertensive emergency

Older >50 years

  • DDx: Mass lesion, Temporal arteritis

Progression or pattern change = change in attack frequency, severity, or clinical features

  • DDx: Mass lesion, Subdural hematoma, Medication overuse

Morning worse = headache awakes the patient

  • DDx: Mass lesion

Exertion / posture / sexual activity worsens headache

  • DDx: Idiopathic intracranial hypertension, Carotid or vertebral artery dissection, SAH

Exposure Hx

  • DDx: Illicit drug use, Toxins, CO poisoning

Trauma Hx

  • DDx: Trauma

Secondary risk factors = HIV, cancer

  • DDx: Meningitis, Brain abscess, Metastases

Pregnancy

  • DDx: Pre-eclampsia, Venous sinus thrombosis, Pituitary apoplexy, Carotid dissection

This post was copyedited by Sean McIntosh.

References

1.
Donohoe C. The role of the physical examination in the evaluation of headache. Med Clin North Am. 2013;97(2):197-216. [PubMed]
2.
Home. ICHD-3 Beta The International Classification of Headache Disorders 3rd edition (Beta version). https://www.ichd-3.org/. Accessed August 25, 2017.

Reviewing with the Staff

The above mnemonic provides a reasonable approach to ensuring to the headache history for the junior learner. While advanced learners should have an appropriate headache history and physical exam that is driven by a differential, junior learners would do well to ensure that each of these items is reviewed to provide a complete history. Each of the findings must be reviewed in context as, alone, none of them are sensitive or specific enough to determine an investigation or treatment plan.

Brent Thoma
Editor-in-Chief of CanadiEM and Assistant Professor at the University of Saskatchewan
Sean Patrick

Sean Patrick

Sean Patrick is a senior medical student at the University of Ottawa with an interest in Emergency Medicine, Leadership, and Simulation.
Sean Patrick

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