Headaches

Headaches

·        Recent onset of severe headache: the most common cause is idiopathic

·        Ask about associations/antecedents 

·         Red flags: fever, change in mental status/personality, fits, focal neurological signs, sudden and severe, affected by postural change, normally headache free, waking at night or in the morning with a headache

·        Types of headache: 

o  Tension headaches, eg chronic daily headache, gradual onset (chronic), sleep not disturbed, treat by ¯stress (massage, relaxation). ? Depression. Types: post-coital, ergotamine misuse

o  Cluster headache: clusters of extreme, recurrent non-throbbing deep pain in and around an eye, spreading onto the face. Eye typically becomes swollen and watery

o  Migraine: visual symptoms, unilateral, throbbing, nausea, aura

o  Facial structure: eg TMJ dysfunction, sinusitis, NOT teeth

o  Neuralgic: eg idiopathic, trigeminal neuralgia

o  „True vascular headache‟: associated with TIA/stroke, artery dissection, giant cell arteritis

o  Associated with ­ICP: focal lesions, venous thrombosis, meningitis, severe hypertension

o   Acute: ?meningitis, sinusitis, head injury

o   Associated with post Lumbar puncture

·        Treatment: Ongoing unchanged tension or migraine headache: TCAs

·        Differential of morning headache: 

o   ­ICP

o   ­CO₂ (eg sleep apnoea)

o   Diabetic going hypoglycaemic overnight