Headache

Primary headache - Not associated with an underlying condition e.g. migraine, tension-type headache, cluster headache

Secondary headache - Associated with underlying pathology e.g. SOL, trauma, intracerebral infection

Key Things to Assess

• Onset

  • Rapid - Key diagnosis to rule out is SA haemorrhage (sudden, thunderclap headache)

  • Subacute/Gradual - Meningitis, Encephalitis

• Character

  • Tight band? - Tension headache

  • Throbbing/Pulsatile - Migraine

• Frequency

  • Recurring - Migraine, Cluster headache, Trigeminal neuralgia

• Duration

  • Chronic, progressive headaches indicate Raised ICP - Check for Papilloedema w/fundoscopy

Red Flag Symptoms

• Sudden, worst-ever thunderclap headache - SA haemorrhage

• Fever, Photophobia, Neck stiffness - Meningitis or Encephalitis

• New neurological symptoms - Haemorrhage, Stroke, Malignancy

• Visual disturbance - Giant Cell Arteritis (GCA), Glaucoma

• Papilloedema, Vomiting, Early morning vomiting - Raised ICP

• Pregnancy - Pre-eclampsia