23y.o. Male, Medical Student
Headache + Intermittent Fever
(2 weeks)

Non-Infectious

INFECTION
Progressively Worsening, Not alleviated by Paracetamols, Increased Cranial Pressure, Early Morning Headache

PRIMARY HEADACHE
Hx: Fever preceded headache, Exposure to Stress, Chronic Symptoms of Headache even before fever onset

Tension Headache
Bilateral Headache, Non-Throbbing, No Other Associated Symptoms

Cluster Headache
Symptoms: severe unilateral orbital, supraorbital, or temporal pain accompanied by autonomic phenomena. Unilateral autonomic symptoms are ipsilateral to the pain and may include ptosis, miosis, lacrimation, conjunctival injection, rhinorrhea, and nasal congestion. Attacks usually last 15 to 180 minutes

Migraine
Symptom: Throbbing, Unilateral Headache, Nausea, vomiting, photophobia, phonophobia; may have aura (usually visual, but can involve other senses or cause speech or motor deficits)

Systemic

Focal

Intra-cranial
Symptoms: Fever, Stiff Neck, Myalgia, Impaired Consciousness, Seizures, Altered Mental State and Neurological Finding Present
Red Flags: Raised ICP - vomitting, pain worse in Valsalva (coughing, forced excretion), Papilledema
History: No previous history, the first most painful headache patient experienced

Typhoid Fever

Psittacosis

Q-fever

Leptospirosis

Influenza

Rickettsia

Septicemia

Dengue

Bacterial Enteritis

Cellulitis

Sinusitis
Symptom: nasal congestion, rhinorrhea, tearing, color and temperature change, and changes in pupil size

Pharynigitis

Otitis Media

Pyelonephritis

Intra-cranial

Extra-cranial

Cerebral Venous Thrombosis

Post -traumatic Headache

Sub-arachnoid Hemorrhage
Hx: Sudden Onset Headache, Extreme Pain
Symptoms: Coughing, Vomitting, Transient Loss of Consciousness
Sign: Papilloedema

Temporal Arteritis

Meningitis
Hx: Headache increasing in severity, One-sided, Throbbing, Relieved by sleep, lasting a few hours
Symptom: Stiff Neck, Alterred Mental State, Photophobia, Vomitting
Sign: Kernig and Brudzinski, Jolt Accentuation of Headache, Ataxia

Cerebral Abscess
Sign: Focal Neurological Sign (CN Involvement, Paresis, Hemiplegia)

Encephalitis
Hx:
Symptom: Altered Mental State, Obtundation, Stupor, Confusion
Sign:

Parameningeal Infection

Cervicocranial Artery Dissection

Cervical Spondylysis

Subdural Hematoma

Increased Intra-cranial Pressure
Sign: Papillioedema, Blurring of vision on forward bending of the head, headaches upon waking early in the morning that improve with sitting up, and double vision or loss of coordination and balance

Epidural Hematoma

Mass Lesion
Symptoms: Nocturnal Awakening, Visual Field Defect , Nausea, vomiting, worsening of headache with changes in body position (particularly bending over), an abnormal neurologic examination, and/or a significant change in prior headache pattern

Febrile Seizure/Illness
Hx: Psychosis

Drug Induced
Symptoms: Glyceryl Trinitrate, Alcohol Withdrawal

Spontaneous Intracranial Hypotension
Symptoms: headache that is relieved with recumbency and exacerbated with upright posture

Toxic Exposure