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