23YO male with intermittent headache for 3 weeks (Other associated…
23YO male with intermittent headache for 3 weeks
Other associated symptoms
Tachycardia and sweating (classic triad) => Pheochromocytoma. Other Sx: hypertension
Presence of aura (awareness of warning symptoms, e.g. dizziness, ringing in ears, zigzag lines, sensory/motor/speech changes) => migraine
Headache getting more severe
Mass lesion/Brain tumour. Other Sx: lymphadenopathy, papilledema
History of medication overuse
Nature of headache
with some pain-free periods => CLUSTER HEADACHE (rare). Other Sx: tearing, rhinorrhea, miosis, ptosis
Unable to sit still during an attack. May go into remission for months or years.
Ask for previous history of headaches.
May occur 1-3x/day during a cluster period, typically in early morning.
Family history may play a role in some cases
Pulsating headache with other features/pounding/throbbing (like a heartbeat),
=> MIGRAINE. Other Sx: nausea/vomiting, photophobia, phonophobia.
May occur once or twice a month
Can alternate between sides
Trigger factors may include stress, wine, weather changes etc. Worsens with exertion.
POUND: pulsatile, duration, unilateral, N/V, disabling intensity
Primary stabbing headache; pain in orbit, frontal and temporal regions => HEMICRANIA CONTINUA. Other Sx: lacrimation, nasal congestion
Bilateral tight bandlike/non-pulsatile discomfort, builds slowly, fluctuates in severity (PAIN SCALE),
can last 30min-1week
=> TENSION-TYPE HEADACHE (most common). Other Sx: none like migraine, i.e. no nausea/vomiting. Either photophobia or phonophobia.
Doesn't get worse during routine activities. OTC meds may help improve the headaches.
May occur once or twice a week, typically in the afternoons
Abrupt start to headache, easy to pinpoint commencement => NEW DAILY PERSISTENT HEADACHES (NDPH). Other Sx: may be migraine or tension like.
Dangerous red flags
First/worst headache => Intracranial haemorrhage.
Fever => Meningitis. Other Sx: fever, altered mental status, neck stiffness