BD TLEAD 9 (Headache)
Primary
Intracranial
Extracranial
Metabolic
Migraine
Cluster Headache
Tension Headache
Meningitis
Encephalitis
Hypertension
Cerebral Venous Sinus Thrombosis
Space occupying lesion
Bleeding
Hydrocephalus
Abscess
Cyst
Tumour
Subarachnoid haemorrhage
Subdural haemorrhage
Epidural haemorrhage
Carbon monoxide poisoning
Substance withdrawal
Pheochromocytoma
Medication overuse headache
Hyponatremia
Otitis Media
Closed-angle glaucoma
Sinusitis
TMJ dysfunction
Trauma [check head for any lesions, contusions]
Temporal arteritis (Giant cell arthritis)
e.g. analgesics, monosodium glutamate, oral contraceptive pills, glyceryl trinitrate, nifedipine
e.g. caffeine [worst when sleeping, vacations or weekends], alcohol [occurs following intoxication]
[headache occurs in enclosed space and leaves upon leaving site of exposure]
[Headache, Fever, Nuchal Stiffness, Kernig's and Brudzinski's sign +ve, Photophobia, Phonophobia ; Look for concomittant infection and the purpuric rash of meningococcemia. Rule out 2° sources e.g. sinusitis, base of skull osteomyelitis, dental infection, etc.]
[Throbbing headache along the temporal area, Tenderness along course of superficial temporal artery + absent pulsation, maybe also intermittent unilateral vision loss and jaw claudication, >50 years old more likely.]
[Fever, Headache, Altered mental Status, Confusion, Lethargy, Focal neurological changes, Seizures, Photophobia, Phonophobia]
[nuchal stiffness, thunderclap headache - "worst headache ever", sudden onset of maximal pain, onset of headache with exertion, cough or sexual activity]
[more subacute; usually initial concussion, a lucid interval followed by drowsiness ; Elder & patients with bleeding diathesis or on anticoagulants]
[transient loss of consciousness; lucid interval followed by deterioration - headache, vomiting, drowsiness, confusion, aphasia, seizures, and hemiparesis]
[Unilateral headache often starting with severe eye pain, blurring of vision, visual loss and halos around lights. Eye is red with fixed, moderately dilated pupil.]
(69%): bilateral tight bandlike (non pulsatile) discomfort which builds slowly, fluctuates in severity, and may persist for days. Accompanying features of migraine are absent
(16%): episodes of unilateral, pulsating headache with additional features e.g. sensitivity to triggers (light, sound, movement), nausa/vomiting, neurologic dysfunction (even numbness, weakness). Some patients report an aura e.g. visual Δs (flashing
lights, zigzag lines), sensory, motor, or speech Δs that may mimic a transient ischemic attack. Patients prefer to keep still during attacks. Most patients with disabling headache probably have migraine.
(0.1%): typically, explosive pain reccuring in daily short-lasting bouts, for 1-3 months with months of pain-free periods. This
headache is associated with ipsilateral autonomic signs such as tearing, rhinorrhorea, miosis, ptosis. Patients tend to move about during attacks.
[class triad: episodic headache, sweating, and tachycardia ; Sustained or paroxysmal hypertension, headache, generalised sweating ; Other symptoms include forceful palpitations, tremor, pallor, dyspnea, generalized weakness, and panic attack-type symptoms (particularly in pheochromocytomas that produce epinephrine)]
[Nausea and malaise which progresses to Headache, lethargy, obtundation and eventually seizures, coma, and respiratory arrest ]
[Headache, localised head pain, encephalopathy, focal neurological symptoms and signs, seizures]
[Nasal congestion and obstruction, Purulent nasal discharge, Maxillary tooth discomfort, Facial pain or pressure that is worse or localized to the sinuses when bending forward. Other signs and symptoms include fever, fatigue, cough, hyposmia or anosmia, ear pressure or fullness, headache, and halitosis. May also have signs and symptoms of eustachian tube dysfunction (e.g. ear pain, fullness or pressure, hearing loss, or tinnitus)]
[Otalgia (ear pain) and decreased hearing. +/- Fever ; High fever, severe pain behind the ear, facial paralysis suggest unusual complications]
[Pain, Ear discomfort or dysfunction, Headache, TMJ discomfort of dysfunction - acute or chronic musculoskeletal pain triggered by jaw motion, dysfunction of the masticatory system, temporomandibular joint (TMJ) tenderness, and neck stiffness and pain]
[Fever, focal neurological symptoms]
[Weight loss, history of malignancy, focal neurological symptoms - hemiparesis, apahasia, N/V a/w early morning]
[Focal neurological symptoms, seizures]
[Nausea/Vomiting, Behavioural changes, Lethargy, History of neurosurgery of CNS shunt]