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HEADACHE, ALWAYS EXCLUDE THE BIG ONES! - Coggle Diagram

- - - - diffuse, dull, aching, band-like. Worse on touching head and worsened by noise. May last hours to days. Worse towards end of day.
    - - unilateral throbbing headache. Onset in childhood/early adulthood. More females than males. Usually fam hx. With or without aura. Recurrent, lasts 2-48h. Not usually more than 2x weekly.
      - Precipitants: alcohol, chocolate, cheese, menstruation / OCP, stress, exercise, sleep deprivation
      - Management: Avoid triggers,s simple analgesics
    - - Men, middle age, severe unilateral pain 10min - 2h, around one eye. Conjunctival injection, lacrimation, rhinorrhoea, transient Horner's syndrome. May occur many times in day / awake from sleep. Clusters separated by weeks/months. Alcohol may precipitate.
  - - - haemorrhage - subarachnoid, subdural, intracerebral (instant onset vomiting, neck stiffness, impaired consciousness)
      - arterial dissection (carotid - Horner's syndrome, vertebral - cerebral ischaemia)
      - Idiopathic intracranial hypertension (papilloedema, visual obscurations, CN 6, pulsatile tinnitus)
      - stroke (ischaemic, haemorrhagic)
      - vascular malformation
      - venous sinus thrombosis
      - acute severe systemic hypertension
    - - Eye: glaucoma (misting, haloes), retrobulbar neuritis (unilateral loss of vision), eye strain
      - Dental disorders (tooth infection, TMJ dysfx)
      - Sinusitis (rhinorrhoea, tender on percussion, preceding cold)
    - - vasodilator drugs - nitrates, PPIs
      - Medication overuse headache
        
        headaches most days when have used analgesics >14 days in month. Must stop analgesics to treat headaches.
      - hypercapnia, hypoxia, carbon monoxide
      - withdrawal: caffeine, benzos, amphetamines
    - - meningitis, encephalitis, TB cerebral abscess, subdural empyaema
      - Temporal arteritis (thickened tender scalp veins, jaw claudication, unilateral headache, >50y, raised ESR)
        
        Management: prednisolone 60mg daily urgently to prevent visual loss or brainstem stroke. Monitor ESR to inform weaning of steroids.
      - fever, bacteraemia
      - viremia / viral infections