Headache (1)

Question 1

What is a primary headache?

What is a secondary headache?

Answer 1

➊ Not associated to an underlying condition e.g. migraine, tension-type headache, cluster headache

➋ Associated with underlying pathology e.g. SOL, trauma, intracerebral infection

Question 2

What are the important things to assess with a headache? Describe what each may suggest?

Answer 2

Onset:
• Rapid - Key diagnosis to rule out is SA haemorrhage (sudden, thunderclap headache) - Other differentials include Meningitis, Encephalitis
• Subacute/Gradual

Character:
• Tight band? - Tension headache
• Throbbing/Pulsatile - Migraine

Frequency:
• Recurring - Migraine, Cluster headache, Trigeminal neuralgia

Duration:
• Chronic, progressive headaches indicate Raised ICP - Check for Papilloedema w/fundoscopy

Question 3

What is important to exclude when assessing a headache?

What does this include and what does each indicate?

Answer 3

➊ Red flags for serious conditions, like raised ICP and IC haemorrhage

➋ • Sudden, worst-ever thunderclap headache - SA haemorrhage
• Fever, Photophobia, Neck stiffness - Meningitis or Encephalitis
• New neurological symptoms - Haemorrhage, Stroke, Malignancy
• Visual disturbance - Temporal arteritis, Glaucoma
• Papilloedema, Vomiting - Raised ICP
• Pregnancy - Pre-eclampsia