Headache

Last updated 03.11.12

 

Index

 

Definition

-   

 

Features

-  Common symptom

 

Causes

-  Vascular: Haematoma (SAH, Subdural, Epidural) temporal arteritis, HTN, Migraine

-  Infective: meningits, Viral illness (Influenza, common cold..)

-  Neurological: Increased ICP, trigeminal neuralgia, Brain Tumour, post ictal (seizure), post LP

-  Cluster headache

-  Tension headache

-  Glaucoma

-  Sinusitis

-  OSA

-  Metabolic: hypercalcaemia, uraemia..

-  Medications: Nitrates (GTN Patch)

 

SOCRATES

-  Site

-  Jaw pain/claudication: temporal arteritis

-  Unilateral: migraine, cluster, temporal arteritis

-  Occipital: tension

-  Maxilla/frontal: sinusitis

-  Generalised: CVA, meningitis, SAH

-  Onset

-  After brushing teeth: trigeminal neuralgia

-  After eating: trigeminal neuralgia, temporal arteritis

-  Thunder clap (sudden severe onset): SAH

-  Aura, visual changes: migrane, epilepsy (seizure)

-  Post ictal: seizure

-  Head Injury: fracture, extradural, subdural or intracranial haematoma

-  Character

-  Worst pain ever: SAH

-  Radiation

-  Associated S/S

-  Stress & muscle tension: tension

-  Stiff neck, photophobia, fever, rash: meningits

-  Photophobia, aura: migraine

-  Morning headache & snoring: OSA

-  Lacrimation: cluster

-  Visual changes: temporal arteritis

-  Morning headache, sleep disturbance, improves through day: increased ICP, brain tumour

-  Timing

-  Instant & severe: SAH

-  Following febrile illness or rash: meningits

-  Recurrent/previous episodes or new

-  Worse in morning: increased intracranial pressure

-  Exacerbating/Relieving

-  Severity

-  Worst pain ever: SAH

-  Nagging, dull ache: tension headache

 

Associated S/S

-  Fever

-  HTN

-  Depression

-  Pregnancy: pre-eclampsia, eclampsia

 

Ex

-  Vitals

-  Temp: meningits

-  BP

-  Pregnancy: pre-eclampsia, eclampsia

-  HTN

-  Head & neck examination: tension headache

-  Cranial nerves

-  Fundoscopy

-  Tender temproal artery: temporal arteritis

 

Ix

-  ESR/CRP: temporal arteritis

-  Temproal artery biopsy: temporal arteritis

-  Tonometry: IIOP: glaucoma

-  FBE: WBC

-  Fundoscopy

-  Papilloedema: IICP (Brain tumour..)

-  Retinopathy: HTN

-  Optic cupping & atrophy: glaucoma

-  CT-Brain/MRI: Brain tumour, meningits

-  Lumbar Puncture: meningits, SAH

-  Neuro exam

-  Headache diary

 

 

 

References