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