Department of Neurology, SJUH

Acute headacheAcute headache

Problems that can not wait until the post take ward round

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Department of Neurology, SJUH

Neurological emergenciesNeurological emergencies

Subarachnoid haemorrhage Raised intracranial pressure Cerebral infection

Department of Neurology, SJUH

Acute headache assessment Acute headache assessment

History Examination Investigations

The most important investigation in the evaluation of headache is the history

Department of Neurology, SJUH

Headache historyHeadache history

Onset Site Character Duration Frequency Diurnal pattern

Associated symptoms

Aggravating factors Relieving factors Treatment Ideas

Department of Neurology, SJUH

Headache patternHeadache pattern

Acute Evolving Intermittent Chronic

Department of Neurology, SJUH

Headaches in A&EHeadaches in A&E

Prospective study of all patients with a primary diagnosis of headache

93 cases in 3 months 39 (42%) had sudden onset headache 30 (32%) had a CT scan

Department of Neurology, SJUH

Headaches in A&E Headaches in A&E

3 subarachnoid haemorrhages 1 intracerebral haemorrhage 3 meningitis 3 cerebral tumours

Department of Neurology, SJUH

Other causes of acute Other causes of acute headacheheadache

Migraine Cluster headache Tension headache Temporal arteritis

Department of Neurology, SJUH

MigraineMigraine

Migraine without aura: common migraine

Migraine with aura: classical migraine Aura symptoms: visual (99%), sensory

(31%), dysphasia (18%), motor (6%).

Department of Neurology, SJUH

Migraine without auraMigraine without aura

Attacks lasting 4-72 hours At least two of following characteristics:

unilateral, pulsating, moderate to severe, aggravated by movement

At least one associated symptom: nausea or vomiting, photophobia, phonophobia

Department of Neurology, SJUH

Migraine with auraMigraine with aura

One or more transient focal aura symptoms

Gradual development of aura symptom over >4 mins

Aura symptoms last 4-60 mins Headache follows or accompanies

the aura within 60 mins.

Department of Neurology, SJUH

Migraine variantsMigraine variants

Hemiplegic Basilar Ophthalmoplegic Transient migrainous accompaniments

Department of Neurology, SJUH

Cluster headacheCluster headache Severe unilateral pain Orbital, supraorbital, temporal Associated conjunctival injection,

lacrimation, nasal congestion, rhinorrhoea, forehead and facial sweating

Miosis, ptosis, eyelid oedema Frequency: 1 alt days to 8 per day

Department of Neurology, SJUH

Cluster headacheCluster headache

Male:female ratio 5:1 Cluster lasts 6-12 weeks Seasonal variation Circadian rhythmicity

Department of Neurology, SJUH

Tension headacheTension headache

Acute or chronic Bilateral Suboccipital, over top of head Tight or pressure pain Poor concentration, dizziness,

difficulty focusing

Department of Neurology, SJUH

Raised pressure headacheRaised pressure headache Non-specific Bursting Waking Aggravated by bending, coughing, sneezing Associated with vomiting, visual blurring,

features due to underlying lesion Papilloedema