9.2.1 Headaches Categorising

Question 1

What are the two types of headache?

Answer 1

Primary headache disorder

Secondary headache disorder (due to another condition)

Question 2

What is a primary headache disorder?

Answer 2

Non-life or sight threatening
Many chronic

• Tension type headache
• Migraine
• Cluster headache

Most common headache cause

Question 3

What is a secondary headache?

Answer 3

Due to another condition
Some are life or sight threatening
Many acute
- Medication-related and medication- overuse
- Systemic: hypertension, pre-eclampsia

Question 4

What are some acute causes of secondary headaches?

Answer 4

Vascular
- Haemorrhage- SubA,SubD and ExtraD haemorrhages
- Thombosis- venous sinus thrombosis

Infective/inflammatory
- Meningitis
- Encephalitis
- Abscess
- Temporal arteritis

Opthalmic
- Glaucoma

Situational (exacerbating factors)
- Cough
- Exertion
- Coitus

Opthalmic VISion

Question 5

What are some chronic causes of secondary headaches?

Answer 5

• Migraine
• Cluster headaches
• Drug side effects- analgesics, caffeine (particularly withdrawal), vasodilators
• Systemic- hypertension, pre-ecalmpsia, phaeochromocytoma
• Tension headaches
• Giant cell/temporal arteritis
• Trigeminal neuralgia
• Raised ICP

Migraines Can Drive Some Tall Guys To Insanity

Migraine
Cluster headaches
Drug side effects
Systemic
Tension headaches
Giant cell arteritis
Trigeminal neuralgia
ICP increase

Question 6

How do you take a history for headaches?

Answer 6

Presenting Complaint
- SOCRATES

Previous Medical History
- Previous headaches?
- Conditions causing secondary headache?

Drug History
- Analgesic, medication over-use? Other drugs causative of headache?

Family History
- Migraines?

Social History
- Stress?
- Lack of sleep?
- Alcohol and caffeine consumption, diet?

RED FLAGS

Question 7

What are the red flags of headache presentation?

Answer 7

SNOOP
Systemic signs
Neurological symptoms
Onset new or changed in patient > 50 years old
Onset thunderclap presentation
Papilloedema, positional provocation, precipitated by exercise

Question 8

What are the causes for each of the SNOOP headache causes?

Answer 8

Systemic
- Meningitis
- Immunosuppressed
- Pregnant
- Underlying cancer

Neurologic Symptoms
- Space occupying lesion
- Intracranial haemorrhage
- Glaucoma

Onset new or changed
- Malignancy
- Giant cell arteritis

Onset in thunderclap presentation
- Vascular (haemorrhage)

Papilloedema
- Indicators of raised ICP

Question 9

What is done on clinical examination of someone presenting with headache?

Answer 9

Vital signs
- BP
- PR
- Temperature

Neurological examination
- Cranial and peripheral nerve examination
- Glasgow Coma Scale

Other relevant systems
- Guidance by history

BE ALERT TO PRESENCE OF RED FLAGS