Headache History

Question 1

How would you differentiate between a primary and secondary headache

Answer 1

Primary - no underlying condition

• no sudden onset or neurodeficit
• several past episodes

Secondary - headache with an underlying cause

• new headache
• sudden onset with neurodeficit

Systemic symptoms?
Changes in consciousness
50+ = consider SOL
Postural, positional changes
Precipitated: valsalva, exertion, sex
Papilloedema

Question 2

Possible differentials for a thunderclap headache

Answer 2

SAH => CT and LP
Intracerebral bleed
Cerebral venous thrombosis
Arterial dissection (intracranial/extracranial)
Reversible cerebral vasoconstriction syndrome
Pituitary apoplexy

Question 3

Differentiating between headaches due to CSF pressure changes

Answer 3

High pressure

• worse in morning
• better upright
• worse with valsalva

Low pressure

• worse as day goes on
• better lying down

Question 4

Key criteria to differentiate between primary headaches

Answer 4

Duration

• constant?
• attack?

Localisation
-uni or bilateral

Accompanying symptoms

• N+V, aura, photophobia
• lacrimation?

Intensity
-does it increase with physical activity

Question 5

Possible differentials for primary headache

Answer 5

Migraine
Medication overuse?
Cluster?
Other trigeminoautonomic cephalgias?