Department of Neurology, SJUH

Acute headache
Problems that can not wait until
the post take ward round

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Department of Neurology, SJUH
Neurological emergencies
Subarachnoid haemorrhage
Raised intracranial pressure
Cerebral infection
Department of Neurology, SJUH
Acute headache assessment
History
Examination
Investigations
The most important investigation in the
evaluation of headache is the history
Department of Neurology, SJUH
Headache history
Onset
Site
Character
Duration
Frequency
Diurnal pattern
Associated
symptoms
Aggravating factors
Relieving factors
Treatment
Ideas
Department of Neurology, SJUH
Headache pattern
Acute
Evolving
Intermittent
Chronic
Department of Neurology, SJUH
Headaches 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
3 subarachnoid haemorrhages
1 intracerebral haemorrhage
3 meningitis
3 cerebral tumours
Department of Neurology, SJUH
Other causes of acute
headache
Migraine
Cluster headache
Tension headache
Temporal arteritis
Department of Neurology, SJUH
Migraine
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 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 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 variants
Hemiplegic
Basilar
Ophthalmoplegic
Transient migrainous accompaniments
Department of Neurology, SJUH
Cluster 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 headache
Male:female ratio 5:1
Cluster lasts 6-12 weeks
Seasonal variation
Circadian rhythmicity
Department of Neurology, SJUH
Tension 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 headache
Non-specific
Bursting
Waking
Aggravated by bending, coughing, sneezing
Associated with vomiting, visual blurring,
features due to underlying lesion
Papilloedema