Headaches Headache: Red flags Neurology
Hea
Type
RF Male, smokers
Features Age < 20 yrs +
malignancy, patients > 50 Presentations Dy
Tunin
Pain occurs once/twice a day (15mins-2hrs)
yrs, patients < 5 yrs Abno
New-onset neurological Sym
Posit
Clusters lasting 4-12 weeks
deficit sudd
(cond
Intense pain, unilateral, behind the eye
(recurrent attack always affect the same side), Thunderclap sudden-onset Migraine
Trem
patient restless during attack reaching max intensity Recurrent headache / visual + GI disturbances Soun
Cluster Redness, lacrimation, lid swelling within 5 mins (subarachnoid Aetiology: change in brainstem blood flow Cont
Mx haemorrhage) unstable trigeminal nerve nucleus + nuclei in the Tinni
100% O2 ~ 15 mins via non-rebreathe Immunosuppression and basal thalamus release of calcitonin-related Ix un
mask + Sumatriptan malignancy peptide + substance P neurogenic inflammation
Symptoms suggestive of pain + vasodilatation of cerebral + dural
Cond
GCA or narrow-angle vessels
Large vessel vasculitis, ‘skip’ damage along glaucoma Precipitating factors ‘CHOCOLATE’
affected artery on histology Headache precipitated by Chocolate (high phenylethylanine) Hangovers Presb
Dyst
Typically patient > 60 yrs physical exertion/Valsalva Orgasms Cheese (high tyramine) OCP Lie-ins
Usually rapid onset (e.g. <1 month) of unilateral manoeuvre Alcohol Tumult (loud noise) Exercise
headache (85%) Clinical pattern
Jaw claudication (65%) 1. Well being before attack Glu
Tempora Tender, palpable temporal artery (O
l
2. Prodromal symptoms
Raised ESR
arteritis Mx 3. Main attack- headache, nausea, vomiting
4. Sleep + feeling drained afterwards
High-dose prednisolone dramatic Men
response Migraine: Pregnancy, Migraine with aura (classical) dis
Urgent ophthalmology review contraception, Visual/aura for 15-30 mins, followed by a
unilateral, throbbing headache within 1hr, D
hormones transient aphasia, tingling, numbness, local ototo
Pregnancy generalised No
Neurovascular irritation referred to scalp Aspirin Diagnostic criteria if no aura Myo
dam
muscles/soft tissues, described as ‘tight band’ Paracetamol/Ibuprofen Sudd
A ≥ 5 headaches (Fulfil B-D)
Bilateral, non-pulsatile headache w/o vomiting brain
or sensitivity to head movement COCP B Lasting 4-72 hrs
Absolute contraindication C (2/4) Unilateral, pulsating, moderate – severe Seen
Aco
Mx epile
Acute Aspirin, NSAID, and paracetamol Menstruation pain, aggravation by/causing avoidance of PA neu
Tension Beni
Prophylaxis upto 10 sessions of Mefanamic acid/ aspirin + D During: nausea +/vomiting, photo/phonophobia 50 ti
acupuncture over 5-8 weeks/ low-dose
paracetamol + caffeine E Not attributed to another disorder Tard
amitriptyline Mx Anti-
HRT
Acute Oral triptan (Nasal if 12-17 yrs) + cellu
Otosc
Patients can be prescribed NSAID/paracetamol E.g.
HRT with a Hx of migraines- Prophylaxis Topiramate/Propranolol + Tics
Analgesia rebound (mixed analgesics e.g.
but it may make them Riboflavin Brief
Medicati paracetamol + codeine/opiates)
Present for 15 days or more worse while
on- Com
overuse May be psychiatric comorbidity
Tour
Rx C
Hea
Type
RF Male, smokers
Features Age < 20 yrs +
malignancy, patients > 50 Presentations Dy
Tunin
Pain occurs once/twice a day (15mins-2hrs)
yrs, patients < 5 yrs Abno
New-onset neurological Sym
Posit
Clusters lasting 4-12 weeks
deficit sudd
(cond
Intense pain, unilateral, behind the eye
(recurrent attack always affect the same side), Thunderclap sudden-onset Migraine
Trem
patient restless during attack reaching max intensity Recurrent headache / visual + GI disturbances Soun
Cluster Redness, lacrimation, lid swelling within 5 mins (subarachnoid Aetiology: change in brainstem blood flow Cont
Mx haemorrhage) unstable trigeminal nerve nucleus + nuclei in the Tinni
100% O2 ~ 15 mins via non-rebreathe Immunosuppression and basal thalamus release of calcitonin-related Ix un
mask + Sumatriptan malignancy peptide + substance P neurogenic inflammation
Symptoms suggestive of pain + vasodilatation of cerebral + dural
Cond
GCA or narrow-angle vessels
Large vessel vasculitis, ‘skip’ damage along glaucoma Precipitating factors ‘CHOCOLATE’
affected artery on histology Headache precipitated by Chocolate (high phenylethylanine) Hangovers Presb
Dyst
Typically patient > 60 yrs physical exertion/Valsalva Orgasms Cheese (high tyramine) OCP Lie-ins
Usually rapid onset (e.g. <1 month) of unilateral manoeuvre Alcohol Tumult (loud noise) Exercise
headache (85%) Clinical pattern
Jaw claudication (65%) 1. Well being before attack Glu
Tempora Tender, palpable temporal artery (O
l
2. Prodromal symptoms
Raised ESR
arteritis Mx 3. Main attack- headache, nausea, vomiting
4. Sleep + feeling drained afterwards
High-dose prednisolone dramatic Men
response Migraine: Pregnancy, Migraine with aura (classical) dis
Urgent ophthalmology review contraception, Visual/aura for 15-30 mins, followed by a
unilateral, throbbing headache within 1hr, D
hormones transient aphasia, tingling, numbness, local ototo
Pregnancy generalised No
Neurovascular irritation referred to scalp Aspirin Diagnostic criteria if no aura Myo
dam
muscles/soft tissues, described as ‘tight band’ Paracetamol/Ibuprofen Sudd
A ≥ 5 headaches (Fulfil B-D)
Bilateral, non-pulsatile headache w/o vomiting brain
or sensitivity to head movement COCP B Lasting 4-72 hrs
Absolute contraindication C (2/4) Unilateral, pulsating, moderate – severe Seen
Aco
Mx epile
Acute Aspirin, NSAID, and paracetamol Menstruation pain, aggravation by/causing avoidance of PA neu
Tension Beni
Prophylaxis upto 10 sessions of Mefanamic acid/ aspirin + D During: nausea +/vomiting, photo/phonophobia 50 ti
acupuncture over 5-8 weeks/ low-dose
paracetamol + caffeine E Not attributed to another disorder Tard
amitriptyline Mx Anti-
HRT
Acute Oral triptan (Nasal if 12-17 yrs) + cellu
Otosc
Patients can be prescribed NSAID/paracetamol E.g.
HRT with a Hx of migraines- Prophylaxis Topiramate/Propranolol + Tics
Analgesia rebound (mixed analgesics e.g.
but it may make them Riboflavin Brief
Medicati paracetamol + codeine/opiates)
Present for 15 days or more worse while
on- Com
overuse May be psychiatric comorbidity
Tour
Rx C
