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Department of Neurology, SJUH

Acute headache

Problems that can not wait until

the post take ward round

www.bradfordvts.co.uk

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Department of Neurology, SJUH

Neurological emergencies

Subarachnoid haemorrhage

Raised intracranial pressure

Cerebral infection

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Department of Neurology, SJUH

Acute headache assessment

History

Examination

Investigations

The most important investigation in the

evaluation of headache is the history

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Department of Neurology, SJUH

Headache history

Onset

Site

Character

Duration

Frequency

Diurnal pattern

Associated

symptoms

Aggravating factorsRelieving factors

Treatment

Ideas

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Headache pattern

Acute

Evolving

IntermittentChronic

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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

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Headaches in A&E

3 subarachnoid haemorrhages

1 intracerebral haemorrhage

3 meningitis 3 cerebral tumours

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Other causes of acute

headacheMigraine

Cluster headache

Tension headacheTemporal arteritis

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Migraine

Migraine without aura: common

migraine

Migraine with aura: classical migraine

Aura symptoms: visual (99%), sensory

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

5/20/2018 Acute Headache.ppt

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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

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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 accompaniesthe aura within 60 mins.

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Department of Neurology, SJUH

Migraine variants

Hemiplegic

Basilar

Ophthalmoplegic

Transient migrainous accompaniments

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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

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Department of Neurology, SJUH

Cluster headache

Male:female ratio 5:1

Cluster lasts 6-12 weeks

Seasonal variationCircadian rhythmicity

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Department of Neurology, SJUH

Tension headache

Acute or chronic

Bilateral

Suboccipital, over top of headTight or pressure pain

Poor concentration, dizziness,

difficulty focusing

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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