Headache

Life-threatening Causes:

• Meningitis
• Subarachnoid Hemorrhage
  • SAH: The ED perspective
  • AFTB lecture Notes (SAH)
• Space Occupying Lesion
• Hypertensive Encephalopathy
• Temporal Arteritis
• Pre-eclampsia

Common causes of headache

Primary headaches

• Tension headache
• Migraine
• Cluster headache.

Secondary headaches

• Intracranial
  • Cerebral space-occupying lesion (cerebral aneurysm, AVM, tumour, haematoma)
  • Infection (abscess, meningitis, encephalitis)
  • Haemorrhage (intracerebral, subarachnoid, subdural)
  • Cerebral venous thrombosis
  • Post-traumatic (subdural, extradural, cerebral contusion)
  • Benign intracranial hypertension
  • Cerebral vasculitis such as SLE
  • Post-lumbar puncture (worse on standing)
  • Posterior reversible encephalopathy syndrome (a syndrome of headaches, altered mental status, seizures, and visual loss associated with white matter vasogenic edema predominantly affecting the posterior occipital and parietal lobes of the brain; usually occurring in patients who are hypertensive or receiving immunosuppressant’s).
• Local
  • Musculo-skeletal: TMJ dysfunction
  • Vascular: Temporal arteritis
  • Neuralgia (greater occipital, glossopharyngeal, trigeminal)
    • SUNCT (Shortlasting Unilateral Neuralgiform Headache attacks with Conjunctival injection and Tearing) syndrome
  • Eyes: Glaucoma (always examine for a painful red eye with cloudy cornea, and ovoid fixed pupil)
  • Ears/Sinus: Sinusitis, otitis media, mastoiditis
  • Neck: Cervical osteoarthritis, cervicogenic headache
  • Teeth: Dental caries, tooth abscess
• Systemic
  • Malignant hypertension
  • Hypercapnia
  • Carbon monoxide poisoning
  • Systemic infection
    • Viral infection (Dengue fever, Ross River)
  • Pre-eclampsia (Is the patient pregnant?)
• Drug related
  • Nitrates, Calcium-channel blockers, NSAIDs
  • Medication overuse headache

Controversy

• Cluster Headache:
  • High flow oxygen therapy for Cluster Headache [Reference]
• Migraine:
  • Should steroids be given for migraine to reduce recurrence? – Probably not
  • Reference 1, Reference 2, Reference 3, Reference 4, Reference 5
• Meningoencephalitis
  • Suspect HSV encephalitis if  altered level of consciousness, behavioural disturbance, focal neurological deficits or seizures. Especially in the immunesuppressed