HEADACHE

Common causes

• Simple headaches - rare event, not associated with any other features.
• Migraine - Classic symptoms: Aura; visual disturbance; headache; nausea; vomiting.
• Migraine - Other types - many varying combinations of classic migraine symptoms
• Trauma associated.
• Associated with a viral illness.
• Tension headaches: band at back and/or front of head.

Danger signs

• New onset of Migraine in patient over 40 years.
• If headache follows recent (within 72 hours) trauma: If headache; then nausea; then vomiting; then visual disturbance - Contact GP
• Headache with fever/photophobia/neck stiffness and purple rash and drowsiness may signify meningitis - Contact GP
• Severe occipital headache (worse ever). Contact GP
• A new persistent morning headache. Contact GP
• Headache and any persistent focal neurological sign (e.g. limb weakness).Contact GP
• Temporal tenderness and pain, may signify Temporal Arteritis - associated with blindness - Contact GP

Notes for children

• Rare, persistent headaches not relieved by paracetamol - Contact GP.

General advice

• Patients often wary this is associated with raised blood pressure. A norinal blood pressure may reassure them.
• Tension headaches may be: stress/posture/myopia/other association.

Therapy

• Analgesia.
• Analgesia ASAP in migraine - and if accompanies vomiting - consider anti-emetic.
• Treat underlying cause in tension headache.
• Anti-allergic eye drops - sodium chromoglycate.

Dictionary

Photophobia: abnomal sensitivity to light.

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