Acute headache

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Acute headache

• Problems that can not wait until the post take
  ward round
• www.bradfordvts.co.uk

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Neurological emergencies

• Subarachnoid haemorrhage
• Raised intracranial pressure
• Cerebral infection

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Acute headache assessment

• History
• Examination
• Investigations

• The most important investigation in the
  evaluation of headache is the history

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Headache history

• Onset
• Site
• Character
• Duration
• Frequency
• Diurnal pattern

• Associated symptoms
• Aggravating factors
• Relieving factors
• Treatment
• Ideas

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Headache pattern

• Acute
• Evolving
• Intermittent
• Chronic

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Headaches in AE

• 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 AE

• 3 subarachnoid haemorrhages
• 1 intracerebral haemorrhage
• 3 meningitis
• 3 cerebral tumours

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Other causes of acute headache

• Migraine
• Cluster headache
• Tension headache
• Temporal 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).

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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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Migraine with aura

• One or more transient focal aura symptoms
• Gradual development of aura symptom over gt4 mins
• Aura symptoms last 4-60 mins
• Headache follows or accompanies the aura within
  60 mins.

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Migraine variants

• Hemiplegic
• Basilar
• Ophthalmoplegic
• Transient migrainous accompaniments

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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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Cluster headache

• Malefemale ratio 51
• Cluster lasts 6-12 weeks
• Seasonal variation
• Circadian rhythmicity

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Tension headache

• Acute or chronic
• Bilateral
• Suboccipital, over top of head
• Tight or pressure pain
• Poor concentration, dizziness, difficulty
  focusing

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Raised pressure headache

• Non-specific
• Bursting
• Waking
• Aggravated by bending, coughing, sneezing
• Associated with vomiting, visual blurring,
  features due to underlying lesion
• Papilloedema