Headache: Difference between revisions
No edit summary |
|||
| (22 intermediate revisions by 3 users not shown) | |||
| Line 1: | Line 1: | ||
__NOTOC__ | __NOTOC__ | ||
<div style="width:40%; float:right; padding:5px 0 5px 5px; margin:0 0 0 5px; background:#DCDCDC;"> | |||
==Types of Headache== | |||
===Acute=== | ===Acute=== | ||
The '''most serious''' causes of an acute headache are | The '''most serious''' causes of an acute headache are | ||
*[[Meningitis]] | *[[Meningitis]] | ||
| Line 12: | Line 12: | ||
*[[Sinusitis]] | *[[Sinusitis]] | ||
*[[Head injury]] | *[[Head injury]] | ||
*[[ | *[[GTN]] spray | ||
===Recurrent=== | ===Recurrent=== | ||
| Line 18: | Line 18: | ||
*[[Migraine]] - this is by far the most common and can be debillitating for the patient during an episode | *[[Migraine]] - this is by far the most common and can be debillitating for the patient during an episode | ||
*[[Cluster headache]] | *[[Cluster headache]] | ||
*[[Coital headache]] | |||
*[[Tension headache]] | |||
*[[Medication-induced headache]] | |||
===Subacute=== | ===Subacute=== | ||
The most important cause of a subacute headache is [[giant cell arteritis]]. Easy to | The most important cause of a subacute headache is [[giant cell arteritis]]. Easy to confirm diagnosis, this can be fatal if not picked up. | ||
===Chronic=== | ===Chronic=== | ||
The first condition to rule out is [[raised intracranial pressure]] ([[ICP]]). This is can be indicative of a number of serious conditions (e.g. [[hydrocephalus]], [[space-occupying lesions]] which could be a [[brain tumour]]). | The first condition to rule out is [[raised intracranial pressure]] ([[ICP]]). This is can be indicative of a number of serious conditions (e.g. [[hydrocephalus]], [[space-occupying lesions]] which could be a [[brain tumour]]) or of [[benign raised intracranial pressure]]. | ||
</div> | |||
==Headache as a Condition== | |||
[[image:guillotine.jpg|right|thumb|170px|Mr Jones has found an effective solution for his headache. Whilst the side effect profile is rather severe, he can expect 100% resolution of all future headache symptoms.]] | |||
===Definition=== | ===Definition=== | ||
Pain (or ache) in the head region. | Pain (or ache) in the head region. | ||
===Epidemiology=== | ===Epidemiology=== | ||
[[image:common.jpg|left]] Mega mega common. According to wikipedia, in a given year, 90% of people will have at least one! | [[image:common.jpg|left]] Mega mega common. According to wikipedia, in a given year, 90% of people will have at least one! It's one of the commonest causes of attendance to [[primary care]]. | ||
===Pathophysiology=== | ===Pathophysiology=== | ||
| Line 53: | Line 52: | ||
===Clinical Features=== | ===Clinical Features=== | ||
====Red Flag symptoms==== | ====Red Flag symptoms==== | ||
These are the ones that you will now start imagining you have every time you get a headache: | [[image:emergency.gif|left]]These are the ones that you will now start imagining you have every time you get a headache: | ||
*'''Very sudden onset, severe headache''' - this could be a [[subarachnoid haemorrhage]]. | *'''Very sudden onset, severe headache''' - this could be a [[subarachnoid haemorrhage]]. | ||
*Accompanied with stiff neck and other signs of [[meningism]]. | *Accompanied with stiff neck and other signs of [[meningism]]. | ||
| Line 63: | Line 62: | ||
The exact symptoms are more likely to be related to the type of headache. Click the links on each type to learn more: | The exact symptoms are more likely to be related to the type of headache. Click the links on each type to learn more: | ||
*[[Migraine]] - headache, often preceded with sensory aura. Vomitting, nausea and photophobia common. | *[[Migraine]] - headache, often preceded with sensory aura. Vomitting, nausea and photophobia common. | ||
*[[Cluster headache]] - very severe headache, present around once a day in clusters of several weeks, followed by months free of headache until the next cluster. | * [[Cluster headache]] - very severe headache, present around once a day for a few hours in clusters of several weeks, followed by months free of headache until the next cluster. | ||
*[[Tension headache]] - bilateral pain present all the time. Often related to muscle tightness in neck,head or pain. Associated with [[stress]]. | *[[Tension headache]] - bilateral pain present all the time. Often related to muscle tightness in neck,head or pain. Associated with [[stress]]. | ||
*[[Medication-induced headache]] - ironically often related to overuse of pain relief relief for headache! Also linked with the [[oral contraceptive]]. | *[[Medication-induced headache]] - ironically often related to overuse of pain relief relief for headache! Also linked with the [[oral contraceptive]]. | ||
Latest revision as of 14:52, 12 June 2012
Types of Headache
Acute
The most serious causes of an acute headache are
Other causes include:
- Sinusitis
- Head injury
- GTN spray
Recurrent
This is a list of causes of recurrent, acute headache:
- Migraine - this is by far the most common and can be debillitating for the patient during an episode
- Cluster headache
- Coital headache
- Tension headache
- Medication-induced headache
Subacute
The most important cause of a subacute headache is giant cell arteritis. Easy to confirm diagnosis, this can be fatal if not picked up.
Chronic
The first condition to rule out is raised intracranial pressure (ICP). This is can be indicative of a number of serious conditions (e.g. hydrocephalus, space-occupying lesions which could be a brain tumour) or of benign raised intracranial pressure.
Headache as a Condition
Definition
Pain (or ache) in the head region.
Epidemiology
Mega mega common. According to wikipedia, in a given year, 90% of people will have at least one! It's one of the commonest causes of attendance to primary care.
Pathophysiology
The cause of the pain depends on the reason for the headache. In the case of raised intracranial pressure, the brain itself can't feel pain because it doesn't have pain receptors. However, it presses on the meninges, causing pain.
Other causes of headache are often through muscular, arterial or venous processes.
Risk Factors
There are specific risks for the different types of headache - check out their pages above to find out more. However, overall:
- Being female
- Stressful job
- Fatigue
- Anxiety and depression
Clinical Features
Red Flag symptoms
These are the ones that you will now start imagining you have every time you get a headache:
- Very sudden onset, severe headache - this could be a subarachnoid haemorrhage.
- Accompanied with stiff neck and other signs of meningism.
- Increasingly bad headaches, worse in the mornings, accompanied with progressive neurological signs and vomitting or signs of raised ICP, such as papillodoema.
- Associated with pain in the eye or ear
- Recurring headache in children
Other symptoms
The exact symptoms are more likely to be related to the type of headache. Click the links on each type to learn more:
- Migraine - headache, often preceded with sensory aura. Vomitting, nausea and photophobia common.
- Cluster headache - very severe headache, present around once a day for a few hours in clusters of several weeks, followed by months free of headache until the next cluster.
- Tension headache - bilateral pain present all the time. Often related to muscle tightness in neck,head or pain. Associated with stress.
- Medication-induced headache - ironically often related to overuse of pain relief relief for headache! Also linked with the oral contraceptive.
Investigations
The majority of headaches need no investigation. In more worrying red flag cases, a CT is recommended.
Management
Commonly, one uses normal friendly analgesics
Prognosis
The vast majority will be fine. Many go on to suffer chronic headache, but only to very few is this a hugely debilitating condition. However, if lulled into a false sense of security by this page, you actually do have a massive brain tumour that you ignore, your risk is a little higher.