Headache

In these lists, headache can be anything from mildly irritating to acutely life-threatening. It is one of the most common presentations in primary care; differentiating between

Acute

This young lady has a chronic headache. Not sure why. Our best guess is that we think it might be due to acute glaucoma.

The most serious causes of an acute headache are

• Meningitis
• Subarachnoid haemorrhage
• Encephalitis
• Acute glaucoma

Other causes include:

• Sinusitis
• Head injury
• Coital headache

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

Subacute

The most important cause of a subacute headache is giant cell arteritis. Easy to confirmy 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).

Less serious causes are:

• Tension headache
• Medication-induced headache

Headache as a Condition

Thinking about Raj too much, or just meeting him once, can cause headache, such as this handsome man is trying to fight off with a nice walk.

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!

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 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

2 week wait brain referral for headache types of headache imaging and investigations braint tumour management

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.