Headache Specific Causes

HEADACHE FROM RAISED INTRACRANIAL PRESSURE

Characteristics:

- generalised.

- aggravated by bending or coughing.

- worse in the morning on awakening; may awaken patient from sleep.

- the severity of the headache gradually progresses. Associated features:

- vomiting in later stages.

- transient loss of vision (obscuration) with sudden change in posture.

- eventual impairment of conscious level.

Management: further investigations are essential - CT or MRI HEADACHE DUE TO INTRACRANIAL HAEMORRHAGE

Characteristics:

- instantaneous onset.

- severe pain, spreading over the vertex to the occiput, or described as a 'sudden blow to the back of the head'.

- patient may drop to knees or lose consciousness. Associated features:

- usually accompanied by vomiting.

- focal neurological signs suggest a haematoma. Management: further investigation - CT scan/lumbar puncture (see Meningism, page 71).

NON-NEUROLOGICAL CAUSES OF HEADACHE Local causes:

SmMses: Well localised. Worse in morning. Affected by posture, e.g. bending.

X-ray - sinus opacified. Treatment - decongestants or drainage. Ocular: Refraction errors may result in 'muscle contraction' headaches - resolves when corrected with glasses.

Glaucoma does not produce headache without other symptoms, e.g. misting of vision, 'haloes'. Cupping seen on fundoscopy. Dental disease: Discomfort localised to teeth. Check for malocclusion. Check temporomandibular joints.

Systemic causes:

Headache may accompany any febrile illness or may be the presenting feature of accelerated hypertension or metabolic diesase, e.g. hypoglycaemia, hypercalcaemia. Many drugs produce headache

- through vasodilatation e.g. bronchodilators, antihistamines

- on withdrawal e.g. amphetamines, benzodiazepines, caffeine.

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