HEADACHE FROM RAISED INTRACRANIAL PRESSURE
- 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
- 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.
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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