see CSF shunt complications

see Chronic Headaches


see Headache Assessment Form

Acute headaches - causes

Diagnosis History Examination
Sub-arachnoid haemorrhage Sudden onset headache (secs)
FMx CVA at young age, berry aneurysm, polycystic kidneys 
Variable from mild headache to focal signs and coma
Meningitis Fever
Preceding RTI
Encephalitis as above +/- altered mental state/seizures
overseas/rural travel
as above
Cerebral abscess as above +/- focal neurological symptoms
Hx of ASD
as above +/- focal neurological symptoms
Acute angle closure glacoma Red eye
Retro-orbital headache
Visual disturbance
Decreased visual acuity
Corneal haze
Mid-size un-reactive pupil
Raised intra-ocular pressure
Temporal arteritis 50's female
Hx Polymyalgia rheumatica
Temporal headache/tenderness
Jaw claudication
Tender of temporal artery
ESR > 100 mm/hr
+/- optic nerve atrophy
Migraine Rapid onset unilateral headache (30 mins)
+/- preceding aura (classic migraine)
FHx - migraine
Aura = lightning/herringbone visual pattern
Markedly photophobic
Focal neurological signs (rare and require further evaluation for other cause)
Migraine variants Abdominal migraine - seen in children Ophtalmoplegic - with diplopia/gaze disturbance
Hemiplegic - with focal signs

(fully investigate first presentations)

Cluster headache Retro-orbital headache
Occurs in recurrent 'clusters' then spontaneously remit for several months
Unilateral red, watering eye
Tension headache Band like constriction radiating to neck
Worse in afternoon
Tender over scalp

Indications for urgent CT