
Characteristics | Duration | Fequency | Mechanism | Treatment | |
Tension Tight band feeling, stress, low mood | -Diffuse, ache,dull – Worse on touching scalp, agg by noise -Associated with tension – Depression may co- exist | – Hours – days Worse towards end of the day | – Chronic / Episodic – Infrequent – daily | Muscular due to persistent contraction e.g. cleching teeth, head posture, furrowing brow | Reassurence ↓ psychological stress and analgesic over use Antidepressants β – blockers |
Migrane Vomiting, sensitive to light/noise/movement, pre-migraine aura | With or without aura – onset childhood – early adult life – menopause – unilateral throbbing headache Exacerbated by movement. Ass symp: nausea, vommiting, photo -, phono-, and osmophobia | – 2- 48hrs | – Recurrent – Twice weekly | Vascular and neuronal processes probably co-exist with changes in serotonin activity initiating attacks. | Avoid precipitating factors Prophylaxis: for severe /frequent attacks 5HT2 receptor blocker, β adrenergic receptor blocker |
Cluster Episodes of night pain, usually in one eye, lasting around 8 weeks, inbetween periods of no symptoms | Severe unilateral pain around one eye +/- temporal pain Ass symp: – ipsilateral conjuctival infection – lacrimation – rhinorrhea / blockage – transient horners syndrome | – 10mins -2hrs | – Once – twice daily – wakes from sleep – attacks from weeks – months | Serum histamine levels rise during attacks – ‘histamine cephalgia’ | Prednisolone Methysergide Ca 2+ channel blockers Lithium carbonate |
Temporal arteritis Tender scalp, >50, threat to vision | – Severe throbbing – Overlies involved vessel (thus tender), non pulsitile – Ass symp: strokes, hearing loss, myelopathy and neuropathy – Jaw claudication (pain on chewing / talking) – Visual (blindness / diplopia) | Urgent tx required as soon as dx! | Urgent tx required as soon as dx! | Autoimmune condition of unknown origin Large and medium-sized arteries undergo intense ‘giant-cell’ infiltration, with fragmentation of the lamina and narrowing of the lumen, resulting in distal ischaemia as well as stimulating pain sensitive fibres. | Prednisolone |
Raised intercranial pressure Worse on waking, increase BP, decreased pulse | – generalised – aggravated by bending or coughing – worse in the morning on awkening, may wake patient from sleep -severity gradually progresses Ass symp: vommiting, transient loss of vison, eventual imparement of concious level | CT MRI | |||
Low pressure headache | – posturally dependant (worse when erect eased on laying down) – MRI shows characteristic displacement of midline structures e.g. cerebellar tonsils, meningeal enhancement with contrast Gd and elevated CSF protien | – spontaneous intracranial hypotension, postlumbar puncture, after obvious or occult CSF leak | Spontaneous improvement is usual Provide with fluids | ||
amnesia, impaired consciousness | – instantaneous onset – severe pain spreading over the vertex to the occiput – patient may drop to knees or loose conciousness Ass symp: vomminting, focal neurological signs haemotoma | CT |