Summary of Headaches
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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 /
– Infrequent – daily
Muscular due to persistent contraction
e.g. cleching teeth, head posture, furrowing brow
↓ psychological stress and analgesic over use
β – blockers
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
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’
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.
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
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
– 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



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Dr Tom Leach

Dr Tom Leach MBChB DCH EMCert(ACEM) FRACGP currently works as a GP and an Emergency Department CMO in Australia. He is also a Clinical Associate Lecturer at the Australian National University, and is studying for a Masters of Sports Medicine at the University of Queensland. After graduating from his medical degree at the University of Manchester in 2011, Tom completed his Foundation Training at Bolton Royal Hospital, before moving to Australia in 2013. He started almostadoctor whilst a third year medical student in 2009. Read full bio

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