Headache
Headache is one of relatively common symptom we come across
is our daily practice.
However there a number of rather sinister causes and it is
very important that these are not missed during history taking and evaluation.
Important Causes
Sub arachnoid
Haemorhage
Sudden onset of headache associated with vomiting.
Patient may describe it as the worst headache of life.
Tension Headache
Bilateral and like a band around the head
Migraine
Unilateral associated with an aura and visual symptoms /
flashes
Mainly fronto parietal location
Cluster headache
Unilateral and retro orbital ie pain behind the eye
Temporal arteritis
Unilateral and temporal in location
Associated with pain and weakness in shoulders / polymyalgia
rheumatica.
Space occupying
lesion
Pain worse in morning and associated with weakness of arm or
leg / focal neurological symptoms
Sometimes seizures may occur.
Meningitis
Headache with fever and neck stiffness
Septicemia and rash may co-exist
Benign intracranial
hypertension
Usually occurs in females and is measured by Lumbar puncture
+ CSF manometry
Medications :
Calcium channel blockers and nitrates can cause raised
intracranial pressure
Also tetracyclines and Vitamin A derivatives
Cavernous sinus
thrombosis
Can occur with use of oral contraceptive pills and thus is
more common in females
Investigations for finding
the cause of headache
Routine investigations eg FBC, Urea, Electrolytes and Random
sugar levels
Visual fields and visual acquity testing
ESR will be raised in Giant cell arteritis
CRP and White cell count will be raised in infections.
CT head will exclude intra cranial space occupying lesions ,
sub dural/extra dural haematoma , abscesses, dilated ventricles etc
MRI brain will help exclude pituitary adenomas
MRV ; Magnetic Resonance Venography will exclude Venous
sinus thrombosis
Lumbar puncture is useful to diagnose meningitis by
examination of CSF
CSF is examined by looking at its color, Routine cytology
and Biochemistry to exclude viral bacterial or tuberculous meningitis
Manometry will help determine CSF pressure to exclude Benign Intra cranial hypertension
