Neurology Made Simple : Headache , Causes and Investigations

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