Headache is common and causes considerable worry, but rarely represents sinister disease. The causes may be divided into primary or secondary, and most patients, whether presenting in clinic or as emergencies, have primary syndromes.
The tempo of evolution of headache is critical; sudden-onset headache ,maximal immediately, is always a ‘red flag’ and should prompt rapid assessment in hospital for possible subarachnoid hemorrhage or other sinister causes, even though only 10–25% of patients harbour
serious pathology.
Clues to other possible causes rash in meningitis should be sought.
Primary headache syndromes
- Migraine
- Tension-type headache
- Primary stabbing/coughing/exertional/sex-related headache
- Thunderclap headache
- New daily persistent headache syndrome
Secondary causes of headache
- Medication overuse headache (chronic daily headache)
- Intracerebral bleeding (subdural haematoma, subarachnoid or intracerebral haemorrhage)
- Raised intracranial pressure ,brain tumour, intracranial hypertension
- Infection (meningitis, encephalitis, brain abscess)
- Inflammatory disease (temporal arteritis, other vasculitis, arthritis)
- Referred pain from other structures (orbit, temporomandibular joint, neck)
It is important to establish whether the headache comes and goes, with periods of no headache in between or whether it is present all or almost all the time .
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