Headache

Headache accounts for a large proportion of medical consultations. The table below summarises the main characteristics of common or important causes:

Condition	Notes
Migraine	Recurrent, severe headache which is usually unilateral and throbbing in nature May be be associated with aura, nausea and photosensitivity Aggravated by, or causes avoidance of, routine activities of daily living. Patients often describe 'going to bed'. In women may be associated with menstruation
Tension headache	Recurrent, non-disabling, bilateral headache, often described as a 'tight-band' Not aggravated by routine activities of daily living
Cluster headache*	Pain typical occurs once or twice a day, each episode lasting 15 mins - 2 hours with clusters typically lasting 4-12 weeks Intense pain around one eye (recurrent attacks 'always' affect same side) Patient is restless during an attack Accompanied by redness, lacrimation, lid swelling More common in men and smokers
Temporal arteritis	Typically patient > 60 years old Usually rapid onset (e.g. < 1 month) of unilateral headache Jaw claudication (65%) Tender, palpable temporal artery Raised ESR
Medication overuse headache	Present for 15 days or more per month Developed or worsened whilst taking regular symptomatic medication Patients using opioids and triptans are at most risk May be psychiatric co-morbidity

Other causes of headache

Acute single episode

meningitis
encephalitis
subarachnoid haemorrhage
head injury
sinusitis
glaucoma (acute closed-angle)
tropical illness e.g. Malaria

Chronic headache

chronically raised ICP
Paget's disease
psychological

*some neurologists use the term trigeminal autonomic cephalgia to group a number of conditions including cluster headache, paroxysmal hemicrania and short-lived unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT). It is recommended such patients are referred for specialist assessment as specific treatment may be required, for example it is known paroxysmal hemicrania responds very well to indomethacin