Disease modifying treatment available:
Time critical diagnosis and management:
Lateralising:
Overuse of nasal decongestants can cause headache.
| Disorder | Clinical features | Associated features | Investigations | Disease modifying treatment available | Time critical |
|---|---|---|---|---|---|
| Subarachnoid haemorrhage | |||||
| Trigeminal autonomic cephalalgia | |||||
| Cerebral venous sinus thrombosis |
Seizure Bilateral papilloedema Visual field defect Weakness |
Pregnancy Crohn's disease Antiphospholipid syndrome Polycythaemia rubra vera Nephrotic syndrome Essential thrombocythaemia Antithrombin deficiency Protein C deficiency Protein S deficiency Paroxysmal nocturnal haemoglobinuria Myelofibrosis Ulcerative colitis |
|||
| Idiopathic intracranial hypertension |
Bilateral papilloedema Intracranial hypertension |
||||
| Temporal arteritis |
Antiphospholipid syndrome |
||||
| Acromegaly |
Peripheral neuropathy Bitemporal hemianopia |
||||
| Bacterial meningitis |
Seizure |
||||
| Hypertension |
Chronic kidney disease Ischaemic stroke |
Posterior reversible encephalopathy syndrome |
|||
| Eclampsia |
Seizure |
Posterior reversible encephalopathy syndrome |
|||
| Pre-eclampsia |
Posterior reversible encephalopathy syndrome Antiphospholipid syndrome |
||||
| Carbon monoxide toxicity |
Seizure |
||||
| Cluster headache | |||||
| Intracranial hypotension |
Dementia Superficial siderosis |
||||
| Tension headache | |||||
| Reversible cerebral vasoconstriction syndrome | |||||
| Migraine with aura |
Hallucination |
||||
| Migraine with brainstem aura |
Vertigo |
||||
| Migraine without aura |
Photophobia Nausea |
||||
| Paroxysmal hemicrania | |||||
| Hemicrania continua | |||||
| Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing | |||||
| Short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms | |||||
| Viral meningitis | |||||
| Vogt-Koyanagi-Harada disease |
Visual loss Alopecia Vitiligo Hearing loss Nausea Retinal detachment Uveitis Poliosis |
||||
| Glaucoma |
Photophobia Red eye Visual loss |
||||
| Sinusitis | |||||
| Posterior reversible encephalopathy syndrome |
Seizure Visual loss Reduced conscious level |
Pre-eclampsia Eclampsia Hypertension |
|||
| Analgesia overuse headache | |||||
| Migraine |
Nausea Vomiting Photophobia Phonophobia |
||||
| Bartonella quintana infection |
Pyrexia Bone pain Rash |
||||
| Bartonella bacilliformis infection |
Pyrexia Myalgia |
||||
| IgG4-related disease | |||||
| Acute rhinosinusitis |
Clinical features potentially suggestive of a serious underlying cause:
- Explosive onset (thunderclap headache)
- Visual loss (migraine is a common cause of headache and visual disturbance)
- Papilloedema
- New onset headache in someone aged > 50
- Jaw claudication
- Elevated ESR and CRP
- Focal neurological features lasting greater than 1 hour
- Headache associated with postural change such as bending, straining, exertion or coughing or waking from sleep
- Headache worse on standing
- New daily persistent headaches
- Conjunctival injection
- Possible carbon monoxide poisoning
- Rapid progression of a focal neurological deficit or cognitive decline
- New onset headache with a background of cancer or immunosuppression
- Progressive headache worsening over weeks
- Refractory headache
- Unclassified headache
| Laboratory Investigation | Result |
|---|