Headaches can be summarised as any pain in the head (above the eye). The nature of headaches can vary depending on the underlying cause:
Causes of the headache is at molecular level with no demonstrated underlying aetiology e.g. Migraines, Tension & Cluster Headaches.
|Tension Headache||Banding around the head; usually results from stress or mood.|
|Pain from Neck (Cervicogenic) Headache||Band from neck to the forehead (can have scalp tenderness); this can be unilateral or bilateral. Consider traumatic cause and treat accordingly.|
|Cluster Headache||Often a nightly pain in the eyes for a period of time and then stops for a few months. This headache usually affects males (more common with smoking males).|
|Migraine||Sensory disturbances (Aura) such as visual; can have nausea/vomiting. Can occur as unilateral. Pain usually appear as ‘throbbing’ in nature.|
Causes of the headache has an underlying cause, which can be life-threatening if left untreated e.g. TBIs, tumours, or infection.
|Meningitis||Fever, photophobia, stiff neck, rash, limb pain, cold peripherals, and mottled skin. Accompanied with a headache.|
|Encephalitis||Fever and confusion (reduced GCS).|
|Subarachnoid Haemorrhage||Very sudden headache onset, described as “thunder-clap.’ This can include stiff neck. Consider traumatic cause|
|Head Injury||Considered in trauma patients, including falls, or mechanism of injury suggesting head &/or spinal injury.|
|Acute Febrile Illness||Fever with symptoms of underlying cause of infection (e.g. Respiratory infection, tonsillitis etc.)|
|Raised Intracranial Pressure||Can be traumatic or non-traumatic caused (e.g. Aneurysm, tumour, infection) appear as raising blood pressure, reduced pulse and worsening headache when sneezing/waking.|
|Medication OveruseHeadache||Caused by regular, long-term medication use to treat headaches, this results in a ‘rebound’ headache.|
|Dehydration||The homeostatic balance of fluid and electrolytes has been disrupted due to water being expelled faster than it can be replenished, causing the brain to temporarily contract, causing intense pain.|
A detailed history should be done in order for a full clinical picture and differential diagnosis.
Due to the complexity of headaches, the expectation is not to diagnose the headache cause, but rather identify clinical warning signs.
Treat every headache patient cautiously and thoroughly, instead of discharging them after administering analgesia.
|Thanh Bui, AP60825|
Event Medic, Emergency Medical Technician &
Volunteer Development Officer