Headache DDx

Headache – Differential Diagnosis

Common causes

• Minor viral infections
• Tension type headache
• Migraine
• Acute sinusitis
• Referred neck pain
• Analgesia induced headache
• Caffeine withdrawal
• Trigeminal Neuralgia
• TMJ syndrome
• Cluster headache
• Post-concussion headache

Must Not Miss

• Raised Intracranial Pressure
  • Subarachnoid haemorrhage
  • Subdural haematoma
  • Brain tumour
  • Brain abscess
  • Meningitis
  • Encephalitis
• Malignant hypertension
• Pre-eclampsia
• Temporal arteritis
• Acute Glaucoma

Easily missed

• Drug & Toxins
• Depression& MUS
• Dental problems
• HIV
• Idiopathic-intracranial-hypertension

Red flags

• Severe thunderclap headache
• Neurological symptoms
  • (confusion, persistent focal neurological signs)
• Severe progressive headache
• New onset headache > 50 years of age
• Recent change in normal headaches
• Associated symptoms
  • Petechial rash/neck stiffness
  • Awoken by headaches
  • Early morning headaches
  • Worsened by valsalva manoeuvres
  • Jaw claudication
  • Temporal scalp tenderness
• Systemic symptoms (fever, weight loss)
• HIV infection
• History of cancer

Investigations to consider

• FBC, CRP/ ESR
• U&Es
• Blood & viral cultures
• X-ray (C spine, Skull)
• Lumbar puncture
• CT/MRI
• Temporal artery biopsy
• Intraocular pressure measurements