Headache DDx

Headache – Differential Diagnosis

Common causes

Must Not Miss

Easily missed

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