Headaches

Introduction

Broadly there’s two types of headaches – Primary and Secondary with primary being things like migraines and tension headaches while secondary headaches are ones where there’s another underlying medical cause such as infection, stroke, trauma (among others).

Red flags

• Worst ever headache
• Sudden onset headache - ‘thunderclap’ / Maximal at onset headache
• Headaches with fever or rash
• Meningococcal type symptoms including photophobia, neck pain/stiffness, vomiting
• Pregnant patients (pre-eclampsia being the consideration here)
• Headache post trauma
• Patients on Warfarin or other anticoagulants (some examples include enoxaparin, rivaroxaban and apixaban)
• Headaches with a change in level of consciousness (AVPU or GCS)
• Neurological symptoms (think things such as changes to pupils, FAST +ve)
• Long duration or a progressive headache that gets worse over weeks
• Patients with new onset headache with Hx of Cancer or HIV infection
• Headaches associated with postural changes
• Aura symptoms that: Last longer than an hour; Include motor weakness; Are different from previous aura; Occur for the first time on using oral contraceptive pill

Learning more

Reading

http://paramedichq.com/index.php/neurological/headache/ https://geekymedics.com/headache-history-taking/

Podcasts

https://medicmindset.com/2019/06/17/thinking-headache/ https://atcomd.wordpress.com/2019/12/16/episode-31-headache/

Sources

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4590146/
• https://aci.health.nsw.gov.au/networks/eci/clinical/clinical-resources/clinical-tools/neurology/headache
• https://www.ambulance.qld.gov.au/docs/clinical/cpg/CPG_Headache.pdf