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CDHB

Head Pain

Initial assessment and resuscitation

• Airways, Breathing, Circulation: brief appraisal.

Complete assessment

History, Examination, Investigations: directed according to the differential problem list.

Definitive management

According to the cause. Possible causes include:

• Trauma - scalp, skull fracture, intracranial haematoma.
• Tension headaches, migraines, sinusitis, cluster headaches, temporomandibular joint disease, cervical spine disease, hypertension, oral contraceptive or other drug induced headaches.
• New headache:
  • Meningeal irritation - subarachnoid haemorrhage, meningitis / meningoencephalitis.
  • Hypertensive encephalopathy.
  • Pre-eclampsia/eclampsia
• Paracranial causes - temporal arteritis, eyes, ears, sinuses, teeth, cervical spine.

Note: Chronic or new headaches with focal neurological signs or papilloedema need urgent investigations. CT head scan should precede lumbar puncture if focal signs, papilloedema, or an impaired level of consciousness is present.

Important to exclude

• Subarachnoid haemorrhage/ other intercranial haemorrhage
• Space occupying lesions
• Meningitis/ meningoencephalitis
• Vertebral/ carotid artery dissection
• Cerebral venous thrombosis
• Giant cell arteritis
• Acute angle closure glaucoma

Topic Code: 1272