The usual cause of bilateral, non-pulsatile headache ± scalp muscle tenderness, but without vomiting or sensitivity to head movement. Stress relief, eg massage or antidepressants, may have more to offer than a neurologist.
👉 Raised intracranial pressure:
Typically worse on waking, lying down or bending forward, or with coughing. Also vomiting, papilloedema, fits, false localizing signs or behavioural change. Do imaging to exclude a space-occupying lesion, and consider idiopathic intracranial hypertension. LP is contraindicated until after imaging.
👉 Medication overuse headache:
Culprits are mixed analgesics, especially those containing paracetamol, codeine, opiates, ergotamine and triptans.
This is a common reason for episodic headache becoming chronic daily headache.
Analgesia must be withdrawn—aspirin or naproxen may mollify the rebound headache.
A preventive may help once other drugs withdrawn (eg tricyclics, valproate, gabapentin. Advise patients to use over-the-counter analgesia no more than 6 days per month.
* FREQUENCIES OF HEADACHE TYPES
Systemic infection 7%
With head trauma 3%
With drugs 2%
CVD, Metabolic diseases, intracranial diseases, cluster headaches, neuralgias
* RED FLAGS 🎌 SIGNS IN HEADACHE
👉 ELEVATED BP
👉 NECK STIFFNESS
👉 ASSOCIATED WITH BLINDNESS/VASCULITIS
* INVESTIGATIONS FOR HEADACHES
👉 Serum biochemistry
👉 Arterial blood gases
👉 Biopsy of blood vessels
👉 Oxford handbook of Clinical Medicine
👉 A Compendium of Clinical Medicine by A. O. Falase and O. O. Akinkugbe
👉 Prof. Mayowa O. O. slide on HEADACHE