Headache Differential + red flags

Headache DifferentialNo signs on examination (good for osce....) tension migraine cluster post-trauma drugs (nitrates, calcium channel antagonists) carbon monoxide poisoning or anoxia SAH Signs of meningism? meningitis (may have NO fever/rash) SAH (exam may be normal) Decreased Conscious lvl or localizing signs? stroke encephalitis/meningitis cerebral abscess SAH venous sinus occlusion (focal neuro deficits) tumor subdural hematoma TB meningitis Papilledema? tumor Venous sinus occlusion (focal neuro deficits) malignant (accelerated) hypertension idiopathic intracranial hypertension any CNS infect if prolonged eg >2w -eg TB meningitis Others Giant cell arteritis (ESR up) Acute glaucoma vertebral artery dissection (neck pain + cerebellar/medullary signs) cervical spondylosis sinusitis paget's disease (alk phos +++) altitude sickness

Worrying features or 'red flags' 1st and worst headache  - SAH thunderclap headache - SAH unilat headache + eye pain - cluster headache, acute glaucoma unilat headache + ipsilat symps - migraine, tumor, vascular cough initiated - raise dICP/venous thrombosis worse in morn or bend forward - raised ICP/venous thrombosis persisting headache +/- scalp tenderness in >50's -giant cell arteritis headache w/fever or neck stiff - meningitis change in the patter of 'usual' headaches decreased lvl of consciousness Two other vital q's-where have you been? (malaria)-might you be pregnant? (pre-eclampsia, espec if proteinuria + BP up)

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