i. Acute new-onset headache
History excludes previous
Perform a full neurological examination in search for the cause. If
examination fails to provide clues then a CAT scan or MRI should be
Causes of new onset headache and clinical features
1. Meningitis: Acute, severe headache with stiff neck and fever
2. Intracranial hemorrhage:
Acute, severe headache with stiff neck but without fever suggests
3. Brain tumor: Intermittent deep, dull aching of moderate
intensity, which may worsen with exertion or change in position and
may be associated with nausea and vomiting.
4. Temporal arteritis:
Temporal (giant cell) arteritis is an inflammatory disorder of
arteries that frequently involves the extracranial carotid
6. Other causes:
- Systemic Illness There is hardly any illness that is never
manifested by headache; however, some illnesses are frequently
associated with headache. These include
systemic lupus erythematosus, chronic pulmonary failure with
hypercapnia (early morning headaches),
inflammatory bowel disease, many of the illnesses associated with
HIV, and the acute blood pressure elevations that occur in
pheochromocytoma and in malignant hypertension.
Hypertension per se
is a very uncommon cause of headache; diastolic pressures of at
least 120 mmHg are requisite for hypertension to cause headache.
Some drugs and drug-withdrawal states, e.g., oral contraceptives,
ovulation-promoting medications, and
glucocorticoid withdrawal, are
also associated with headache in some individuals.
Nitrates may be
associated with headache that is usually controlled with
- Idiopathic Intracranial Hypertension (Pseudotumor Cerebri)
Headache, clinically resembling that of brain tumor, is a common
presenting symptom of pseudotumor cerebri, a disorder of raised
intracranial pressure probably resulting from impaired cerebrospinal
fluid CSF absorption by the arachnoid villi.
- Cough headache are characterized by transient, severe head pain
upon coughing, bending, lifting, sneezing, or stooping. The
incidence of serious intracranial structural anomalies causing this
condition is about 25%; the Chiari malformation is a common cause.
Thus, MRI is indicated for most patients with cough headache.
- Lumbar Puncture Headache following lumbar puncture. Head pain is
dramatically positional; it begins when the patient sits or stands
upright; there is relief upon reclining or with abdominal
- Postconcussion headaches.
- Post-coital headache occurs mainly in males (4:1).
ii. Chronic recurrent headache
History shows recurrent
Causes of recurrent headache
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