headache
HEADACHE
Headache is a very common problem presenting to primary care physicians and neurologists.
Most headaches are diagnosed based on the history & physical exam w/ no imaging or laboratory examination necessary.
Other types of headaches such as secondary headaches may require further evaluation & referral to a specialist.

Headache Signs and Symptoms

Introduction

Headache

  • Very common problem presenting to primary care clinicians and neurologists
    • Almost half of adults worldwide experiences headache and 30% of them have migraine headache
    • Most common primary headache is tension-type headache while cluster headache is relatively common affecting about 1 in 1000 adults worldwide

Red Flag Signs and Symptoms

Further evaluation and/or referral is needed 

  • Worsening headache
  • Headache with fever and neck stiffness
  • Thunderclap headache
    • Sudden-onset of severe headache reaching maximum intensity within seconds to minutes
    • First or worst headache of the patient’s life (eg possible subarachnoid hemorrhage)
  • New-onset headache with:
    • Signs of systemic illness
    • Compromised immunity (eg caused by human immunodeficiency virus or immunosuppressive drug)
    • Age <20 years old and a history of malignancy
    • Age >50 years old with symptoms suggestive of temporal arteritis
    • Elderly patient with subacute cognitive change (eg possible subacute or chronic subdural hematoma)
    • History of malignancy known to metastasize to the brain
    • Vomiting without other obvious cause
    • Lyme disease
  • New-onset of severe headache in pregnancy or postpartum
  • Focal neurologic signs (not typical aura)
  • New-onset neurological deficit or cognitive dysfunction
  • Change in personality
  • Impaired level of consciousness
  • Recent head trauma (within the past 3 months)
  • Headache triggered by cough, sneeze, or valsalva
  • Headache triggered by exercise, exertion, or sexual intercourse
  • Rapid onset with strenuous exercise
  • Orthostatic headache
  • Symptoms suggestive of giant cell arteritis
  • Papilledema with altered level of consciousness and/or focal signs
  • Papilledema in an alert patient without focal neurological signs (eg possible pseudotumor cerebri)
  • Symptoms and signs of acute narrow-angle glaucoma
    • Eg non-reactive mid-dilated pupil, acutely inflamed eye, and visual disturbance with pain and nausea
  • Substantial change in the characteristics of the headache
Editor's Recommendations
Most Read Articles
01 Dec 2020
Tetanus toxoid 5 Lf, diphtheria toxoid 2 Lf, pertussis toxoid 2.5 mcg, filamentous haemagglutinin 5 mcg, fimbriae types 2 and 3 5 mcg, pertactin 3 mcg
Dr. Hsu Li Yang, Dr. Tan Thuan Tong, Dr. Andrea Kwa, 08 Jan 2021
Antimicrobial resistance has become increasingly dire as the rapid emergence of drug resistance, especially gram-negative pathogens, has outpaced the development of new antibiotics. At a recent virtual symposium, Dr Hsu Li Yang, Vice Dean (Global Health) and Programme Leader (Infectious Diseases), NUS Saw Swee Hock School of Public Health, presented epidemiological data on multidrug-resistant (MDR) gram-negative bacteria (GNB) in Asia, while Dr Tan Thuan Tong, Head and Senior Consultant, Department of Infectious Diseases, Singapore General Hospital (SGH), focused on the role of ceftazidime-avibactam in MDR GNB infections. Dr Andrea Kwa, Assistant Director of Research, Department of Pharmacy, SGH, joined the panel in an interactive fireside chat, to discuss challenges, practical considerations, and solutions in MDR gram-negative infections. This Pfizer-sponsored symposium was chaired by Dr Ng Shin Yi, Head and Senior Consultant of Surgical Intensive Care, SGH.
Jairia Dela Cruz, 23 hours ago
Spending too much time sitting cannot be good for the body, and rising to one's feet breaks up such a behaviour and yields small, but meaningful, reductions in certain cardiovascular disease (CVD) risk factors, according to the results of a meta-analysis.
5 days ago
Daily intake of cow’s milk formula in early life helps prevent the development of cow’s milk allergy later on without competing with breastfeeding, a recent study has found.