1. Department of Neurology, SJUH Acute headache Problems that can not wait until the post take ward round www.bradfordvts.co.uk

2. Department of Neurology, SJUH Neurological emergencies l Subarachnoid haemorrhage l Raised intracranial pressure l Cerebral infection

3. Department of Neurology, SJUH Acute headache assessment l History l Examination l Investigations l The most important investigation in the evaluation of headache is the history

4. Department of Neurology, SJUH Headache history l Onset l Site l Character l Duration l Frequency l Diurnal pattern l Associated symptoms l Aggravating factors l Relieving factors l Treatment l Ideas

5. Department of Neurology, SJUH Headache pattern l Acute l Evolving l Intermittent l Chronic

6. Department of Neurology, SJUH Headaches in A&E l Prospective study of all patients with a primary diagnosis of headache l 93 cases in 3 months l 39 (42%) had sudden onset headache l 30 (32%) had a CT scan

7. Department of Neurology, SJUH Headaches in A&E l 3 subarachnoid haemorrhages l 1 intracerebral haemorrhage l 3 meningitis l 3 cerebral tumours

8. Department of Neurology, SJUH Other causes of acute headache l Migraine l Cluster headache l Tension headache l Temporal arteritis

9. Department of Neurology, SJUH Migraine l Migraine without aura: common migraine l Migraine with aura: classical migraine l Aura symptoms: visual (99%), sensory (31%), dysphasia (18%), motor (6%).

10. Department of Neurology, SJUH Migraine without aura l Attacks lasting 4-72 hours l At least two of following characteristics: unilateral, pulsating, moderate to severe, aggravated by movement l At least one associated symptom: nausea or vomiting, photophobia, phonophobia

11. Department of Neurology, SJUH Migraine with aura l One or more transient focal aura symptoms l Gradual development of aura symptom over >4 mins l Aura symptoms last 4-60 mins l Headache follows or accompanies the aura within 60 mins.

12. Department of Neurology, SJUH Migraine variants l Hemiplegic l Basilar l Ophthalmoplegic l Transient migrainous accompaniments

13. Department of Neurology, SJUH Cluster headache l Severe unilateral pain l Orbital, supraorbital, temporal l Associated conjunctival injection, lacrimation, nasal congestion, rhinorrhoea, forehead and facial sweating l Miosis, ptosis, eyelid oedema l Frequency: 1 alt days to 8 per day

14. Department of Neurology, SJUH Cluster headache l Male:female ratio 5:1 l Cluster lasts 6-12 weeks l Seasonal variation l Circadian rhythmicity

15. Department of Neurology, SJUH Tension headache l Acute or chronic l Bilateral l Suboccipital, over top of head l Tight or pressure pain l Poor concentration, dizziness, difficulty focusing

16. Department of Neurology, SJUH Raised pressure headache l Non-specific l Bursting l Waking l Aggravated by bending, coughing, sneezing l Associated with vomiting, visual blurring, features due to underlying lesion l Papilloedema