Acute Headache with Local Signs
| Cause | Comment/management |
|---|---|
| Acute sinusitis | Suspect from associated fever, facial pain especially on bending over, mucopurulent nasal discharge, and tenderness on pressure over the affected sinus. |
| Obtain X-rays of the sinuses, looking for mucosal thickening, a fluid level or opacification. | |
| Treatment is with coamoxiclav (or erythromycin and metronidazole if allergic to penicillin) and steam inhalations. | |
| Discuss management with an ENT surgeon. | |
| Acute angle-closure glaucoma | Usually unilateral; eye red and injected, visual acuity reduced due to corneal clouding, pupil fixed. Refer urgently to an ophthalmologist. |
| Giant-cell arteritis | See text,
Appendix 19.1 and Chapter 99. |
| Temporomandibular joint disorder | A group of disorders affecting the temporomandibular joint (TMJ) and the muscles of mastication. Signs include limitation of jaw opening, tenderness to palpation of the TMJ and palpable spasm of masseter and internal pterygoid muscles. Seek advice from an oral surgeon. |
| Cervicogenic headache | Headache referred from disorder of the cervical spine. |
| Mucormycosis | Diabetes, orbital and facial pain, periorbital and orbital cellulitis, proptosis, purulent nasal discharge, mucosal necrosis. |