Acute Headache with No Abnormal Signs
| Cause | Comment |
|---|---|
| Tension-type headache | Usually described as pressure or tightness around the head. Does not have the associated symptoms or aura of migraine (although some patients may have both types of headache). |
| Migraine | See Table 15.6 for diagnostic criteria. |
| Medication-overuse headache | Suspect in patients who have frequent or daily headaches despite (or because of) the regular use of medications for headache. |
| Drug-related | Seen with nitrates, nicorandil and dihydropyridine calcium antagonists and sildenafil. |
| Toxin exposure | Seen with carbon monoxide poisoning (Chapter 36). |
| Subarachnoid haemorrhage | Around 20% of patients with subarachnoid haemorrhage have acute headache with no other signs. See text and Chapter 67. |
| Giant cell arteritis | See text and Chapter 99. |
| Cerebral venous thrombosis | Headache frequently precedes other symptoms, and can be the only symptom. Onset may be ‘thunderclap’, acute or progressive |
| Pituitary apoplexy | Usually associated with ophthalmoplegia and reduced visual acuity. See Chapter 93. |
| Carotid or vertebral arterial dissection | Unilateral headache, which may be accompanied by neck pain. May follow neck manipulation or minor trauma. Usually accompanied by other signs (ischaemic stroke, Horner syndrome or pulsatile tinnitus). |
| Spontaneous intracranial hypotension | Due to leak of CSF from spinal meningeal defects or dural tears. Headache worse on standing and relieved by lying down (like post-LP headache). May be accompanied by nausea and vomiting, dizziness, auditory changes, diplopia, visual blurring, interscapular pain and/or radicular pain in the arms or legs. |
| Benign (idiopathic) ‘thunderclap’ headache | Assumes subarachnoid haemorrhage and cerebral venous thrombosis have been excluded. |