Features of different types of headaches

Explanation

First let us learn the types of headaches that one would be inclined to get scanned.

  1. Thunderclap headache-suggests SAH (Subarachnoid hemorrhage). CT scan WITHOUT contrast required.
  2. Nocturnal headache that WAKES patient up from sleep-suggests malignant or other significant etiology. Imaging required.
  3. Headache with neurological deficit-?stroke/tumor/complicated migraine
  4. Headache progressing over weeks to months with loss of appetite and weight-malignant etiology. Imaging required.
  5. Headache with fever and neck rigidity-meningitis/encephalitis(with altered sensorium)

The commonest type of headache tested on is Migraine. Commonly one is given the scenario of complicated migraine. First a few features of common migraine:

Associated nausea: Very commonly it presents with this. In contrast, the headache of raised intracranial pressure which makes a person vomit in a projectile way - lacks nausea.

Aura/fortification: Although commonly presented in typical migraine, these flashing lights are not common and most migrainers do not get these.

Hemicrania: The reason for migraine's name - this feature of half the head hurting is not common.

Disrupts activity:  This is one of the most important and very commonly presenting feature of migraine.

 Neurological deficit: This is typically presented as a rapidly progressing curtain over the system being affected. For instance, half of the visual field fades off and returns. As opposed to a TIA which appears almost instantly, this takes about 5-10 minutes to set in. Same thing may happen in the sensory cortex and there may be hemi-anesthesia that gradually sets in over a few minutes and soon disappears. This scenario is commonly tested on in tests.