The document discusses various types of acute headaches that require urgent evaluation in the emergency department. It covers neurological emergencies that can cause acute headaches like subarachnoid hemorrhage and raised intracranial pressure. The most important part of evaluating acute headaches is taking a thorough history. It then describes characteristics of different headache types like migraines, cluster headaches, and tension headaches that may present acutely. It highlights that a CT scan identified subarachnoid hemorrhage, intracerebral hemorrhage, and meningitis as causes of sudden onset headaches in some emergency department patients.

1. Acute headache Problems that can not wait until the post take ward round www.bradfordvts.co.uk

2. Neurological emergencies Subarachnoid haemorrhage Raised intracranial pressure Cerebral infection

3. Acute headache assessment History Examination Investigations The most important investigation in the evaluation of headache is the history

4. Headache history Onset Site Character Duration Frequency Diurnal pattern Associated symptoms Aggravating factors Relieving factors Treatment Ideas

5. Headache pattern Acute Evolving Intermittent Chronic

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

7. Headaches in A&E 3 subarachnoid haemorrhages 1 intracerebral haemorrhage 3 meningitis 3 cerebral tumours

8. Other causes of acute headache Migraine Cluster headache Tension headache Temporal arteritis

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

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

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

12. Migraine variants Hemiplegic Basilar Ophthalmoplegic Transient migrainous accompaniments

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

14. Cluster headache Male:female ratio 5:1 Cluster lasts 6-12 weeks Seasonal variation Circadian rhythmicity

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

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