References

Ahmed M, Martinez A, Cahill D, Chong K, Whitehouse WP When to image neurologically normal children with headaches; development of a decision rule. Acta paediatr. 2010; 99:(6)940-3

Ameri A, Bousser MG Cerebral venous thrombosis. Neurol Clin. 1992; 10:(1)87-111

Bahra A, May A, Goadsby PJ Cluster headache: a prospective clinical study with diagnostic implications. Neurology. 2002; 58:(3)354-61

Bigal ME, Lipton RB Excessive acute migraine medication use and migraine progression. Neurology. 2008; 71:(22)1821-8

Blau JN Headache: history, examination, diferential diagnosis and special investigations.(eds). New York: Elsevier; 1986

Blau JN, MacGregor EA Migraine consultations: a triangle of viewpoints. Headache. 1995; 35:(2)104-6

Bonita R, Thomson S Subarachnoid haemorrhage; epidemiology, diagnosis, management, and outcome. Stroke. 1985; 16:(4)591-4

Bousser MG, Kittner SJ Oral Contraceptive and stroke. Cephalalgia. 2000; 20:(3)183-9

, 3rd. London: British Association for the Study of Headache; 2010

Cittadini E, Matharu MS, Goadsby PJ Paroxysmal hemicrania: a prospective clinical study of 31 cases. Brain. 2008; 131:(4)1142-5

Cohen AS Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing. Cephalalgia. 2007; 27:(7)824-32

Cohen AS, Burns B, Goadsby PJ High-fow oxygen for treatment of cluster headache: a randomized trial. JAMA. 2009; 302:(22)2451-7

Craig J, Patterson V, Roche L, Jamieson J Accident and emergency neurology: time for a re-appraisal?. Health Trends. 1997; 29:89-91

De Bruijn SF, Stam J, Kappelle LJ Thunderclap headache as frst symptom of cerebral venous sinus thrombosis. CVST Group. Lancet. 1996; 348:1623-5

Digre KB, Corbett JJ Idiopathic intracranial hypertension(pseudotumor cerebri): a reappraisal. Neurologist. 2001; 7:2-67

Dodick DW Thunderclap headache. J Neurol Neurosurg Psychiatry. 2002; 72:(1)6-11

Ekbom K, Krabbe A, Micieli G, Prusinski A Cluster headache attacks treated for up to three months with subcutaneous sumatriptan (6 mg). Sumatriptan Cluster Headache Long-term Study Group. Cephalalgia. 1995; 15:(3)230-6

Fisher CM Late life migraine accompaniments—further experience. Stroke. 1986; 17:(5)1033-42

Fleetwood IG, Steinberg GK Arteriovenous malformations.2002

Foresyth PA, Posner JB Headache in patients with brain tumours: a study of 111 patients. Neurology. 1992; 43:(9)1678-83

Goadsby PJ, Boes C New daily persistent headache. J Neurol Neurosurg Psychiatry. 2002; 72:(2)116-119

Goadsby PJ, Ahmed F, Tyagi A, Weatherall M The changing face of chronic migraine. Lancet Neurol. 2010; (December)1-4

Hagen K, Albretsen C, Vilming ST, Salvesen R Management of medication overuse headache: 1–year randomized multicentre open-label tria. Cephalalgia. 2009; 29:(2)221-32

Hall SH, Hunder GG 1984; 59:(11)793-6

Harrison MJ, Bevan AT Early symptoms of temporal arteritis. Lancet. 1967; 2:638-40

Hayreh SS, Podhajsky PA, Zimmerman B Ocular manifestations of giant cell arteritis. Am J Ophthalmol. 1998; 125:(4)509-20

Healy LA, Wilske KRNew York: Grune and Stratton; 1978

Hopkins ALondon, WB: Saunders; 1988

Headache Classifcation Subcommittee of the International Headache Society. The International Classifcation of Headache Disorders. Cephalalgia. 2004; (1)9-160

Katsarava Z, Obermann M, Yoon MS, Dommes P Prevalence of cluster headache in a population-based sample in Germany. Cephalalgia. 2007; 27:(9)1014-9

Kernick DP, Ahmed F, Bahra A, Dowson A Imaging patients with suspected brain tumour: guidance for primary care. Br J Gen Pract. 2008b; 58:(557)880-5

Kudrow L The cyclic relationship of natural illumination to cluster period frequency. Cephalalgia. 1987; 7:(6)76-8

Lakeman FD, Whitely RJ Diagnosis of herpes simplex encephalitis; application of polymerase chain reaction to cerebrospinal fuid from brain biopsied patients and correlation with disease. National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group. J Infect Dis. 1995; 171:(4)857-63

Landtblom AM, Fridriksson S, Borvie J, Hillman J, Johansson G, Johansson I Sudden onset headache; a prospective study of features, incidence and causes. Cephalalgia. 2002; 22:(5)354-60

Latinovic R, Gulliford M, Ridsdale L Headache and migraine in primary care: consultation, prescription and referral rates in a large population. J Neurol Neurosurg Psychiatry. 2006; 77:(3)385-7

Levy MJ, Jäger HR, Powell M, Matharu MS, Meeran K, Goadsby PJ Pituitary volume and headache: size is not everything. Arch Neurol. 2004; 61:(5)721-5

Linn FH, Wijdicks EF, van der Graaf Y, Weerdesteyn–van Vliet FA, Bartelds AI, van Gijn J Prospective study of sentinel headache in aneurismal subarachnoid haemorrhage. Lancet. 1994; 344:590-3

Locksley HB Natural history of subarachnoid hemorrhage, intracranial aneurysms and arteriovenous malformations. Based on 6368 cases in the cooperative study. J Neurosurg. 1966; 25:(2)219-39

Lövblad KO, Schneider J, Bassetti C, El-Koussy M Fast contrast-enhanced MR whole-brain venography. Neuroradiology. 2002; 44:(8)681-8

Lowry JK, Synder JJ, Lowry PW Brain tumors in the elderly; recent trends in a Minnesota cohort study. Arch Neurol. 1998; 55:(7)922-8

May A, Leone M, Afra J, Linde M EFNS guidelines on the treatment of cluster headache and other trigeminal autonomic cephalalgias. Eur J Neurol. 2006; 13:(10)1066-77

Natoli J, Mannack A, Dean B, Butler Q Global prevalence of chronic migraine; a systematic review. Cephalalgia. 2009; 30:(5)599-609

Nordborg E, Nordborg C Giant cell Arteritis; epidemiological clues to its pathogenesis and an update on its treatment. Rheumatology (Oxford). 2003; 42:(3)413-21

Olesen J, Tfelt-Hansen P, Welch KMA, Goadsby PJ, Ramadan NM, 3rd. Philadelphia: Lippincott, Williams and Wilkins; 2005

Rossi P, Jensen R, Nappi G, Allena M A narrative review on the management of medication overuse headache: the steep road from experience to evidence. J Headache Pain. 2009; 10:(6)407-17

London: Royal College of Physicians; 2011

Russell MB, Olesen J A nosographic analysis of the migraine aura in a general population.1996

Sender J, Bradford S, Watson D, Lipscombe S Setting up a specialist headache clinic in primary care; general practitioners with a special interest in headache. Headache Care. 2004; 1:(3)165-71

Scher AI, Stewart WF, Buse D, Krantz DS, Lipton RB Major life changes before and after the onset of chronic daily headache: a population based study. Cephalalgia. 2008; 28:(8)868-76

Steiner TJ, Scher AI, Stewart WF, Kolodner K, Liberman J, Lipton RB The prevalence and disability burden of adult migraine in England and their relationship to age, gender and ethnicity. Cephalalgia. 2003; 23:(7)519-27

Steiner TJ, Stovner LJ, Dua T, Birbeck GL Time to act on headache disorders. J Headache Pain. 2011; 12:(5)501-3

Wall M, George D Idiopathic intracranial hypertension. A prospective study of 50 patients. Brain. 1991; 114:155-80

Weatherall MW Acute neurology in a twenty-frst century district general hospital. J R Coll Physicians. 2006; 36:196-200

Weatherby S Acute headaches. In: Kernick D, Goadsby P Oxford: OUP Oxford; 2008

Headaches: recognizing a serious cause

02 March 2012
Volume 4 · Issue 3

Abstract

Headache is one of the most frequent medical complaints with an estimated 95% of the general population experiencing it at some stage in their lifetime, and 90% of people experiencing it per year (Latinovic, 2006). Although serious causes of headache are fairly uncommon, their recognition is important as the vast majority can be treated. They usually present in the acute setting to accident and emergency and acute assessment units. A considerable proportion of acute headaches are benign and patients seek medical attention because of an underlying concern of brain tumour or haemorrhage. Symptoms that indicate a high risk of a serious underlying pathology, or ‘red flags’, may enable clinicians to differentiate those in need of urgent medical attention.

Headache affects virtually everyone at some point in their lifetime. It is one of the commonest symptoms for consultation in both primary and secondary care (Bone and Fuller, 2002; Royal College of Physicians and Association of British Neurologists, 2011). Headaches account for 55% of neurology referrals from acute assessment units (AAU) (Craig et al, 1997; Weatherall, 2006). Around 30% of a neurologist's caseload involves dealing with various kinds of headache disorders (Sender et al, 2004).

Fortunately, the vast majority of headaches are benign. In patients with new-onset headache presenting to their general practitioner, the one-year risk of a malignant brain tumour is only 0.045% (Kernick et al, 2008). Serious headaches, including those related to brain tumours, account for only 1% of all headaches, with the vast majority presenting acutely through accident and emergency departments (A&E) and AAUs. It is therefore extremely important for paramedics to be able to recognize common headache subtypes and identify those that require urgent attention by the relevant specialty.

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