Diagnosis

First of all is this a primary headache syndrome or is the headache just a symptom of another underlying condition. Click on the definition that best describes the headache to be taken to the next page.

GOLDEN RULE - a new persistent daily headache i.e. a headache lasting more than 2 weeks in a patient who has never had anything similar in the past (even if they are prone to migraines) should be investigated as a High pressure headache

1. Thunderclap headache - this is the 'worst headache ever' and the pain peaks within 5 minutes; so that is 'no pain' to to worst pain ever in less than 5 minutes

2. Headache with fever - the worry here is meningitis; there is usually neck stiffness too

3. High pressure headache - this is a headache which gets worse when lying down OR where someone has identified papilloedema (swelling behind the eyes) OR which is triggered by coughing, laughing, sneezing, exercise.

4. Headache with focal neurological deficit - this is a headache with a change in personality, memory or language problems, weakness or numbness; OR a history of seizures

5. Headache in the context of active cancer or immunosuppression (either due to drugs or HIV)

6. Headache less than three months after head trauma.

7. Headache with visual disturbance - flashing lights on coughing OR loss of vision on couching OR loss of central or peripheral vision OR blurred vision OR sudden loss of part of the visual field OR double vision.

8. Low pressure headache - this is a headache which gets immediately worse on standing up and immediately better on lying flat.

9. Trigeminal neuralgia - this is severe electric shock-like pains in the face or teeth which can be triggered by touching the face. There can be a constant background pain with that.

10. Suspected sinusitis - this is pain in the face which gets worse when you lie in certain positions and is associated with a blocked nose.

11. Suspected giant cell temporal arteritis - this usually occurs in patients who are older than 60 and is associated with tenderness in one temple.

12. A primary headache syndrome - this is 'anything else' but comprises 'tension-type headache', medication induced headache, migraine and trigeminal-autonomic cephalalgias.