Headache Checklist
GRI ED
Warning
HEADACHE CHECKLIST
Discuss with Senior ED decision maker
NB: if >4 days after COVID vaccine and not responding to simple
painkillers: see Headache Post Vaccine guidance.
Consider SAH: CT (and admit for LP if CT –ve) if any of the following:
For alert patients older than 15 y with new severe non-traumatic headache reaching maximum intensity within 1 h. (Not for patients with new neurologic deficits, previous aneurysms, SAH, brain tumors, or history of recurrent headaches - 3 episodes over the course of 6 months)
| □ Age >40 | □ Neck pain or stiffness / limited neck flexion on examination |
| □ Witnessed loss of consciousness | □ Onset during exertion |
|
□ Thunderclap (instantly peaking pain) |
Other features of headache suggesting urgent investigation with CT:
| □ Abnormal conscious level or neurological examination |
□ Morning headaches or posture related |
| □ Fever | □ Known malignancy or immuno-compromised / HIV |
| □ Current anti-coagulant use | □ Recent trauma |
Other causes of headache to consider:
| Migraine: Unilateral, pulsating, builds up over minutes to hours, moderate to severe in intensity, associated with nausea and/or vomiting and/or sensitivity to light and/or sensitivity to sound, disabling, aggravated by routine physical activity | Tension-type headache: generally not as severe as migraine. The pain is typically bilateral, characteristically pressing or tightening in quality. Nausea is not present and the headache is not aggravated by physical activity. There may be associated pericranial tenderness, sensitivity to light or sensitivity to noise. |
| Giant cell Arteritis ; Cervicogenic headache ; Medication overuse headache ; Trigeminal Autonomic cephalgias (Cluster headache, Paroxysmal hemicrania) Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA) are very rare ; Carbon Monoxide poisoning |