R51
DESCRIPTION
Headache can be benign or serious.
Headache can have serious underlying causes including:
- encephalitis
- hypertensive emergencies
- meningitis
- venous sinus thrombosis
- mastoiditis
- stroke
- benign intracranial hypertension
- brain tumour
Headache due to a serious disease will often be associated with neurological symptoms and signs including:
- vomiting
- impaired consciousness
- fever
- pupillary changes and difference in size
- mood change
- focal paralysis
- cranial nerve fall-out
- visual disturbances
- convulsions
- neck stiffness
- confusion
Tension headache due to muscle spasm:
- May be worse in the afternoon, but often present all day.
- Is normally felt in the neck and the back of the head, but may be felt over the entire head.
- Is often associated with dizziness and/or blurring of vision.
- Is often described as a tight band around the head or pressure on the top of the head.
- Does not progress through stages like a migraine (no nausea, no visual symptoms).
GENERAL MEASURES
- Teach relaxation techniques where appropriate.
- Reassurance, where applicable.
- Exclude analgesia overuse headache.
MEDICINE TREATMENT
Children
- Paracetamol, oral, 10-15 mg/kg/dose 6 hourly when required. See Paediatric dosing tool.
Adults
- Paracetamol, oral, 1 g 4-6 hourly when required.
- Maximum dose: 15 mg/kg/dose.
- Maximum dose: 4 g in 24 hours.
REFERRAL
- Refer patients with suspected meningitis immediately after initial treatment. See: Meningitis.
- Headache in children lasting for 3 days.
- Recent headache of increasing severity.
- Headache with neurological manifestations.
- Analgesia overuse headache.
- Newly developed headache persisting for >1 week in an adult.
- Chronic recurrent headaches in an otherwise healthy patient: refer if no improvement after 1 month of treatment.
- Tension headache due to muscle spasm: refer if no improvement after 1 month of treatment.