Acute assessment of headaches

A medical consult is recommended where there is no specific protocol for a condition

Always consider sepsis — signs and symptoms can include

High or low temperature
Fast breathing
Fast pulse
Low BP or dizziness
Confusion and/or agitation

Headaches can occur alone or as part of another illness

Red Flags — Urgent Medical Consult
Sudden onset and very severe (‘worst headache ever’), blackout Fever, stiff neck, photophobia (pain looking at light) Confusion, altered level of consciousness, one-sided weakness, facial droop, slurred speech Blurred/double vision OR painful red eye Temporal arteries tender, tongue or jaw ache on eating — over 60 years of age Worse with bending, coughing, sneezing History of recent head trauma AND on anticoagulant Pregnant or postpartum If new symptoms, reoccurring or person re-presents within 72 hours Not responding to usual measures

Sudden onset and very severe (‘worst headache ever’), blackout
Fever, stiff neck, photophobia (pain looking at light)
Confusion, altered level of consciousness, one-sided weakness, facial droop, slurred speech
Blurred/double vision OR painful red eye
Temporal arteries tender, tongue or jaw ache on eating — over 60 years of age
Worse with bending, coughing, sneezing
History of recent head trauma AND on anticoagulant
Pregnant or postpartum
If new symptoms, reoccurring or person re-presents within 72 hours
Not responding to usual measures

Check

Calculate age-appropriate REWS

Adult — AVPU, RR, O₂ sats, pulse, BP, Temp
Child (less than 13 years) — AVPU, respiratory distress, RR, O₂ sats, pulse, central capillary refill time, Temp

Weight, BGL

If REWS score 3 or more or if any danger signs — urgent medical consult
If available POC Test — WBC
History and head-to-toe exam
Coma Scale — see Injuries — head

Table 1.10 Some causes of headaches

Signs and symptoms or circumstances of headache	Possible cause
Following recent fall, hit to the head, car accident	Concussion — medical consult Intracranial bleeding eg subdural haemorrhage (haemorrhage can occur up to 7 days post-trauma)
Sudden or progressive neurological symptoms — weakness, clumsiness, loss of balance, altered sensation of limbs, vision or speech changes, depressed level of consciousness	Suspected intracranial bleeding OR clot (stroke) — medical consult
Fever, vomiting, photophobia (sensitivity to light) Non-blanching rash with flat red-purple blotches, neck stiffness, irritability in babies	Meningitis
Abrupt and severe at onset +/- photophobia Neck stiffness, syncope (depressed level of consciousness if severe)	Sub-arachnoid haemorrhage — medical consult
Occurs in morning with vomiting, worsens over time	Raised intracranial pressure OR tumour — medical consult
In pregnancy or early postpartum — A new and/or severe headache with high BP, visual disturbances, +/- abdominal pain	Severe preeclampsia
Sudden loss or blurring of vision Painful red eye, nausea/vomiting, recent bleeding in eye or drops to dilate pupil	Acute glaucoma
After playing sport, walking or working in heat	Heat illness
Other causes of headaches Tension, migraine Infection — dental or ear Dehydration Drug withdrawal, hangover Shingles — one sided head/facial rash Side effect of medications Bites and stings — centipede or redback spider High BP