Questionnaire/history:

- > 50 years?

Onset:

Sudden-onset severe headache reaching maximum intensity within 5

minutes (thunderclap headache)?

Duration, frequency and temporal pattern (eg progressive, persistent, dramatically changed)?

Pain severity?

Site?

Spread of pain?

Associated features?

- Fever?

- Impaired consciousness?

- Seizure?

- Neck pain/stiffness?

- Photophobia?

- New-onset neurological deficit?

- Change in personality?

- New onset cognitive dysfunction?

- Aura?

- Atypical aura (duration > 1 hour or including motor weakness)?

- Aura occurring for the first time in a patient during use of combined oral contraceptives?

- Dizziness?

- Visual disturbance?

- Vomiting?

- Nausea?

- Tearing?

- Swelling of the eyelid?

- Rhinorrhoea?

Precipitating?

- Preceding recent (usually within the past 3 months) head trauma?

- Triggered by a Valsalva manoeuvre (such as coughing, sneezing)?

- Bending?

- Exertion (physical or sexual)?

- Worsens on standing or lying?

Relieving factors?

Effect on activities (eg withdrawal or agitation)?

Contacts with similar symptoms?

Current or recent pregnancy?

Past medical history?

Current medication?

Drug allergies?

Examination:

BP?

Temperature?

Fundoscopy (papilloedema)?

Cranial nervous system?

Peripheral nervous system?

Neck?

Temporal arteries (especially in a person over the age of 50 years)?

Diagnosis:

According to the criteria described by the International Classification of Headache disorders (https?//ichd-3.org)

Primary headaches (not associated with another underlying condition)?

- Migraine?

- Tension-type headache?

- Trigeminal autonomic cephalgia (eg cluster headache)?

- Primary cough headache or cold-stimulus headache?

Secondary headaches (result of underlying local or systemic pathology)?

- Trauma or injury to the head and/or neck?

- Cranial or cervical vascular disorders (eg subarachnoid haemorrhage, intracerebral haemorrhage, central venous thrombosis or giant cell arteritis)?

- Non-vascular intracranial disorders (eg idiopathic intracranial hypertension or malignancy)?

- Exposure to withdrawal from a substance (eg carbon monoxide, cocaine, opioids, ergotamines, triptans, simple analgesics or alcohol)?

- Infection (eg bacterial or viral meningitis)?

- Disorders of homeostasis (eg hypoxia or hypertension)?

- Disorders of the cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial and cranial structures (eg acute glaucoma, temporomandibular disorder or sinusitis)?

- Psychiatric disorders (eg somatization disorder)?

Painful cranial neuropathies, other facial pains and other headaches (eg trigeminal neuralgia and optic neuritis)?

Management:

According to cause

Reference(s): NICE CKS: Headache – assessment