1. Headache in General Practice 21 st October 2015

2. Headache (http://cks.nice.org.uk/headache-assessment#!topicsummary) To differentiate secondary from primary cause check: – Blood Pressure – Temporal arteries (if over 50) – Neurological examination including fundoscopy – Neck movements

3. Red Flags (http://cks.nice.org.uk/headache-assessment#!scenariorecommendation:1) Trauma followed by progressive symptoms Sudden, peaking within 5 minutes (sub-arach) Sudden, with neurological symptom Fever+neck stiffness+drowsy+photophobia Temporal artery tenderness Raised pressure-vomiting, postural, wakes from sleep. Papilloedema. Seizure History of cancer Severe unilateral eye pain.

4. Brain Tumour - Presentation Headache Seizure Nausea Drowsiness Mental/behavioural change Progressive unilateral weakness Loss of coordination Vision change Speech change Change in sense of smell

5. Malignant Brain Tumour (http://www.nhs.uk/Conditions/brain-tumour-malignant/Pages/Introduction.aspx) Graded 3-4. Malignant tumours are usually secondaries from elsewhere Most primary malignant brain tumours are gliomas (astrocytoma, oligodendroglioma, ependymoma) 5000/year. Most over 50. Radiotherapy increases risk.

6. Benign Brain Tumour (http://www.nhs.uk/Conditions/brain-tumour-malignant/Pages/Introduction.aspx) Graded 1-2. More varied in cell type than malignant tumours Include gliomas, neuromas, adenomas, craniopharyngiomas, meningiomas, haemangioblastomas 4300/year. Most are gliomas.

7. Other Secondary Causes Medication overuse-tension type or migraine headache more than 15 days per month with frequent use of analgesia. Pain attributable to other cause.

8. Migraine Recurrent disabling headache with nausea and sensitivity to light/sound. 4 hours to 3 days duration At least 2 of: – Unilateral – Pulsating – Moderate/severe intensity – Aggravated by routine physical activity Normal neurological examination. Aura-visual/sensory/dysphasia, gradual worsening, fully reverses in an hour.

9. Tension Type Headache Non-disabling 30 minutes to 7 days duration No nausea Maybe photophobia/phonophobia but not both At least 2 features of: – Bilateral – Pressing/tightening in character – Mild to moderate intensity – Not aggravated by routine activity