General Medicine
Headache
Headache for MBBS: primary versus secondary headache, red flags, migraine treatment, lumbar puncture and meningitis management, mapped to NMC codes IM17.1 to IM17.14.
MedNext Academy | 3 min read
Headache
Headache for MBBS: primary versus secondary headache, red flags, migraine treatment, lumbar puncture and meningitis management, mapped to NMC codes IM17.1 to IM17.14.
This chapter builds a safe approach to headache, separating benign primary syndromes from dangerous secondary causes by recognising red flags. It covers migraine and its treatment, the indications for imaging and lumbar puncture, cerebrospinal fluid interpretation and the emergency management of meningitis.
High-yield: Headache
- Headache is classified into primary types such as migraine and tension-type and secondary types with an underlying cause.
- Red flag features include sudden thunderclap onset, fever with neck stiffness, focal deficit and new headache in an older patient.
- A thunderclap headache reaching peak intensity within seconds suggests subarachnoid haemorrhage.
- Migraine is often unilateral, throbbing, aggravated by activity and associated with nausea and photophobia.
- Migraine with aura features transient neurological symptoms preceding the headache.
- Tension-type headache is bilateral, band-like and not aggravated by routine activity.
- Neuroimaging is indicated when red flags or focal neurological signs are present.
- A lumbar puncture is used to diagnose meningitis and to detect subarachnoid haemorrhage when the scan is normal.
- Cerebrospinal fluid xanthochromia supports subarachnoid haemorrhage when the computed tomography is negative.
- Bacterial meningitis shows a high neutrophil count, high protein and low glucose in the cerebrospinal fluid.
- Acute migraine is treated with simple analgesics or triptans, avoiding overuse that causes rebound headache.
- Prophylactic migraine drugs include beta-blockers, amitriptyline and topiramate for frequent attacks.
- Empirical antibiotics for bacterial meningitis must not be delayed for imaging or lumbar puncture.
- Cluster headache is a strictly unilateral, severe periorbital headache with autonomic features.
- Medication-overuse headache develops from frequent use of acute headache treatments.
Headache essentials
- **Red flags:** Thunderclap onset, fever with neck stiffness, focal deficit or new headache in the older patient.
- **Migraine:** Unilateral, throbbing, worsened by activity, with nausea and photophobia.
- **Lumbar puncture:** For meningitis and for subarachnoid haemorrhage when the scan is normal (xanthochromia).
- **Meningitis:** Give empirical antibiotics promptly; do not delay for imaging.
NMC competencies in this chapter
- **IM17.1:** Definition, classification and bedside pattern recognition
- **IM17.3:** Migraine classification and classical versus non-classical forms
- **IM17.5:** Differential diagnosis and prioritisation from clinical features
- **IM17.7:** Indications for lumbar puncture and cerebrospinal fluid findings
- **IM17.9:** Interpretation of cerebrospinal fluid parameters
- **IM17.11:** Abortive therapy for migraine
- **IM17.12:** Prophylactic therapy for migraine
- **IM17.13:** Drug regimens for bacterial, tubercular and viral meningitis
Frequently Asked Questions
What are the red flags in a headache?
Red flags include a sudden thunderclap onset, fever with neck stiffness, a focal neurological deficit, and a new or changed headache in an older patient, all of which prompt urgent evaluation.
When is a lumbar puncture done in headache?
A lumbar puncture is done to diagnose meningitis and to detect subarachnoid haemorrhage when the computed tomography is normal, looking for xanthochromia in the latter.
How is acute migraine treated?
Acute migraine is treated with simple analgesics or triptans, while overuse is avoided to prevent medication-overuse headache; frequent attacks warrant prophylaxis.
How does this chapter help for NEET-PG?
Red flag recognition, migraine features, cerebrospinal fluid patterns and meningitis management are common exam themes that map directly to questions.
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