children or young adults. Two thirds of cases occur before the age of 5.
Meningitis often starts during a viral infection such as influenza or a bacterial infection such as a
respiratory or ear infection.
The main manifestations are a severe headache, fever, vomiting, neck rigidity and, in severe
cases, mental confusion.
The Brudzinski sign is positive: with the patient supine and the chest held firmly to the bed, try
to flex the neck. In meningitis, this procedure causes involuntary flexion of the hips (Figure
1.13(74)).
The diagnosis of headache from meningitis is obvious from its acute onset, the age of the patient,
the fever and the neck rigidity. The headache is generalized, radiating to the neck (Figure
1.14(75)).
Non-Inflammatory
Vascular
Migraine
This is the most frequent cause of recurrent headaches. It consists in an initial constriction of the
head arteries (giving rise to prodromal symptoms) followed by vasodilatation and distension of
the vessels (which causes a throbbing pain). The main manifestations are a unilateral, severe and
throbbing pain, photophobia, nausea and possibly vomiting.
The attacks are precipitated by stress, cheese, chocolate, red wine and the contraceptive pill.
The headache is located around the eye, radiating to the side of the head; it is unilateral or
bilateral (Figure 1.15(76)).
Cerebral (Sub-Arachnoid) Haemorrhage
This is more frequent in males over 40. The main manifestations are an intense head pain, neck
rigidity and vomiting followed by loss of consciousness.
Neoplastic
Cerebral Tumour
This is an uncommon cause of headache but if a person develops headaches which become
progressively worse in terms of frequency, duration and intensity and are accompanied by
vertigo, vomiting and intellectual impairment, a cerebral tumour should be suspected. The