HEADACHE104 General Medical Emergencies
(ii) Sumatriptan is contraindicated in known coronary artery disease
(CAD), previous myocardial infarction, and in patients with
possible unrecognized coronary artery disease, such as men over
40 years or post-menopausal women, with CAD risk factors.
(iii) Sumatriptan is also contraindicated within 24 h of ergotamine-
containing therapy.
5 Discharge the patient back to the GP, after a discussion of precipitating factors
such as fatigue, a lcohol, caf feine, hunger, etc. t hat might t hen be avoided.Tension (muscle contraction) headache
DIAGNOSIS
1 This is a ‘featureless headache’ with none of the above associated symptoms
as for migraine, and that lacks a family history or trigger factors other than
stress, or some craniocervical musculoskeletal problems.
2 Women are more commonly affected and the pain comes on gradually, is
bilateral, mild to moderate, dull, constant and band-like.
3 Mild nausea, phonophobia and photophobia can occur, but are usually
absent and vomiting is rare. Headaches often become chronic.MANAGEMENT1 Give the patient an analgesic such as paracetamol 500 mg and codeine
phosphate 8 mg two tablets orally 6-hourly.
2 Reassure the patient and discharge back to the care of the GP.Post-traumatic headache
DIAGNOSIS
1 Headache following head injury may begin immediately or after a few days,
and is present in up to 30% of patients at 6 weeks after mild concussion.
2 Inability to concentrate, irritability, dizziness, insomnia and even depres-
sion may develop, known as the ‘post-concussion syndrome’.
3 Request an urgent CT head scan if there is persistent worsening of headache,
recurrent vomiting, clouding of consciousness, or focal neurological signs,
to exclude a subdural haematoma.MANAGEMENT1 Treatment is supportive including analgesics, rest, and reassurance that
complete recovery is the rule.
2 Refer the patient back to the GP, as symptoms may persist for up to 1 year.
3 Discuss patients wit h an abnorma l CT scan wit h t he neurosurgeons.