Headaches Overview - Primary vs Secondary Headaches What’s the Core Difference? • Primary headache = headache is the disease itself • Secondary headache = headache is a symptom of something else 🧠 Primary Headaches These are not dangerous, just painful and recurrent. Use the mnemonic "Mi-T-C": • Migraine – Unilateral, throbbing, ± aura, nausea, photophobia • Tension – Bilateral, tight band, dull, non-pulsatile • Cluster – Unilateral, around eye, tearing, rhinorrhea, severe 🎯 Key Features: • Tension: Band-like pressure, both sides • Migraine: Throbbing, one side, nausea, aura • Cluster: Severe, one eye, tears, same time daily ⚠️ Secondary Headaches – Use the mnemonic "VITAMIN C" (common for causes in medicine): • Vascular (e.g., stroke, aneurysm) • Infection (e.g., meningitis) • Trauma (e.g., concussion) • Arteritis (e.g., temporal arteritis) • Mass (tumor) • Increased pressure (e.g., hydrocephalus) • Neurologic (e.g., seizures) • Chemical (e.g., CO poisoning) These can be life-threatening. Always rule these out if: • Sudden onset (“worst headache of life”) • Headache + fever, confusion, vision change • Headache in immunocompromised or elderly ⚠️ Common Secondary Causes: • SAH (Thunderclap) • Meningitis (fever + neck stiffness) • Brain tumor (worse with Valsalva) • Temporal arteritis (jaw claudication + ESR ↑) • HTN emergency, CO poisoning, glaucoma 🚩 Red Flag Features (SNOOP): S Systemic (fever, weight loss, cancer, HIV) N Neurological signs (seizure, confusion, focal signs) O Onset: sudden or “thunderclap” O Older (>50 years) P Pattern change or progressive headache #Headaches #Primary #Secondary #Comparison #Neurology #Diagnosis
