GIM Question 11 Instructor

You are called to the ward at night because a patient has a headache.

  1. What symptoms might you ask about?

    The goal of assessing a patient with an acute headache is to determine if this is a benign or worrisome headache (i.e. intracranial haemorrhage, increased intracranial pressure, space occupying lesion, giant cell arteritis).
    Symptoms to ask about include:

    • Pain – onset, provoking/relieving factors, severity, location, quality, radiation, history or tension/migraine/cluster headaches
    • Nausea/vomiting, fever, visual disturbances, neurological symptoms (parasthesias, motor weakness), jaw claudication, scalp tenderness
    • Assess for altered level of consciousness

    For symptoms suggestive of a raised intracranial pressure or intracranial haemorrhage – “thunderclap” headache, persistent unilateral headache, or headaches with vomiting – appropriate imaging +/- a lumbar puncture should be performed for diagnosis.

  2. Assuming there are no “red flags,” how would you treat this headache?
    Treat with Acetaminophen 500-1000mg PO q6h (up to 4g/d).
    Tylenol should not be used in patients with known or suspected liver failure.
  3. What if your therapy does not work?

    NSAIDS may also be used for headache relief:

    • Ibuprofen 400mg PO q4-6h
    • Naproxen 500-750mg PO TID

    NSAIDS should be avoided in patients with GI bleeds, GI ulcers and/or acute kidney injury.


  1. Clinch CR, Hébert FE. Evaluation of Acute Headaches in Adults. American Family Physician. 2001, 63:685-692.
  2. McCulloch DK. Migraine and Tension Headache Diagnosis and Treatment Guideline. 2011. Online resource:1-16.

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