Headache: a useful clinical feature in detecting serious underlying cause

ABSTRACT

To examine the utility of clinical features in detecting serious underlying causes of headache in patients presenting to an emergency room. Descriptive Observational Study. Pakistan Railway Hospital spanning over a period of one year from July 2010 to June2011. Medical records of the patients attending the Emergency Room with headache as the major complaint were studied. 312 patients presented to ER with a complaint of headache. Of these 7.7% [n=24] had malignant headache and 92.3% [n=288] had benign headache. One hundred and ninety six patients [62.8%] were women and 116 [37.2%] were men. In males there were 86.2% patients with benign headache and 13.8% with malignant headache. While in females 94.9% had benign and 4.1% malignant headache. Ninety percent of patients had altered consciousness at presentation proved to have malignant cause for their headache. This figure was 91% for limb weakness, 100% for papillary and gaze abnormalities, 89% for extensor plantar response, and 85% each for papilledema and neck rigidity. Females present at younger age with headache and tend to have benign than malignant headache in majority of cases. Males present at relatively older age and tend to have malignant than benign headache in majority of cases. Younger patients presenting with headache usually have benign and elderly patients usually have malignant illness as the cause of their headache. With a good history and thorough physical examination Imaging like CT Scan and MRI can be avoided