Primary Headaches: Most common, not life-threatening. Examples include:
- Migraine: Throbbing pain, often unilateral, with nausea/vomiting, photophobia, or phonophobia.
- Tension-type: Dull, pressing pain, bilateral, no nausea/vomiting.
- Cluster: Severe, unilateral, orbital/supraorbital pain, with autonomic symptoms.
- Secondary Headaches: Require urgent evaluation if red flags present (e.g., sudden onset, fever, neurological deficits). Examples:
- Subarachnoid hemorrhage: Sudden, severe "thunderclap" pain.
- Meningitis: Severe pain, fever, neck stiffness.
- Brain tumor: Progressive pain, focal neurological signs.
- Approach:
- History: Onset, duration, triggers, associated symptoms.
- Examination: Vital signs, neurological exam, signs of infection.
- Investigations: CT/MRI if red flags present; otherwise, treat empirically.
Rationale: Primary headaches are benign and managed symptomatically. Secondary headaches require urgent workup due to potential serious causes.