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Surgical sieve
🤕 Headache
Thunderclap, fever, focal signs, or new in the over-50s? Those are the ones that matter.
| Subarachnoid haemorrhage Must exclude | Thunderclap — maximal within seconds. Neck stiffness, vomiting, photophobia.CT head within 6h; LP at 12h for xanthochromia if CT negative. |
|---|---|
| Meningitis / encephalitis Must exclude | Fever, photophobia, neck stiffness, rash, confusion.Antibiotics ± aciclovir immediately. |
| Raised intracranial pressure / mass Must exclude | Worse on waking or lying flat, worse on coughing, vomiting, papilloedema.CT head. Avoid LP before imaging. |
| Giant cell arteritis Must exclude | Over 50, new headache, scalp tenderness, jaw claudication, visual symptoms.Visual symptoms → IV methylprednisolone immediately, before biopsy. |
| Intracranial haemorrhage Must exclude | Focal signs, reduced GCS. Low threshold if anticoagulated.CT within 1h if anticoagulated. |
| Venous sinus thrombosis Time-sensitive | Progressive headache, seizures, focal signs. Pregnancy, dehydration, thrombophilia.CT/MR venogram. |
| Acute angle-closure glaucoma Time-sensitive | Painful red eye, hazy cornea, fixed mid-dilated pupil, halos, vomiting.Same-hour ophthalmology; acetazolamide + pilocarpine. |
| CO poisoning Time-sensitive | Whole household affected, better away from home. Saturations falsely normal.COHb on co-oximetry, 100% oxygen. |
| Hypertensive emergency Time-sensitive | Very high BP with headache, visual change, papilloedema, encephalopathy. |
| Migraine Common | Unilateral, throbbing, photophobia, aura, previous identical episodes.A first "migraine" over 50 needs more thought. |
| Tension headache Common | Bilateral, band-like, no red flags, normal examination. |
| Medication overuse or withdrawal Consider | Analgesia >15 days/month. Caffeine or opioid withdrawal. |
| Sinusitis Consider | Facial pain, worse leaning forward, nasal discharge. Watch for orbital spread. |
13 differentials · 8 open a full pathway in the app.