| What is a thunderclap headache? | Sudden onset (maximal intensity occurs within seconds to minutes, thunderclap headache) | • Headache with fever, change in personality, mental status, level of consciousness • Fever, neck stiffness or meningism • New onset of severe headache in pregnancy or postpartum or while on hormone treatment • Rapid onset with strenuous exercise • Sudden onset (maximal intensity occurs within seconds to minutes, thunderclap headache) • New headache type in a patient with malignancy or immunosuppression • First or worst headache of the patient’s life • Focal neurologic signs (not typical aura) • Severe headache awakening from sleep | 249 | definition | 0.980 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952344_neurology_headache.pdf | • Headache with fever, change in personality, mental status, level of consciousness • Fever, neck stiffness or meningism • New onset of severe headache in pregnancy or postpartum or while on hormone treatment • Rapid onset with strenuous exercise • Sudden onset (maximal intensity occurs within seconds to minutes, thunderclap headache) • New headache type in a patient with malignancy or immunosuppression • First or worst headache of the patient’s life • Focal neurologic signs (not typical aura) • Severe headache awakening from sleep | 1 | page=1,block=100 | 0.700 | valid |
| What condition is indicated by a headache with neck stiffness? | Fever, neck stiffness or meningism | • Headache with fever, change in personality, mental status, level of consciousness • Fever, neck stiffness or meningism • New onset of severe headache in pregnancy or postpartum or while on hormone treatment • Rapid onset with strenuous exercise • Sudden onset (maximal intensity occurs within seconds to minutes, thunderclap headache) • New headache type in a patient with malignancy or immunosuppression • First or worst headache of the patient’s life • Focal neurologic signs (not typical aura) • Severe headache awakening from sleep | 86 | relationship | 0.970 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952344_neurology_headache.pdf | • Headache with fever, change in personality, mental status, level of consciousness • Fever, neck stiffness or meningism • New onset of severe headache in pregnancy or postpartum or while on hormone treatment • Rapid onset with strenuous exercise • Sudden onset (maximal intensity occurs within seconds to minutes, thunderclap headache) • New headache type in a patient with malignancy or immunosuppression • First or worst headache of the patient’s life • Focal neurologic signs (not typical aura) • Severe headache awakening from sleep |
| What kind of activity can trigger a rapid-onset headache? | Rapid onset with strenuous exercise | • Headache with fever, change in personality, mental status, level of consciousness • Fever, neck stiffness or meningism • New onset of severe headache in pregnancy or postpartum or while on hormone treatment • Rapid onset with strenuous exercise • Sudden onset (maximal intensity occurs within seconds to minutes, thunderclap headache) • New headache type in a patient with malignancy or immunosuppression • First or worst headache of the patient’s life • Focal neurologic signs (not typical aura) • Severe headache awakening from sleep | 211 | relationship | 0.970 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952344_neurology_headache.pdf | • Headache with fever, change in personality, mental status, level of consciousness • Fever, neck stiffness or meningism • New onset of severe headache in pregnancy or postpartum or while on hormone treatment • Rapid onset with strenuous exercise • Sudden onset (maximal intensity occurs within seconds to minutes, thunderclap headache) • New headache type in a patient with malignancy or immunosuppression • First or worst headache of the patient’s life • Focal neurologic signs (not typical aura) • Severe headache awakening from sleep |
| What symptom is associated with a headache and a change in mental status? | Headache with fever, change in personality, mental status, level of consciousness | • Headache with fever, change in personality, mental status, level of consciousness • Fever, neck stiffness or meningism • New onset of severe headache in pregnancy or postpartum or while on hormone treatment • Rapid onset with strenuous exercise • Sudden onset (maximal intensity occurs within seconds to minutes, thunderclap headache) • New headache type in a patient with malignancy or immunosuppression • First or worst headache of the patient’s life • Focal neurologic signs (not typical aura) • Severe headache awakening from sleep | 2 | relationship | 0.970 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952344_neurology_headache.pdf | • Headache with fever, change in personality, mental status, level of consciousness • Fever, neck stiffness or meningism • New onset of severe headache in pregnancy or postpartum or while on hormone treatment • Rapid onset with strenuous exercise • Sudden onset (maximal intensity occurs within seconds to minutes, thunderclap headache) • New headache type in a patient with malignancy or immunosuppression • First or worst headache of the patient’s life • Focal neurologic signs (not typical aura) • Severe headache awakening from sleep |
| What type of headache is concerning during pregnancy or postpartum? | New onset of severe headache in pregnancy or postpartum or while on hormone treatment | • Headache with fever, change in personality, mental status, level of consciousness • Fever, neck stiffness or meningism • New onset of severe headache in pregnancy or postpartum or while on hormone treatment • Rapid onset with strenuous exercise • Sudden onset (maximal intensity occurs within seconds to minutes, thunderclap headache) • New headache type in a patient with malignancy or immunosuppression • First or worst headache of the patient’s life • Focal neurologic signs (not typical aura) • Severe headache awakening from sleep | 123 | relationship | 0.970 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952344_neurology_headache.pdf | • Headache with fever, change in personality, mental status, level of consciousness • Fever, neck stiffness or meningism • New onset of severe headache in pregnancy or postpartum or while on hormone treatment • Rapid onset with strenuous exercise • Sudden onset (maximal intensity occurs within seconds to minutes, thunderclap headache) • New headache type in a patient with malignancy or immunosuppression • First or worst headache of the patient’s life • Focal neurologic signs (not typical aura) • Severe headache awakening from sleep |
| What are some characteristics of chronic tension headache? | Continuous bilateral headache for many years with significant insomnia and psychosomatic complaints | Brain imaging if there are atypical symptoms Analgesics for pain Refer to higher centre with imaging facility • CT/ MRI with MR angiogram or CT angiogram if required • Migraine prophylaxis after ruling out stroke and other diseases Start Amitriptyline (10mg HS) and advice on lifestyle Brain imaging if atypical features exist CHRONIC TENSION HEADACHE Continuous bilateral headache for many years with significant insomnia and psychosomatic complaints. Indomethacin (25mg TID) for | 352 | summary | 0.970 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952344_neurology_headache.pdf | Brain imaging if there are atypical symptoms Analgesics for pain Refer to higher centre with imaging facility • CT/ MRI with MR angiogram or CT angiogram if required • Migraine prophylaxis after ruling out stroke and other diseases Start Amitriptyline (10mg HS) and advice on lifestyle Brain imaging if atypical features exist CHRONIC TENSION HEADACHE Continuous bilateral headache for many years with significant insomnia and psychosomatic complaints. | 1 | page=1,block=61 |
| What is the protocol for secondary headache disorders? | Secondary headache disorders- secondary headache disorders with essential work up, diagnosis and treatment as per individual case can be discharged | • Patient with unrelenting headache • Immunosuppressed patients with continuous headache, • First ever headache with worsening intensity, • Progressive headache with other systemic disease • Severe symptomatic primary headache disorders • Primary headache disorders- symptomatically improved severe episode of headache due to primary headache disorder can be discharged • Secondary headache disorders- secondary headache disorders with essential work up, diagnosis and treatment as per individual case can be discharged | 372 | summary | 0.970 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952344_neurology_headache.pdf | • Patient with unrelenting headache • Immunosuppressed patients with continuous headache, • First ever headache with worsening intensity, • Progressive headache with other systemic disease • Severe symptomatic primary headache disorders • Primary headache disorders- symptomatically improved severe episode of headache due to primary headache disorder can be discharged • Secondary headache disorders- secondary headache disorders with essential work up, diagnosis and treatment as per individual case can be discharged |
| What type of headache disorder can be discharged after symptomatic improvement? | severe episode of headache due to primary headache disorder | • Patient with unrelenting headache • Immunosuppressed patients with continuous headache, • First ever headache with worsening intensity, • Progressive headache with other systemic disease • Severe symptomatic primary headache disorders • Primary headache disorders- symptomatically improved severe episode of headache due to primary headache disorder can be discharged • Secondary headache disorders- secondary headache disorders with essential work up, diagnosis and treatment as per individual case can be discharged | 292 | summary | 0.970 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952344_neurology_headache.pdf | • Patient with unrelenting headache • Immunosuppressed patients with continuous headache, • First ever headache with worsening intensity, • Progressive headache with other systemic disease • Severe symptomatic primary headache disorders • Primary headache disorders- symptomatically improved severe episode of headache due to primary headache disorder can be discharged • Secondary headache disorders- secondary headache disorders with essential work up, diagnosis and treatment as per individual case can be discharged |
| What are some possible causes of progressive headaches of acute or subacute onset lasting more than one week? | Cerebral Venous Thrombosis, Intra Cranial Space Occupying Lesion, Meningitis, Brain abscess | Standard Treatment Workflow (STW) for the Management of HEADACHE ICD-10-G43-44 CONTINUOUS HEADACHES • Progressive headache of acute or subacute onset persisting more than 1 week • Possibilities: Cerebral Venous Thrombosis, Intra Cranial Space Occupying Lesion, Meningitis, Brain abscess • CT with CT Angiogram/ MRI with MR angiogram • Lumbar puncture • Refer to tertiary care centre Referred to higher centre Progressive headache MR venogram | 195 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952344_neurology_headache.pdf | Standard Treatment Workflow (STW) for the Management of HEADACHE ICD-10-G43-44 CONTINUOUS HEADACHES • Progressive headache of acute or subacute onset persisting more than 1 week • Possibilities: Cerebral Venous Thrombosis, Intra Cranial Space Occupying Lesion, Meningitis, Brain abscess • CT with CT Angiogram/ MRI with MR angiogram • Lumbar puncture • Refer to tertiary care centre Referred to higher centre Progressive headache MR venogram | 1 | page=1,block=19 |
| What imaging techniques are recommended for atypical symptoms in headache cases? | CT/ MRI with MR angiogram or CT angiogram if required | Brain imaging if there are atypical symptoms Analgesics for pain Refer to higher centre with imaging facility • CT/ MRI with MR angiogram or CT angiogram if required • Migraine prophylaxis after ruling out stroke and other diseases Start Amitriptyline (10mg HS) and advice on lifestyle Brain imaging if atypical features exist CHRONIC TENSION HEADACHE Continuous bilateral headache for many years with significant insomnia and psychosomatic complaints. Indomethacin (25mg TID) for | 112 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952344_neurology_headache.pdf | Brain imaging if there are atypical symptoms Analgesics for pain Refer to higher centre with imaging facility • CT/ MRI with MR angiogram or CT angiogram if required • Migraine prophylaxis after ruling out stroke and other diseases Start Amitriptyline (10mg HS) and advice on lifestyle Brain imaging if atypical features exist CHRONIC TENSION HEADACHE Continuous bilateral headache for many years with significant insomnia and psychosomatic complaints. | 1 | page=1,block=61 |