Headaches and Visual Symptoms

When evaluating headaches and visual symptoms, it is crucial to determine when further investigation, such as imaging, is warranted. Here are some guidelines that Doctors have to consider:

When to Worry

Sudden Onset: A sudden, severe headache, often described as a "thunderclap" headache, may indicate a serious condition like a subarachnoid hemorrhage.
Neurological Deficits: Symptoms such as visual disturbances, slurred speech, weakness, numbness, or seizures accompanying a headache should raise concern.
Papilledema: The presence of papilledema, or swelling of the optic disc, can indicate increased intracranial pressure and warrants further investigation.
Persistent or Worsening Symptoms: Headaches that persist or worsen over time, especially if they are resistant to treatment, should be evaluated.
Headache with Systemic Symptoms: Fever, weight loss, or other systemic symptoms alongside a headache may suggest an underlying systemic condition.
New Headache in Older Adults: New-onset headaches in individuals over 50 years of age should be investigated to rule out conditions like temporal arteritis.

When to Image

Red Flags: Imaging is recommended if there are red flags such as sudden onset, neurological deficits, or signs of increased intracranial pressure.
Chronic Headache with New Symptoms: If a patient with a history of chronic headaches presents with new or different symptoms, imaging may be necessary.
Headache with Visual Symptoms: If visual symptoms are atypical or persistent, or if there is suspicion of an ocular or neurological cause, imaging can be helpful.
Post-Trauma: Headaches following head trauma, especially with visual symptoms, may require imaging to rule out intracranial injury.

In clinical practice, the decision to image should be guided by a thorough clinical evaluation and consideration of the patient's history and presenting symptoms. Imaging modalities such as MRI or CT scans can provide valuable information in cases where serious underlying conditions are suspected.

Here is a Fantastic Cybersight lecture that explains everything in detail: