Management of Headache 2
By Dr. Thilak Jayalath
A headache is secondary when it is caused by some other condition. The term is used to distinguish this type of headache from the primary headache disorders like migraine, tension-type headache or cluster headache. Many medical conditions can cause headache but there are usually clues in the medical history or examination to suggest secondary headache.
Headache can be caused by general medical conditions such as severe hypertension, or by conditions that affect the brain. Infections of the head and neck, including pharyngitis, sinusitis and meningitis have headache as a symptom. Head trauma, even if it is mild, can often lead to headache. Anything that takes up space inside the head can cause headache, including tumor, subdural hematoma and hydrocephalus. Other problems, like subarachnoid hemorrhage which can result from rupture of an aneurysm can lead to severe headache.
The key to distinguishing secondary headaches from primary headache lies in the features of the headache, other symptoms occurring at the same time, and the physical examination.
First or worst headache
Abrupt onset of headache without any warning or build-up
Fundamental change in the pattern of recurrent headaches
Headache beginning at unusual ages
≤5 years old
≥50 years old
The presence of malignancy, HIV, pregnancy
Abnormal physical examination
with seizure or syncope
with exertion, sex or Valsalva (squeezing)
if the headache is associated with a range of other symptoms such as a rash, a non-resolving neurological deficit, vomiting, pain or tenderness, accident or head injury, an infection or hypertension
Common secondary causes of headache are:
Headache attributed to head or neck trauma
Headache due to ischemic stroke or non-traumatic hemorrhage
Headache resulting from intracranial neoplasm
Headache due overdose of medications
Headache which results from meningitis and encephalitis
Headache due to severe hypertension
Headache attributed to sinusitis, disorder of teeth and jaw
Headache due to psychotic disorder
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