Management of Headache 2

By  Dr. Thilak Jayalath


Secondary Headaches

     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.


These include:

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

Headache onset: 

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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