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

 

References

Celle ME, Carelli V, Fornarino S. Secondary headache in children. Neurol Sci. 2010 Jun;31 Suppl 1:S81-2.

Cupini LM, Sarchielli P, Calabresi P. Medication overuse headache: neurobiological, behavioural and therapeutic aspects. Pain. 2010 Aug;150(2):222-4.

Evers S. Pharmacotherapy of cluster headache. Expert Opin Pharmacother. 2010 Sep;11(13):2121-7.

Garza I, Schwedt TJ. Diagnosis and management of chronic daily headache. Semin Neurol. 2010 Apr;30(2):154-66.

Grazzi L, Andrasik F. Headache in young age: classification of primary forms. Neurol Sci. 2010 Jun;31 Suppl 1:S77-9.

Hershey AD. Recent developments in pediatric headache. Curr Opin Neurol. 2010 Jun;23(3):249-53.

Klein AM, Loder E. Postpartum headache. Int J Obstet Anesth. 2010 Oct;19(4):422-30.

Koehler PJ, Boes CJ. A history of non-drug treatment in headache, particularly migraine. Brain. 2010 Aug;133(Pt 8):2489-500.

Monteith TS, Sprenger T. Tension type headache in adolescence and childhood: where are we now? Curr Pain Headache Rep. 2010 Dec;14(6):424-30.

Nicholson RA. Chronic headache: the role of the psychologist. Curr Pain Headache Rep. 2010 Feb;14(1):47-54.

Pringsheim T, Davenport WJ, Becker WJ. Prophylaxis of migraine headache. CMAJ. 2010 Apr 20;182(7):E269-76.

Rapoport AM. New acute treatments for headache. Neurol Sci. 2010 Jun;31 Suppl 1:S129-32.

Seifert TD, Evans RW. Posttraumatic headache: a review. Curr Pain Headache Rep. 2010 Aug;14(4):292-8.

Stovner LJ, Andree C. Prevalence of headache in Europe: a review for the Eurolight project. J Headache Pain. 2010 Aug;11(4):289-99.

Tfelt-Hansen PC. Verisimilitude (or "truthlikeness") as an alternative to pro and cons: migraine and cluster headache mechanisms. J Headache Pain. 2010 Oct;11(5):379-89.

Tonini MC, Bussone G. Headache in the elderly: primary forms. Neurol Sci. 2010 Jun;31 Suppl 1:S67-71.

Torelli P, Allais G, Manzoni GC. Clinical review of headache in pregnancy. Neurol Sci. 2010 Jun;31 Suppl 1: s55-8.

 

 

 

 

 

 

 

 

Sri Lanka Association for the Study of Pain

The Sri Lankan Chapter of the International Association for the Study of Pain

© January 2014. Sri Lanka Association for the Study of Pain (SLASP). All Rights Reserved.

For Comments  ranjithwp@pdn.ac.lk

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Resource Materials

̃ Pain: An Overview

̃ Physiology of Pain

̃ Pharmacological Management of Pain

̃ Neuropathic Pain

̃ Abdominal Pain

̃ Orofacial Pain: An Overview

̃ Pain: Psychological Correlates

̃ Assessment of Pain

̃ Management of Acute Post-Surgical Pain

̃ Management of Pain in Obstetrics

̃ Management of Musculoskeletal Pain and Chronic Pain Syndromes

̃ Management of Pain in Children

̃ Management of Pain in Neonates

̃ Management of Acute Pain in Trauma

̃ Management of Cancer Pain

̃ Management of Headache

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