🩺 MedAtlax

Secondary Headaches

3 min read

IM

Secondary Headaches

  • Intracranial disease: (meningitis, brain hemorrhage, brain tumor)
  • Eye diseases: (vision problems are the commonest)
  • Sinusitis
  • Temporal arteritis: (inflammation of the temporal artery)
  • Head trauma
  • Systemic diseases: (HTN)

FM

Urgent Considerations

Meningitis

  • Presents with fever, headache, stiff neck.
  • Patients may develop meningococcal sepsis, presenting with hypotension, altered mental state, and purpuric or petechial rash.
  • Patients should have a lumbar puncture (LP) within 1 hour of arrival at hospital, provided it is safe to do so, and commence antibiotic treatment immediately afterwards.
  • If high suspicion, antibiotics should be administered empirically before LP.
  • If LP is delayed for CT, blood cultures should be obtained and broad-spectrum antibiotics given before CT.

Subarachnoid Haemorrhage (SAH) Z

  • About 1% of all patients presenting to the emergency department with headaches have SAH.
  • It may present with a ‘thunderclap’ headache (sudden onset of severe headache, seen in 12% of SAH).

Sudden onset, worst headache of life

  • Immediate CT

Hypertensive Encephalopathy

  • Elevated BP, mean arterial pressure >150 to 200 mmHg
  • Immediate CT
  • BP should be quickly lowered by 20% to 25% (labetalol, nicardipine).

Giant Cell Arteritis

  • Patient >50 years, with their first severe headache
  • Erythrocyte sedimentation rate is checked
  • Immediate treatment with corticosteroids is required to prevent blindness if diagnosis is suspected.

Acute Angle-Closure Glaucoma

  • Headache in older person (>50 years)
  • Decreased visual acuity, nausea/vomiting, eye pain, mid-dilated fixed pupil
  • Intra-ocular pressure should be reduced (pilocarpine, timolol, acetazolamide)
  • Ophthalmology consultation.

Raised Intracranial Pressure

  • Untreated may lead to permanent sight loss, permanent neurological deficit, and death.

  • Constant, severe headache. May be aggravated by coughing, straining, or bending.

  • One third of patients report a headache that is worse on waking.

  • Patients also experience visual symptoms including blurred or double vision, and transient losses of vision.

  • Examine fundi for papilloedema.

  • Urgent neuroimaging looking for mass lesion, followed by lumbar puncture if safe.

  • Effect of pain on activity

  • Relationship with food

  • Response to any previous treatment

  • Any recent change in vision

  • Association with recent trauma

  • State of general health

Temporal Arteritis Z

Temporal arteritis (giant cell arteritis) is where the arteries, particularly those at the side of the head (the temples), become inflamed (vasculitis). It’s serious and needs urgent treatment.

  • Commonly affects elderly female.
  • The ESR is markedly elevated.

Symptoms

  • Fatigue.
  • Fever.
  • Jaw pain that may become worse after chewing.
  • Tenderness at the scalp or temples.
  • Vision problems, such as double vision, blurry vision, or transient (brief) vision loss; if this is not treated, it could be followed by permanent, irreversible vision loss.

Treatment

  • The mainstay of therapy for temporal arteritis is glucocorticoids, such as oral prednisone in high dose. Z

  • Patients sometimes need to take glucocorticoids for up to two years.

Thunderclap Headaches

Sudden-onset headache pain, with peak intensity occurring within several minutes.

Causes:

  • Subarachnoid hemorrhage,

  • Hypertensive emergencies,

  • Vertebral artery dissections, and

  • Acute angle–closure glaucoma.

  • Known systemic illnesses that predispose to secondary headaches (cancer, HIV).

  • Altered mental status

  • History of trauma

  • History of malignancy

  • Pregnancy.

  • Neck stiffness

Rare/Serious

  • Cough Headache – secondary.
  • Brain AVM (arteriovenous malformation).
  • Brain aneurysm.

Graph View

Backlinks