Sunday, February 4, 2018

Headache : An Overview of Secondary Headaches


Headaches are possibly the most common symptoms patients might present with to Neurologists , and even to a General Practitioner!

Here's a more practical and clinical approach to identifying the cause of a headache.

Headache disorders can be secondary to a systemic or neurological condition such as Meningitis or Dengue ; or can be due to a primary headache disorder such as Migraine or Tension headache.

In this post I'd like to summarize causes of secondary headaches.

Important  Causes of Secondary Headache

- Refractive Errors : if an Adolescent or person in his 20's comes with headache , it's important to look into the possibility of a Myopia causing headache.

- Hypertension : especially occipital headache in a 40-50 year old obese male.

- Sinusitis : Maxillary and Frontal sinusitis can commonly cause headache and may confuse for a primary headache disorder.
Associated with Post nasal drip , upper respiratory tract infection , sinus pain on bending over and tender sinuses.

- Systemic Infections :
Dengue - Especially a bifrontal headache
Typhoid fever

- Meningitis , Encephalitis, Brain Abscess
Meningitis is typically fever , headache and altered sensorium with neck stiffness.
If these features are present with Diffuse Neurological depression it can be Encephalitis and if Focal features it could be an Abscess.
Tuberculous Meningitis is an important entity to be considered for Chronic headache in India.

- Venous Sinus thrombosis : Suspect in Females on OC Pills / Hormone Replacement or Men on chemotherapy.
Presents with chronic headache and may be accompanied by focal features occassionally.

- Trauma

- Sub Arachnoid Hemorrhage : the typical Thunder clap headache followed by complete collapse of the person is typically for SAH.
Typically in 30-40 year old men , with history of senitnel headaches and generally hypertensive.

- Brain Tumors

- Temporal Arteritis : 60 years and above - Large vessel Vasculitis causing sharp superficial headache especially in temporal region , raised ESR and responsive to steroids to a good extent.


The next post will be a summary of clinical profiles of primary headache disorders.

Hope this helped !
Happy Studying!
Stay awesome !
~ A.P. Burkholderia.

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