Subscribe to RSS
DOI: 10.1055/s-0042-1757753
Secondary Headache Disorders: Approach, Workup, and Special Considerations for Select Populations
Abstract
Headache is one of the most common diagnoses in neurology. A thorough understanding of the clinical presentation of secondary headache, which can be life-threatening, is critical. This review provides an overview of the diagnostic approach to a patient with headache, including discussion of “red,” “orange,” and “green” flags. We emphasize particular scenarios to help tailor the clinical workup to individual circumstances such as in pregnant women, when particular attention must be paid to the effects of blood pressure and hypercoagulability, as well as in older adults, where there is a need for higher suspicion for an intracranial mass lesion or giant cell arteritis. Patients with risk factors for headache secondary to alterations in intracranial pressure, whether elevated (e.g., idiopathic intracranial hypertension) or decreased (e.g., cerebrospinal fluid leak), may require more specific diagnostic testing and treatment. Finally, headache in patients with COVID-19 or long COVID-19 is increasingly recognized and may have multiple etiologies.
Keywords
secondary headache - idiopathic intracranial hypertension - CSF leaks - Elderly patients - pregnancy - COVID-19 - long COVID-19Publication History
Article published online:
11 October 2022
© 2022. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalgia 2013; 33 (09) 629-808
- 2 Robbins MS, Grosberg BM. Hemicrania continua-like headache from metastatic lung cancer. Headache 2010; 50 (06) 1055-1056
- 3 Rosenberg JH, Silberstein SD. The headache of SAH responds to sumatriptan. Headache 2005; 45 (05) 597-598
- 4 Friedman BW, Hochberg ML, Esses D. et al. Applying the International Classification of Headache Disorders to the emergency department: an assessment of reproducibility and the frequency with which a unique diagnosis can be assigned to every acute headache presentation. Ann Emerg Med 2007; 49 (04) 409-419 , 419.e1–419.e9
- 5 van Oosterhout W, van Someren E, Schoonman GG. et al. Chronotypes and circadian timing in migraine. Cephalalgia 2018; 38 (04) 617-625
- 6 Dodick DW. Clinical clues and clinical rules: primary vs secondary headache. Adv Stud Med 2003; 3 (02) 87-92
- 7 Do TP, Remmers A, Schytz HW. et al. Red and orange flags for secondary headaches in clinical practice: SNNOOP10 list. Neurology 2019; 92 (03) 134-144
- 8 Pohl H, Do TP, García-Azorín D. et al. Green flags and headache: a concept study using the Delphi method. Headache 2021; 61 (02) 300-309
- 9 Ray JG, Vermeulen MJ, Bharatha A, Montanera WJ, Park AL. Association between MRI exposure during pregnancy and fetal and childhood outcomes. JAMA 2016; 316 (09) 952-961
- 10 Solomon S, Cappa KG. The headache of temporal arteritis. J Am Geriatr Soc 1987; 35 (02) 163-165
- 11 Pavlović JM. Headache in women. Continuum (Minneap Minn) 2021; 27 (03) 686-702
- 12 Robbins MS, Farmakidis C, Dayal AK, Lipton RB. Acute headache diagnosis in pregnant women: a hospital-based study. Neurology 2015; 85 (12) 1024-1030
- 13 Goldszmidt E, Kern R, Chaput A, Macarthur A. The incidence and etiology of postpartum headaches: a prospective cohort study. Can J Anaesth 2005; 52 (09) 971-977
- 14 Robbins MS. Headache in pregnancy. Continuum (Minneap Minn) 2018; 24 (4, Headache): 1092-1107
- 15 Reddi S, Honchar V, Robbins MS. Pneumocephalus associated with epidural and spinal anesthesia for labor. Neurol Clin Pract 2015; 5 (05) 376-382
- 16 Friedman DI. Headaches due to low and high intracranial pressure. Continuum (Minneap Minn) 2018; 24 (4, Headache): 1066-1091
- 17 Wall M, Kupersmith MJ, Kieburtz KD. et al; NORDIC Idiopathic Intracranial Hypertension Study Group. The idiopathic intracranial hypertension treatment trial: clinical profile at baseline. JAMA Neurol 2014; 71 (06) 693-701
- 18 Friedman DI, Quiros PA, Subramanian PS. et al; The NORDIC IIHTT Study Group. Headache in idiopathic intracranial hypertension: findings from the idiopathic intracranial hypertension treatment trial. Headache 2017; 57 (08) 1195-1205
- 19 Friedman DI, Liu GT, Digre KB. Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children. Neurology 2013; 81 (13) 1159-1165
- 20 Subramaniam S, Fletcher WA. Obesity and weight loss in idiopathic intracranial hypertension: a narrative review. J Neuroophthalmol 2017; 37 (02) 197-205
- 21 Avery RA. Interpretation of lumbar puncture opening pressure measurements in children. J Neuroophthalmol 2014; 34 (03) 284-287
- 22 Neville L, Egan RA. Frequency and amplitude of elevation of cerebrospinal fluid resting pressure by the Valsalva maneuver. Can J Ophthalmol 2005; 40 (06) 775-777
- 23 Bidot S, Saindane AM, Peragallo JH, Bruce BB, Newman NJ, Biousse V. Brain imaging in idiopathic intracranial hypertension. J Neuroophthalmol 2015; 35 (04) 400-411
- 24 Mallery RM, Rehmani OF, Woo JH. et al. Utility of magnetic resonance imaging features for improving the diagnosis of idiopathic intracranial hypertension without papilledema. J Neuroophthalmol 2019; 39 (03) 299-307
- 25 Biousse V, Ameri A, Bousser MG. Isolated intracranial hypertension as the only sign of cerebral venous thrombosis. Neurology 1999; 53 (07) 1537-1542
- 26 Wall M, McDermott MP, Kieburtz KD. et al; NORDIC Idiopathic Intracranial Hypertension Study Group Writing Committee. Effect of acetazolamide on visual function in patients with idiopathic intracranial hypertension and mild visual loss: the idiopathic intracranial hypertension treatment trial. JAMA 2014; 311 (16) 1641-1651
- 27 Lai LT, Danesh-Meyer HV, Kaye AH. Visual outcomes and headache following interventions for idiopathic intracranial hypertension. J Clin Neurosci 2014; 21 (10) 1670-1678
- 28 Wang SJ. Spontaneous intracranial hypotension. Continuum (Minneap Minn) 2021; 27 (03) 746-766
- 29 Mokri B. Spontaneous low pressure, low CSF volume headaches: spontaneous CSF leaks. Headache 2013; 53 (07) 1034-1053
- 30 Capizzano AA, Lai L, Kim J. et al. Atypical presentations of intracranial hypotension: comparison with classic spontaneous intracranial hypotension. AJNR Am J Neuroradiol 2016; 37 (07) 1256-1261
- 31 Subramanian A, Kecler-Pietrzyk A, Murphy SM. Spontaneous intracranial hypotension - a common misdiagnosis. QJM 2020; 113 (06) 421-422
- 32 Sayer FT, Bodelsson M, Larsson EM, Romner B. Spontaneous intracranial hypotension resulting in coma: case report. Neurosurgery 2006; 59 (01) E204 , discussion E204
- 33 Schievink WI. Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension. JAMA 2006; 295 (19) 2286-2296
- 34 Schievink WI, Maya MM, Jean-Pierre S, Nuño M, Prasad RS, Moser FG. A classification system of spontaneous spinal CSF leaks. Neurology 2016; 87 (07) 673-679
- 35 Mokri B, Hunter SF, Atkinson JL, Piepgras DG. Orthostatic headaches caused by CSF leak but with normal CSF pressures. Neurology 1998; 51 (03) 786-790
- 36 Kranz PG, Stinnett SS, Huang KT, Gray L. Spinal meningeal diverticula in spontaneous intracranial hypotension: analysis of prevalence and myelographic appearance. AJNR Am J Neuroradiol 2013; 34 (06) 1284-1289
- 37 Dobrocky T, Grunder L, Breiding PS. et al. Assessing spinal cerebrospinal fluid leaks in spontaneous intracranial hypotension with a scoring system based on brain magnetic resonance imaging findings. JAMA Neurol 2019; 76 (05) 580-587
- 38 Kim JH, Choi JY, Kim HJ, Oh K. Orthostatic headache as the presenting symptom of cervical spine metastasis. Headache 2008; 48 (01) 161-163
- 39 Leep Hunderfund AN, Mokri B. Second-half-of-the-day headache as a manifestation of spontaneous CSF leak. J Neurol 2012; 259 (02) 306-310
- 40 Chang T, Rodrigo C, Samarakoon L. Spontaneous intracranial hypotension presenting as thunderclap headache: a case report. BMC Res Notes 2015; 8: 108
- 41 Evans RW, Seifert TD. The challenge of new daily persistent headache. Headache 2011; 51 (01) 145-154
- 42 Brinjikji W, Garza I, Whealy M. et al. Clinical and imaging outcomes of cerebrospinal fluid-venous fistula embolization. J Neurointerv Surg 2022; 14 (10) 953-956
- 43 Stovner Lj, Hagen K, Jensen R. et al. The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia 2007; 27 (03) 193-210
- 44 Song TJ, Kim YJ, Kim BK. et al. Characteristics of elderly-onset (>65 years) headache diagnosed using the International Classification of Headache Disorders, third edition beta version. J Clin Neurol 2016; 12 (04) 419-425
- 45 Pascual J, Berciano J. Experience in the diagnosis of headaches that start in elderly people. J Neurol Neurosurg Psychiatry 1994; 57 (10) 1255-1257
- 46 Prencipe M, Casini AR, Ferretti C. et al. Prevalence of headache in an elderly population: attack frequency, disability, and use of medication. J Neurol Neurosurg Psychiatry 2001; 70 (03) 377-381
- 47 Robbins MS, Lipton RB. Management of headache in the elderly. Drugs Aging 2010; 27 (05) 377-398
- 48 Wu JJ, Yao M, Ni J. Cerebral amyloid angiopathy-related inflammation: current status and future implications. Chin Med J (Engl) 2021; 134 (06) 646-654
- 49 Salloway S, Chalkias S, Barkhof F. et al. Amyloid-related imaging abnormalities in 2 phase 3 studies evaluating aducanumab in patients with early Alzheimer disease. JAMA Neurol 2022; 79 (01) 13-21
- 50 Huston KA, Hunder GG, Lie JT, Kennedy RH, Elveback LR. Temporal arteritis: a 25-year epidemiologic, clinical, and pathologic study. Ann Intern Med 1978; 88 (02) 162-167
- 51 Durán J, Esnaola S, Rubio R, Iztueta A. Obstructive sleep apnea-hypopnea and related clinical features in a population-based sample of subjects aged 30 to 70 yr. Am J Respir Crit Care Med 2001; 163 (3, Pt 1): 685-689
- 52 Arida A, Kyprianou M, Kanakis M, Sfikakis PP. The diagnostic value of ultrasonography-derived edema of the temporal artery wall in giant cell arteritis: a second meta-analysis. BMC Musculoskelet Disord 2010; 11: 44
- 53 Klink T, Geiger J, Both M. et al. Giant cell arteritis: diagnostic accuracy of MR imaging of superficial cranial arteries in initial diagnosis-results from a multicenter trial. Radiology 2014; 273 (03) 844-852
- 54 Nesher R, Mimouni MD, Khoury S, Nesher G, Segal O. Delayed diagnosis of subacute angle closure glaucoma in patients presenting with headaches. Acta Neurol Belg 2014; 114 (04) 269-272
- 55 Ducros A, Bousser MG. Thunderclap headache. BMJ 2013; 346: e8557
- 56 Backes D, Rinkel GJ, Kemperman H, Linn FH, Vergouwen MD. Time-dependent test characteristics of head computed tomography in patients suspected of nontraumatic subarachnoid hemorrhage. Stroke 2012; 43 (08) 2115-2119
- 57 van Gijn J, Rinkel GJ. Subarachnoid haemorrhage: diagnosis, causes and management. Brain 2001; 124 (Pt 2): 249-278
- 58 Ducros A, Wolff V. The typical thunderclap headache of reversible cerebral vasoconstriction syndrome and its various triggers. Headache 2016; 56 (04) 657-673
- 59 Ducros A. L37. Reversible cerebral vasoconstriction syndrome: distinction from CNS vasculitis. Presse Med 2013; 42 (4, Pt 2): 602-604
- 60 Schwedt TJ. Thunderclap headache. Continuum (Minneap Minn) 2015; 21 (4 Headache): 1058-1071
- 61 Wolff V, Armspach JP, Lauer V. et al. Ischaemic strokes with reversible vasoconstriction and without thunderclap headache: a variant of the reversible cerebral vasoconstriction syndrome?. Cerebrovasc Dis 2015; 39 (01) 31-38
- 62 Tolebeyan AS, Zhang N, Cooper V, Kuruvilla DE. Headache in patients with severe acute respiratory syndrome coronavirus 2 infection: a narrative review. Headache 2020; 60 (10) 2131-2138
- 63 Muhammad S, Haasbach E, Kotchourko M. et al. Influenza virus infection aggravates stroke outcome. Stroke 2011; 42 (03) 783-791
- 64 Huang C, Wang Y, Li X. et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395 (10223): 497-506
- 65 Bobker SM, Robbins MS. Residents and fellows: opinions in headache education. Headache 2020; 60: 1806-1811
- 66 Tarabichi A, Ibrahim F, Abbas A, Allam H. COVID-19 associated posterior reversible encephalopathy syndrome (4617). Neurology 2021; 96 (15, Suppl) 4617
- 67 Moriguchi T, Harii N, Goto J. et al. A first case of meningitis/encephalitis associated with SARS-coronavirus-2. Int J Infect Dis 2020; 94: 55-58
- 68 Caronna E, Alpuente A, Torres-Ferrus M, Pozo-Rosich P. Toward a better understanding of persistent headache after mild COVID-19: three migraine-like yet distinct scenarios. Headache 2021; 61 (08) 1277-1280
- 69 Garcia-Azorin D, Layos-Romero A, Porta-Etessam J. et al. Post-COVID-19 persistent headache: a multicentric 9-months follow-up study of 905 patients. Cephalalgia 2022; 42 (08) 804-809
- 70 Iwu CJ, Iwu CD, Wiysonge CS. The occurrence of long COVID: a rapid review. Pan Afr Med J 2021; 38: 65
- 71 Palaiodimou L, Stefanou MI, Katsanos AH. et al. Cerebral venous sinus thrombosis and thrombotic events after vector-based COVID-19 vaccines: a systematic review and meta-analysis. Neurology 2021; 97 (21) e2136-e2147
- 72 Ong JJY, Bharatendu C, Goh Y. et al. Headaches associated with personal protective equipment - a cross-sectional study among frontline healthcare workers during COVID-19. Headache 2020; 60 (05) 864-877