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x Table 14-2 Headache Symptoms that Suggest a Serious Underlying Disorder

A complete neurologic examination is an essential first step in the evaluation. In most cases, patients with an abnormal examination or a history of recent-onset headache should be evaluated by a CT or MRI study. As an initial screening procedure for intracranial pathology in this setting, CT and MRI methods appear to be equally sensitive. In some circumstances, a lumbar puncture (LP) is also required, unless a benign etiology can be otherwise established. A general evaluation of acute headache might include the investigation of cardiovascular and renal status by blood pressure monitoring and urine examination; eyes by funduscopy, intraocular pressure measurement, and refraction; cranial arteries by palpation; and cervical spine by the effect of passive movement of the head and by imaging.

The psychological state of the patient should also be evaluated since a relationship exists between head pain and depression. Many patients in chronic daily pain cycles become depressed, although depression itself is rarely a cause of headache. Drugs with antidepressant actions are also effective in the prophylactic treatment of both tension-type headache and migraine.

Underlying recurrent headache disorders may be activated by pain that follows otologic or endodontic surgical procedures. Thus, pain about the head as the result of diseased tissue or trauma may reawaken an otherwise quiescent migrainous syndrome. Treatment of the headache is largely ineffective until the cause of the primary problem is addressed.

Serious underlying conditions that are associated with headache are described below. Brain tumor is a rare cause of headache and even less commonly a cause of severe pain. The vast majority of patients presenting with severe headache have a benign cause.


 

References

 

 

 

Classification

Headaches are classified according to the International Headache Society characterizes headache as primary or secondary (Table 14–1).

Primary headaches are those in which headache and its associated features are the disorder in itself, whereas secondary headaches are those caused by exogenous disorders. Primary headache often results in considerable disability and a decrease in the patient's quality of life. Mild secondary headache, such as that seen in association with upper respiratory tract infections, is common but rarely worrisome. Life-threatening headache is relatively uncommon.

Table 14-1 Common Causes of Headache

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x Table 14-2 Headache Symptoms that Suggest a Serious Underlying Disorder

 

In most cases, patients with an abnormal examination or a history of recent-onset headache should be evaluated by a CT or MRI study. As an initial screening procedure for intracranial pathology in this setting, CT and MRI methods appear to be equally sensitive. In some circumstances, a lumbar puncture (LP) is also required, unless a benign etiology can be otherwise established. A general evaluation of acute headache might include the investigation of cardiovascular and renal status by blood pressure monitoring and urine examination; eyes by funduscopy, intraocular pressure measurement, and refraction; cranial arteries by palpation; and cervical spine by the effect of passive movement of the head and by imaging.

The psychological state of the patient should also be evaluated since a relationship exists between head pain and depression. Many patients in chronic daily pain cycles become depressed, although depression itself is rarely a cause of headache. Drugs with antidepressant actions are also effective in the prophylactic treatment of both tension-type headache and migraine.

Underlying recurrent headache disorders may be activated by pain that follows otologic or endodontic surgical procedures. Thus, pain about the head as the result of diseased tissue or trauma may reawaken an otherwise quiescent migrainous syndrome. Treatment of the headache is largely ineffective until the cause of the primary problem is addressed.

Serious underlying conditions that are associated with headache are described below. Brain tumor is a rare cause of headache and even less commonly a cause of severe pain. The vast majority of patients presenting with severe headache have a benign cause.


Differential Diagnosis (Unilateral scalp pain - temporal arteritis)

Treatment (Hyperlink)

 

 

 

References

1. http://www.mayoclinic.org/symptom-checker/headaches-child/related-factors/itt-20009075