Skip to main content
Top
Published in: Current Pain and Headache Reports 3/2024

13-12-2023 | Headache | Chronic Pain Medicine (O Viswanath, Section Editor)

Ominous Causes of Headache

Authors: Latha Ganti, S. Chandana Veluri, Thor S. Stead, Richard Rieck

Published in: Current Pain and Headache Reports | Issue 3/2024

Login to get access

Abstract

Purpose of Review

While primary headaches like migraines or cluster headaches are prevalent and often debilitating, it's the secondary headaches—those resulting from underlying pathologies—that can be particularly ominous. This article delves into the sinister causes of headaches, underscoring the importance of a meticulous clinical approach, especially when presented with red flags.

Recent Findings

Headaches, one of the most common complaints in clinical practice, span a spectrum from benign tension-type episodes to harbingers of life-threatening conditions. For the seasoned physician, differentiating between these extremes is paramount.

Summary

Headache etiologies covered in this article will include subarachnoid hemorrhage (SAH), cervical artery dissection, cerebral venous thrombosis, meningitis, obstructive hydrocephalus, and brain tumor.
Literature
6.
go back to reference Chen Y, Mofatteh M, Nguyen TN, Wellington J, Wei W, Liang W, Chen G, Hu Z, Ouyang K, Yang S. Carotid Artery Dissection and Ischemic Stroke Following Cervical Chiropractic Manipulation: Two Case Reports. Vasc Endovascular Surg. 2022 Apr;56(3):303-307. https://doi.org/10.1177/15385744211072660. (Epub 2021 Dec 31. PMID: 34971321). Chen Y, Mofatteh M, Nguyen TN, Wellington J, Wei W, Liang W, Chen G, Hu Z, Ouyang K, Yang S. Carotid Artery Dissection and Ischemic Stroke Following Cervical Chiropractic Manipulation: Two Case Reports. Vasc Endovascular Surg. 2022 Apr;56(3):303-307. https://​doi.​org/​10.​1177/​1538574421107266​0. (Epub 2021 Dec 31. PMID: 34971321).
12.
go back to reference Hoh BL, Ko NU, Amin-Hanjani S, Chou SH-Y, Cruz-Flores S, Dangayach NS, Derdeyn CP, Du R, Hänggi D, Hetts SW, Ifejika NL, Johnson R, Keigher KM, Leslie-Mazwi TM, Lucke-Wold B, Rabinstein AA, Robicsek SA, Stapleton CJ, Suarez JI, Tjoumakaris SI, Welch BG. 2023 Guideline for the Management of Patients With Aneurysmal Subarachnoid Hemorrhage: A Guideline From the American Heart Association/American Stroke Association. Stroke. 2023 Jul;54(7):e314-e370. https://doi.org/10.1161/STR.0000000000000436. (Epub 2023 May 22. PMID: 37212182). Hoh BL, Ko NU, Amin-Hanjani S, Chou SH-Y, Cruz-Flores S, Dangayach NS, Derdeyn CP, Du R, Hänggi D, Hetts SW, Ifejika NL, Johnson R, Keigher KM, Leslie-Mazwi TM, Lucke-Wold B, Rabinstein AA, Robicsek SA, Stapleton CJ, Suarez JI, Tjoumakaris SI, Welch BG. 2023 Guideline for the Management of Patients With Aneurysmal Subarachnoid Hemorrhage: A Guideline From the American Heart Association/American Stroke Association. Stroke. 2023 Jul;54(7):e314-e370. https://​doi.​org/​10.​1161/​STR.​0000000000000436​. (Epub 2023 May 22. PMID: 37212182).
18.
go back to reference Abdulazim A, Heilig M, Rinkel G, Etminan N. Diagnosis of Delayed Cerebral Ischemia in Patients with Aneurysmal Subarachnoid Hemorrhage and Triggers for Intervention. Neurocrit Care. 2023 Oct;39(2):311–319. https://doi.org/10.1007/s12028-023-01812-3. (Epub 2023 Aug 3. PMID: 37537496; PMCID: PMC10542310). Abdulazim A, Heilig M, Rinkel G, Etminan N. Diagnosis of Delayed Cerebral Ischemia in Patients with Aneurysmal Subarachnoid Hemorrhage and Triggers for Intervention. Neurocrit Care. 2023 Oct;39(2):311–319. https://​doi.​org/​10.​1007/​s12028-023-01812-3. (Epub 2023 Aug 3. PMID: 37537496; PMCID: PMC10542310).
19.
go back to reference Cebeci D, Arhan E, Demir E, Uçar M, Uçar HK, Serdaroğlu A, Öztürk Z. Internal carotid artery dissection without intracranial infarct following a minor shoulder trauma: The second pediatric case and review of the literature. J Clin Neurosci. 2018;56:172–5.CrossRefPubMed Cebeci D, Arhan E, Demir E, Uçar M, Uçar HK, Serdaroğlu A, Öztürk Z. Internal carotid artery dissection without intracranial infarct following a minor shoulder trauma: The second pediatric case and review of the literature. J Clin Neurosci. 2018;56:172–5.CrossRefPubMed
22.
go back to reference Kim KT, Baik SG, Park KP, Park MG. A case of complete recovery of fluctuating monocular blindness following endovascular treatment in internal carotid artery dissection. J Stroke Cerebrovasc Dis. 2015;24(9):e283–6.CrossRefPubMed Kim KT, Baik SG, Park KP, Park MG. A case of complete recovery of fluctuating monocular blindness following endovascular treatment in internal carotid artery dissection. J Stroke Cerebrovasc Dis. 2015;24(9):e283–6.CrossRefPubMed
23.
go back to reference Chang AJ, Mylonakis E, Karanasias P, De Orchis DF, Gold R. Spontaneous bilateral vertebral artery dissections: case report and literature review. Mayo Clin Proc. 1999;74:893–6.CrossRefPubMed Chang AJ, Mylonakis E, Karanasias P, De Orchis DF, Gold R. Spontaneous bilateral vertebral artery dissections: case report and literature review. Mayo Clin Proc. 1999;74:893–6.CrossRefPubMed
24.
go back to reference Brott TG, Halperin JL, Abbara S, Bacharach JM, Barr JD, Bush RL, Cates CU, Creager MA, Fowler SB, Friday G, Hertzberg VS, McIff EB, Moore WS, Panagos PD, Riles TS, Rosenwasser RH, Taylor AJ. American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines; American Stroke Association; American Association of Neuroscience Nurses; American Association of Neurological Surgeons; American College of Radiology; American Society of Neuroradiology; Congress of Neurological Surgeons; Society of Atherosclerosis Imaging and Prevention; Society for Cardiovascular Angiography and Interventions; Society of Interventional Radiology; Society of NeuroInterventional Surgery; Society for Vascular Medicine; Society for Vascular Surgery. 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/ SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, and Society for Vascular Surgery. Vasc Med. 2011 Feb;16(1):35–77. https://doi.org/10.1177/1358863X11399328. (Erratum in: Vasc Med. 2011 Aug;16(4):317. PMID: 21471149). Brott TG, Halperin JL, Abbara S, Bacharach JM, Barr JD, Bush RL, Cates CU, Creager MA, Fowler SB, Friday G, Hertzberg VS, McIff EB, Moore WS, Panagos PD, Riles TS, Rosenwasser RH, Taylor AJ. American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines; American Stroke Association; American Association of Neuroscience Nurses; American Association of Neurological Surgeons; American College of Radiology; American Society of Neuroradiology; Congress of Neurological Surgeons; Society of Atherosclerosis Imaging and Prevention; Society for Cardiovascular Angiography and Interventions; Society of Interventional Radiology; Society of NeuroInterventional Surgery; Society for Vascular Medicine; Society for Vascular Surgery. 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/ SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, and Society for Vascular Surgery. Vasc Med. 2011 Feb;16(1):35–77. https://​doi.​org/​10.​1177/​1358863X11399328​. (Erratum in: Vasc Med. 2011 Aug;16(4):317. PMID: 21471149).
26.
go back to reference Palmieri A, Valentinis L, Zanchin G. Update on headache and brain tumors. Cephalalgia. 2021;41(4):431–7.CrossRefPubMed Palmieri A, Valentinis L, Zanchin G. Update on headache and brain tumors. Cephalalgia. 2021;41(4):431–7.CrossRefPubMed
36.
go back to reference Treglia G, Muoio B, Trevisi G, et al. Diagnostic Performance and Prognostic Value of PET/CT with Different Tracers for Brain Tumors: A Systematic Review of Published Meta-Analyses. Intern J Mole Sci. 2019;20(19):4669. https://doi.org/10.3390/IJMS20194669. Treglia G, Muoio B, Trevisi G, et al. Diagnostic Performance and Prognostic Value of PET/CT with Different Tracers for Brain Tumors: A Systematic Review of Published Meta-Analyses. Intern J Mole Sci. 2019;20(19):4669. https://​doi.​org/​10.​3390/​IJMS20194669.
38.
52.
go back to reference • Ferras M, McCauley N, Stead T, Ganti L, Desai B. Ventriculoperitoneal Shunts in the Emergency Department: A Review. Cureus. 2020;12(2):e6857. https://doi.org/10.7759/cureus.6857. (PMID: 32181092; PMCID: PMC7053664). This is a review of venticuloperitoneal shunts, with a focus on the complications that can occur from these devices. • Ferras M, McCauley N, Stead T, Ganti L, Desai B. Ventriculoperitoneal Shunts in the Emergency Department: A Review. Cureus. 2020;12(2):e6857. https://​doi.​org/​10.​7759/​cureus.​6857. (PMID: 32181092; PMCID: PMC7053664). This is a review of venticuloperitoneal shunts, with a focus on the complications that can occur from these devices.
53.
go back to reference • American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Acute Headache: Godwin SA, Cherkas DS, Panagos PD, Shih RD, Byyny R, Wolf SJ. Clinical policy: Critical issues in the evaluation and management of adult patients presenting to the emergency department with acute headache. Ann Emerg Med. 2019 Oct;74(4):e41-e74. https://doi.org/10.1016/j.annemergmed.2019.07.009. This clinical policy by the American College of Emergency Physicians summarizes when neuroimaging is indicated for patients who present to the emergency department with headache. • American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Acute Headache: Godwin SA, Cherkas DS, Panagos PD, Shih RD, Byyny R, Wolf SJ. Clinical policy: Critical issues in the evaluation and management of adult patients presenting to the emergency department with acute headache. Ann Emerg Med. 2019 Oct;74(4):e41-e74. https://​doi.​org/​10.​1016/​j.​annemergmed.​2019.​07.​009. This clinical policy by the American College of Emergency Physicians summarizes when neuroimaging is indicated for patients who present to the emergency department with headache.
54.
go back to reference • Do TP, Remmers A, Schytz HW, Schankin C, Nelson SE, Obermann M, Hansen JM, Sinclair AJ, Gantenbein AR, Schoonman GG. Red and orange flags for secondary headaches in clinical practice: SNNOOP10 list. Neurology. 2019;92(3):134–144. https://doi.org/10.1212/WNL.0000000000006697. Epub 2018 Dec 26. PMID: 30587518; PMCID: PMC6340385. This article summarizes the 15 things to watch out for when patients present with headache: (1) systemic symptoms including fever; (2) neoplasm history; (3) neurologic deficit (including decreased consciousness); (4) sudden or abrupt onset; (5) older age (onset after 65 years); (6) pattern change or recent onset of new headache; (7) positional headache; (8) precipitated by sneezing, coughing, or exercise; (9) papilledema; (10) progressive headache and atypical presentations; (11) pregnancy or puerperium; (12) painful eye with autonomic features; (13) posttraumatic onset of headache; (14) pathology of the immune system such as HIV; (15) painkiller overuse or new drug at onset of headache. • Do TP, Remmers A, Schytz HW, Schankin C, Nelson SE, Obermann M, Hansen JM, Sinclair AJ, Gantenbein AR, Schoonman GG. Red and orange flags for secondary headaches in clinical practice: SNNOOP10 list. Neurology. 2019;92(3):134–144. https://​doi.​org/​10.​1212/​WNL.​0000000000006697​. Epub 2018 Dec 26. PMID: 30587518; PMCID: PMC6340385. This article summarizes the 15 things to watch out for when patients present with headache: (1) systemic symptoms including fever; (2) neoplasm history; (3) neurologic deficit (including decreased consciousness); (4) sudden or abrupt onset; (5) older age (onset after 65 years); (6) pattern change or recent onset of new headache; (7) positional headache; (8) precipitated by sneezing, coughing, or exercise; (9) papilledema; (10) progressive headache and atypical presentations; (11) pregnancy or puerperium; (12) painful eye with autonomic features; (13) posttraumatic onset of headache; (14) pathology of the immune system such as HIV; (15) painkiller overuse or new drug at onset of headache.
Metadata
Title
Ominous Causes of Headache
Authors
Latha Ganti
S. Chandana Veluri
Thor S. Stead
Richard Rieck
Publication date
13-12-2023

Other articles of this Issue 3/2024

Current Pain and Headache Reports 3/2024 Go to the issue

Uncommon and/or Unusual Headaches and Syndromes (F Cohen, Section Editor)

Unraveling the MSG-Headache Controversy: an Updated Literature Review

Hot Topics in Pain and Headache (N Rosen, Section Editor)

Treating the Uninsured and Underinsured with Migraine in the USA

Hot Topics in Pain and Headache (N Rosen, Section Editor)

Transitional Pain Service: Optimizing Complex Surgical Patients