Algorithm of differentiation of primary and secondary headaches
In general practice, headaches in the vast majority of outpatients are of a primary nature. A recent study of outpatients with headaches revealed that with in-depth examination at a specialized headache center, the secondary nature of cephalgia was detected in a smaller proportion of patients. Although outpatient patients are more likely to experience primary headaches, especially migraine, the identification of symptomatic forms of cephalgia is extremely important.
A headache in a patient who has not identified other causes can be considered as primary.
“Hazard signals”, suggesting a high likelihood of symptomatic headaches, can be identified through a carefully collected history and physical examination. To exclude possible secondary headaches, it is necessary to ask patients:
• on the nature of headaches now and other health problems;
• the nature of previous headaches and pathological conditions of the body;
• General health status.
Final diagnoses of outpatients with headache complaints:
1. Primary pain:
– Primary headaches in general 83.8 – Migraine 52.3
– Tension headache 24.0
– Bundle headache 3.6
– Other 3.9 2.
– Secondary headaches in general 16.2
– Post-traumatic headache 1.1
– Vascular diseases 0.3
– Intracranial pathology, not associated with vascular disease 0.3
– Medicinal headaches or “cancellation headaches” 0.9
– Infections 0.4 – Disruption of homeostasis 1.1
– Pathology of the skull, sinuses, teeth and other cranial or facial structures 3.0
– Mental illness 0.3
– Neuralgia 2.8
– Other 6.1
A general somatic, neurological examination and examination of the musculoskeletal system can clarify the relationship between detectable symptoms and headache. For example, in patients with arthritis who have a restriction of movements in the cervical spine, headaches occurring when the position of the neck changes, most likely are associated with arthritis, and in patients with arthritis who have no such restrictions and no pain in the joints , the headache is more likely due to other causes.
To distinguish between primary and secondary headaches, information obtained from anamnesis and physical examination is sufficient. To make a presumptive diagnosis, it is optimal to use a diagnostic algorithm.
Signs indicating the secondary nature of headaches:
1. Patient age over 50 years
2. Changes in the nature of headaches over the past 2 years
3. Pain in the neck or neck
4. Signs of somatic pathology
5. Signs of neurological pathology
6. Pathological findings for somatic or neurological examination