Causes of secondary headaches – the principles of differentiation
The primary examination of the majority of patients suffering from headache is primarily aimed at identifying and correcting the secondary causes of headache, which can be caused by a variety of diseases.
In addition to the fact that chronic pains are less characteristic of secondary headaches, acute headaches are also more often primary.
Migraine is the most common diagnosis that is given to outpatients with complaints of acute headache. During the examination of 561 patients with a leading complaint of acute headache, 56% had primary headache, most of them were diagnosed with migraine (81% of primary headaches and 45% of all headaches). Secondary headaches were most often associated with fever, hypertension and sinusitis.
Causes of secondary acute headaches in outpatient patients:
– Only 44%
– Fever 16%
– Hypertensive crisis 11%
– Sinusitis 8%
– Headaches with excessive medication 5%
– Post-traumatic headaches 2%
– Diseases of the cervical spine 1%
– Progressive intracranial process 1%
– Intracranial infection (eg, meningitis or brain abscess) 1%
– Fractures of the teeth <1%
– Condition after hemodialysis <1%
Patients with suspected signs of secondary headaches may need additional examination aimed at identifying specific pathological conditions. The need to revise the preliminary diagnosis of primary headaches may occur if you suspect secondary headaches if:
• a new type of headache is developing;
• the nature of previous headaches changes;
• symptoms or signs of a somatic or neurological disease develop;
• standard treatment for primary headaches did not improve. After studying the diary of a headache, important symptoms may appear that were not detected during the initial examination and affect the diagnosis of headaches.