CHAPTER 17 HEADACHES ASSOCIATED WITH SYSTEMIC DISEASE Robert A. Duarte, MD, Charles E. Argoff, MD 1. How often are headaches a manifestation of systemic disease? Although headache is one of the most common pain complaints for which patients seek medical help, it is uncommonly associated with a serious systemic illness. The vast majority of headaches seen by practitioners are migraine or tension-type. A smaller number are cluster, and an even smaller number are paroxysmal hemicranias. In an emergency room setting, 10% to 15% of headaches are due to a secondary or systemic cause. Less than 1% of patients seen in a clinical practice with a complaint of headache have an underlying systemic disease that caused the headache. 2. How do the criteria of the International Headache Society categorize headaches associated with systemic diseases? The headache categorization criteria of the International Headache Society eliminate headaches caused by infection of the pericranial structures and divide headaches into those associated with noncephalic infections and those associated with metabolic disorders. 3. What do patients believe is the most common systemic cause for episodic headaches? After eliminating local complaints such as sinuses, patients most often believe that their headaches are due to a brain tumor. These suspicions can be quickly dispelled by an imaging study or by questioning the duration of the headache symptoms. Chronic headaches greater than 5 years’ duration are rarely secondary to neoplastic disease. Other concerns include elevations in blood pressure. Essential hypertension is an uncommon cause for headaches. Within the range of autoregulation, elevation of blood pressure is generally asymptomatic. Clearly, in cases of hypertensive encephalopathy, with papilledema and mental status changes, headaches are a common concomitant. 4. What is the most common systemic cause of headache? Febrile illnesses are often associated with headache. Even the common cold is usually associated with a headache. However, when meningitis is superimposed, these headaches become much more severe, may be bursting in character, and rapidly increase over a period of minutes to hours. The most common cause of a sudden, severe headache in children is meningitis. In severe cases, there is stiff neck, nausea, vomiting, and photophobia. These headaches result from a direct irritation of meningeal nociceptors caused by inflammation or infection. With bacterial meningitis, signs are usually fulminant. However, with an aseptic or viral meningitis, signs may be subtle, progressive over hours to days, and the cerebrospinal fluid (CSF) commonly shows just a few cells (mainly lymphocytes) and increased protein. 5. Describe the headache characteristics associated with Lyme disease Headache is the most common symptom of neurologic Lyme disease, but rarely is headache the presenting symptom. The headache is located bifrontally and/or in the occipital region and is intermittent. When it does occur, the headache tends to resemble migraine or tension-type headache, but is often associated with cognitive impairment or focal neurologic dysfunction. Headaches associated with Lyme disease are usually seen as part of a meningitic process associated with early-stage dissemination, and they typically are responsive to antibiotic therapy. The CSF is usually abnormal, with pleocytosis. Investigate for Lyme disease when a patient has new-onset headache, focal neurologic deficits, and residence in a Lyme-endemic region. In general, routine screening for Lyme disease is not recommended in patients with headache. 6. What percentage of patients with herpes simplex encephalitis have headache? The incidence of headache varies with the accompanying presentation. If focal neurologic deficits are present, up to 90% of patients will also have a significant headache. If meningeal signs are present, headache is present in about 60% of cases. When there is only confusion or some obtundation, headache occurs in about 50% to 80% of patients. Overall, headache is a very common symptom in herpes encephalitis, but it is usually accompanied by focal neurologic deficits, alterations in level of consciousness, and seizures. 7. What exogenous substances can precipitate a headache? The most commonly recognized exogenous substances that can precipitate a headache are the vasodilators. Amyl nitrite, a substance often used to heighten the sexual experience, is a potent vasodilator and may cause a severe, pounding headache, even in patients who do not have a headache diathesis. Similar reactions may occur in patients taking nitrates for cardiac disease. Alcoholic beverages can also cause headaches, both in the acute and the well-known hangover phase. The exact mechanism is unclear. For the acute headache, it appears to be vasodilatation. The hangover may be due to some vasoactive substances that are in the congeners in the alcoholic beverage. Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: Neuroimaging in the Patient with Pain Pharmacologic Management Tension-Type Headache Neuropathic Pain Migraine Temporary Neural Blockade Stay updated, free articles. Join our Telegram channel Join Tags: Pain Management Secrets Jun 14, 2016 | Posted by admin in PAIN MEDICINE | Comments Off on Headaches Associated with Systemic Disease Full access? Get Clinical Tree
CHAPTER 17 HEADACHES ASSOCIATED WITH SYSTEMIC DISEASE Robert A. Duarte, MD, Charles E. Argoff, MD 1. How often are headaches a manifestation of systemic disease? Although headache is one of the most common pain complaints for which patients seek medical help, it is uncommonly associated with a serious systemic illness. The vast majority of headaches seen by practitioners are migraine or tension-type. A smaller number are cluster, and an even smaller number are paroxysmal hemicranias. In an emergency room setting, 10% to 15% of headaches are due to a secondary or systemic cause. Less than 1% of patients seen in a clinical practice with a complaint of headache have an underlying systemic disease that caused the headache. 2. How do the criteria of the International Headache Society categorize headaches associated with systemic diseases? The headache categorization criteria of the International Headache Society eliminate headaches caused by infection of the pericranial structures and divide headaches into those associated with noncephalic infections and those associated with metabolic disorders. 3. What do patients believe is the most common systemic cause for episodic headaches? After eliminating local complaints such as sinuses, patients most often believe that their headaches are due to a brain tumor. These suspicions can be quickly dispelled by an imaging study or by questioning the duration of the headache symptoms. Chronic headaches greater than 5 years’ duration are rarely secondary to neoplastic disease. Other concerns include elevations in blood pressure. Essential hypertension is an uncommon cause for headaches. Within the range of autoregulation, elevation of blood pressure is generally asymptomatic. Clearly, in cases of hypertensive encephalopathy, with papilledema and mental status changes, headaches are a common concomitant. 4. What is the most common systemic cause of headache? Febrile illnesses are often associated with headache. Even the common cold is usually associated with a headache. However, when meningitis is superimposed, these headaches become much more severe, may be bursting in character, and rapidly increase over a period of minutes to hours. The most common cause of a sudden, severe headache in children is meningitis. In severe cases, there is stiff neck, nausea, vomiting, and photophobia. These headaches result from a direct irritation of meningeal nociceptors caused by inflammation or infection. With bacterial meningitis, signs are usually fulminant. However, with an aseptic or viral meningitis, signs may be subtle, progressive over hours to days, and the cerebrospinal fluid (CSF) commonly shows just a few cells (mainly lymphocytes) and increased protein. 5. Describe the headache characteristics associated with Lyme disease Headache is the most common symptom of neurologic Lyme disease, but rarely is headache the presenting symptom. The headache is located bifrontally and/or in the occipital region and is intermittent. When it does occur, the headache tends to resemble migraine or tension-type headache, but is often associated with cognitive impairment or focal neurologic dysfunction. Headaches associated with Lyme disease are usually seen as part of a meningitic process associated with early-stage dissemination, and they typically are responsive to antibiotic therapy. The CSF is usually abnormal, with pleocytosis. Investigate for Lyme disease when a patient has new-onset headache, focal neurologic deficits, and residence in a Lyme-endemic region. In general, routine screening for Lyme disease is not recommended in patients with headache. 6. What percentage of patients with herpes simplex encephalitis have headache? The incidence of headache varies with the accompanying presentation. If focal neurologic deficits are present, up to 90% of patients will also have a significant headache. If meningeal signs are present, headache is present in about 60% of cases. When there is only confusion or some obtundation, headache occurs in about 50% to 80% of patients. Overall, headache is a very common symptom in herpes encephalitis, but it is usually accompanied by focal neurologic deficits, alterations in level of consciousness, and seizures. 7. What exogenous substances can precipitate a headache? The most commonly recognized exogenous substances that can precipitate a headache are the vasodilators. Amyl nitrite, a substance often used to heighten the sexual experience, is a potent vasodilator and may cause a severe, pounding headache, even in patients who do not have a headache diathesis. Similar reactions may occur in patients taking nitrates for cardiac disease. Alcoholic beverages can also cause headaches, both in the acute and the well-known hangover phase. The exact mechanism is unclear. For the acute headache, it appears to be vasodilatation. The hangover may be due to some vasoactive substances that are in the congeners in the alcoholic beverage. Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: Neuroimaging in the Patient with Pain Pharmacologic Management Tension-Type Headache Neuropathic Pain Migraine Temporary Neural Blockade Stay updated, free articles. Join our Telegram channel Join Tags: Pain Management Secrets Jun 14, 2016 | Posted by admin in PAIN MEDICINE | Comments Off on Headaches Associated with Systemic Disease Full access? Get Clinical Tree
