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6 - Other Secondary Headaches in the Emergency Department

Published online by Cambridge University Press:  09 October 2017

Serena L. Orr
Children’s Hospital of Eastern Ontario, Ottawa
Benjamin W. Friedman
Albert Einstein College of Medicine, New York
David W. Dodick
Mayo Clinic, Phoenix, AZ
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A wide range of diseases can present to the ED with headache as the major or only symptom. Infectious diseases, inflammatory diseases, autoimmune diseases, and malignancy can cause headache. Processes that raise or lower intracranial pressure can also result in headache. In this chapter, we discuss the epidemiology, pathophysiology, diagnosis, and treatment of other secondary headaches including brain tumor headache, post-traumatic headache, high- and low-pressure headache, cervicogenic headache, trigeminal neuralgia, and headaches attributed to infection, Chiari malformation, arteritis, disorders of the eye, substances or withdrawal headache, and autonomic dysreflexia. In this chapter we also discuss primary (idiopathic) stabbing headache.

Emergency Headache
Diagnosis and Management
, pp. 50 - 64
Publisher: Cambridge University Press
Print publication year: 2017

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1.Boiardi, A, Salmaggi, A, Eoli, M, Lamperti, E, Silvani, A. Headache in brain tumours: a symptom to reappraise critically. Neurol Sci. 2004;25(Suppl. 3):S143–7.CrossRefGoogle ScholarPubMed
2.Valentinis, L, Tuniz, F, Valent, F, et al. Headache attributed to intracranial tumours: a prospective cohort study. Cephalalgia. 2010;30(4):389–98.Google ScholarPubMed
3.Pfund, Z, Szapary, L, Jaszberenyi, O, Nagy, F, Czopf, J. Headache in intracranial tumors. Cephalalgia. 1999;19(9):787–90; discussion 765.CrossRefGoogle ScholarPubMed
4.Schankin, CJ, Ferrari, U, Reinisch, VM, et al. Characteristics of brain tumour-associated headache. Cephalalgia. 2007;27(8):904–11.CrossRefGoogle ScholarPubMed
5.Lanphear, J, Sarnaik, S. Presenting symptoms of pediatric brain tumors diagnosed in the emergency department. Pediatr Emerg Care. 2014;30(2):7780.CrossRefGoogle ScholarPubMed
6.Forsyth, PA, Posner, JB. Headaches in patients with brain tumors: a study of 111 patients. Neurology. 1993;43(9):1678–83.CrossRefGoogle ScholarPubMed
7.Wilne, SH, Ferris, RC, Nathwani, A, Kennedy, CR. The presenting features of brain tumours: a review of 200 cases. Arch Dis Child. 2006;91(6):502–6.CrossRefGoogle ScholarPubMed
8.Kernick, D, Stapley, S, Goadsby, PJ, Hamilton, W. What happens to new-onset headache presented to primary care? A case-cohort study using electronic primary care records. Cephalalgia. 2008;28(11):1188–95.CrossRefGoogle ScholarPubMed
9.Yung, WK, Albright, RE, Olson, J, et al. A phase II study of temozolomide vs. procarbazine in patients with glioblastoma multiforme at first relapse. Br J Cancer. 2000;83(5):588–93.CrossRefGoogle ScholarPubMed
10.Rogers, LR. Neurologic complications of radiation. Continuum (Minneap Minn). 2012;18(2):343–54.Google Scholar
11.Ryzenman, JM, Pensak, ML, Tew, JM, Jr. Headache: a quality of life analysis in a cohort of 1,657 patients undergoing acoustic neuroma surgery, results from the Acoustic Neuroma Association. Laryngoscope. 2005;115(4):703–11.CrossRefGoogle Scholar
12.Navi, BB, Reichman, JS, Berlin, D, et al. Intracerebral and subarachnoid hemorrhage in patients with cancer. Neurology. 2010;74(6):494501.CrossRefGoogle ScholarPubMed
13.Barnholtz-Sloan, JS, Yu, C, Sloan, AE, et al. A nomogram for individualized estimation of survival among patients with brain metastasis. Neuro Oncol. 2012;14(7):910–18.CrossRefGoogle ScholarPubMed
14.Nutt, SH, Patchell, RA. Intracranial hemorrhage associated with primary and secondary tumors. Neurosurg Clin N Am. 1992;3(3):5919.Google ScholarPubMed
15.Jayson, GC, Howell, A. Carcinomatous meningitis in solid tumours. Ann Oncol. 1996;7(8):773–86.CrossRefGoogle ScholarPubMed
16.Johnston, JL. Parasellar syndromes. Curr Neurol Neurosci Rep. 2002;2(5):423–31.CrossRefGoogle ScholarPubMed
17.Capobianco, DJ, Brazis, PW, Rubino, FA, Dalton, JN. Occipital condyle syndrome. Headache. 2002;42(2):142–6.CrossRefGoogle ScholarPubMed
18.Levy, MJ, Matharu, MS, Meeran, K, Powell, M, Goadsby, PJ. The clinical characteristics of headache in patients with pituitary tumours. Brain. 2005;128(Pt 8):1921–30.CrossRefGoogle ScholarPubMed
19.Edvardsson, B. Cluster headache associated with a clinically non-functioning pituitary adenoma: a case report. J Med Case Rep. 2014;8:451.CrossRefGoogle ScholarPubMed
20.Levy, A. Pituitary disease: presentation, diagnosis, and management. J Neurol Neurosurg Psychiatry. 2004;75(Suppl. 3):iii47–52.CrossRefGoogle ScholarPubMed
21.Mohr, G, Hardy, J. Hemorrhage, necrosis, and apoplexy in pituitary adenomas. Surg Neurol. 1982;18(3):181–9.CrossRefGoogle ScholarPubMed
22.Muthukumar, N, Rossette, D, Soundaram, M, Senthilbabu, S, Badrinarayanan, T. Blindness following pituitary apoplexy: timing of surgery and neuro-ophthalmic outcome. J Clin Neurosci. 2008;15(8):873–9.CrossRefGoogle ScholarPubMed
23.Oh, K, Kim, JH, Choi, JW, Kang, JK, Kim, SH. Pituitary apoplexy mimicking meningitis. Brain Tumor Res Treat. 2013;1(2):111–15.CrossRefGoogle ScholarPubMed
24.Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia. 2013;33(9):629808.CrossRef
25.Centers for Disease Control and Prevention. Rates of TBI-related emergency department visits, hospitalizations, and deaths — United States, 2001–2010. Available at:
26.Nampiaparampil, DE. Prevalence of chronic pain after traumatic brain injury: a systematic review. JAMA. 2008;300(6):711–19.CrossRefGoogle ScholarPubMed
27.Sigurdardottir, S, Andelic, N, Roe, C, Jerstad, T, Schanke, AK. Post-concussion symptoms after traumatic brain injury at 3 and 12 months post-injury: a prospective study. Brain Inj. 2009;23(6):489–97.CrossRefGoogle ScholarPubMed
28.Lucas, S, Hoffman, JM, Bell, KR, Dikmen, S. A prospective study of prevalence and characterization of headache following mild traumatic brain injury. Cephalalgia. 2014;34:93102.CrossRefGoogle ScholarPubMed
29.Lucas, S, Hoffman, JM, Bell, KR, Walker, W, Dikmen, S. Characterization of headache after traumatic brain injury. Cephalalgia. 2012;32(8):600–6.CrossRefGoogle ScholarPubMed
30.De Benedittis, G, De Santis, A. Chronic post-traumatic headache: clinical, psychopathological features and outcome determinants. J Neurosurg Sci. 1983;27(3):177–86.Google ScholarPubMed
31.Lipton, ML, Gulko, E, Zimmerman, ME, et al. Diffusion-tensor imaging implicates prefrontal axonal injury in executive function impairment following very mild traumatic brain injury. Radiology. 2009;252(3):816–24.CrossRefGoogle ScholarPubMed
32.Yuh, EL, Hawryluk, GWJ, Manley, G. Imaging concussion: a review. Neurosurgery. 2014;75:S50–63.CrossRefGoogle ScholarPubMed
33.Aoki, Y, Inokuchi, R, Gunshin, M, et al. Diffusion tensor imaging studies of mild traumatic brain injury: a meta-analysis. J Neurol Neurosurg Psychiatry. 2012;83:870–6.CrossRefGoogle ScholarPubMed
34.Huang, YL, Kuo, YS, Tseng, YC, et al. Susceptibility-weighted MRI in mild traumatic brain injury. Neurology. 2015;84:580–5.CrossRefGoogle ScholarPubMed
35.Stiell, IG, Clement, CM, Rowe, BH, et al. Comparison of the Canadian CT Head Rule and the New Orleans Criteria in patients with minor head injury. JAMA. 2005;294(12):1511–18.CrossRefGoogle ScholarPubMed
36.Miller, J, Lieberman, L, Nahab, B, et al. Delayed intracranial hemorrhage in the anticoagulated patient: a systematic review. J Trauma Acute Care Surg. 2015;79(2):310–13.CrossRefGoogle ScholarPubMed
37.Haydel, MJ, Preston, CA, Mills, TJ, et al. Indications for computed tomography in patients with minor head injury. N Engl J Med. 2000;343(2):100–5.CrossRefGoogle ScholarPubMed
38.Stiell, IG, Wells, GA, Vandemheen, K, et al. The Canadian CT Head Rule for patients with minor head injury. Lancet. 2001;357(9266):1391–6.CrossRefGoogle ScholarPubMed
39.Smits, M, Dippel, DW, de Haan, GG, et al. External validation of the Canadian CT Head Rule and the New Orleans Criteria for CT scanning in patients with minor head injury. JAMA. 2005;294(12):1519–25.CrossRefGoogle ScholarPubMed
40.Bazarian, JJ, Blyth, B, Mookerjee, S, He, H, McDermott, MP. Sex differences in outcome after mild traumatic brain injury. J Neurotrauma. 2010;27(3):527–39.CrossRefGoogle ScholarPubMed
41.Nakao, JH, Jafri, FN, Shah, K, Newman, DH. Jolt accentuation of headache and other clinical signs: poor predictors of meningitis in adults. Am J Emerg Med. 2014;32(1):248.CrossRefGoogle ScholarPubMed
42.Thigpen, MC, Whitney, CG, Messonnier, NE, et al. Bacterial meningitis in the United States, 1998–2007. N Engl J Med. 2011;364(21):2016–25.CrossRefGoogle ScholarPubMed
43.Attia, J, Hatala, R, Cook, DJ, Wong, JG. The rational clinical examination: does this adult patient have acute meningitis? JAMA. 1999;282(2):175–81.CrossRefGoogle ScholarPubMed
44.Tamune, H, Takeya, H, Suzuki, W, et al. Absence of jolt accentuation of headache cannot accurately rule out meningitis in adults. Am J Emerg Med. 2013;31(11):16014.CrossRefGoogle ScholarPubMed
45.Pachner, AR, Steiner, I. Lyme neuroborreliosis: infection, immunity, and inflammation. Lancet Neurol. 2007;6(6):544–52.CrossRefGoogle Scholar
46.Edlow, JA, Panagos, PD, Godwin, SA, Thomas, TL, Decker, WW. Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with acute headache. Ann Emerg Med. 2008;52(4):407–36.CrossRefGoogle ScholarPubMed
47.Brouwer, MC, McIntyre, P, Prasad, K, van de Beek, D. Corticosteroids for acute bacterial meningitis. Cochrane Database Syst Rev. 2015;9:CD004405.CrossRefGoogle Scholar
48.Durcan, FJ, Corbett, JJ, Wall, M. The incidence of pseudotumor cerebri: population studies in Iowa and Louisiana. Arch Neurol. 1988;45(8):875–7.CrossRefGoogle ScholarPubMed
49.Jones, JS, Nevai, J, Freeman, MP, McNinch, DE. Emergency department presentation of idiopathic intracranial hypertension. Am J Emerg Med. 1999;17(6):517–21.CrossRefGoogle ScholarPubMed
50.Wall, M, George, D. Idiopathic intracranial hypertension: a prospective study of 50 patients. Brain. 1991;114(Pt 1A):155–80.Google ScholarPubMed
51.Wall, M, Kupersmith, MJ, Kieburtz, KD, et al. The idiopathic intracranial hypertension treatment trial: clinical profile at baseline. JAMA Neurol. 2014;71(6):693701.CrossRefGoogle ScholarPubMed
52.Yri, HM, Jensen, RH. Idiopathic intracranial hypertension: Clinical nosography and field-testing of the ICHD diagnostic criteria. A case-control study. Cephalalgia. 2015;35(7):55362.CrossRefGoogle ScholarPubMed
53.Hingwala, DR, Kesavadas, C, Thomas, B, Kapilamoorthy, TR, Sarma, S. Imaging signs in idiopathic intracranial hypertension: are these signs seen in secondary intracranial hypertension too? Ann Indian Acad Neurol. 2013;16(2):229–33.Google ScholarPubMed
54.Committee NIIHSGW, Wall, M, McDermott, MP, et al. Effect of acetazolamide on visual function in patients with idiopathic intracranial hypertension and mild visual loss: the idiopathic intracranial hypertension treatment trial. JAMA. 2014;311(16):1641–51.Google ScholarPubMed
55.Yri, HM, Ronnback, C, Wegener, M, Hamann, S, Jensen, RH. The course of headache in idiopathic intracranial hypertension: a 12-month prospective follow-up study. Eur J Neurol. 2014;21(12):1458–64.CrossRefGoogle ScholarPubMed
56.Bezov, D, Lipton, RB, Ashina, S. Post-dural puncture headache: part I diagnosis, epidemiology, etiology, and pathophysiology. Headache. 2010;50(7):1144–52.CrossRefGoogle ScholarPubMed
57.Schievink, WI, Maya, MM, Moser, F, Tourje, J, Torbati, S. Frequency of spontaneous intracranial hypotension in the emergency department. J Headache Pain. 2007;8(6):325–8.CrossRefGoogle ScholarPubMed
58.Schievink, WI. Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension. JAMA. 2006;295(19):2286–96.CrossRefGoogle ScholarPubMed
59.Chung, SJ, Kim, JS, Lee, MC. Syndrome of cerebral spinal fluid hypovolemia: clinical and imaging features and outcome. Neurology. 2000;55(9):1321–7.CrossRefGoogle ScholarPubMed
60.Russo, A, Tessitore, A, Cirillo, M, et al. A transient third cranial nerve palsy as presenting sign of spontaneous intracranial hypotension. J Headache Pain. 2011;12(4):493–6.CrossRefGoogle ScholarPubMed
61.Basurto Ona, X, Osorio, D, Bonfill Cosp, X. Drug therapy for treating post-dural puncture headache. Cochrane Database Syst Rev. 2015;7:CD007887.CrossRefGoogle Scholar
62.Mokri, B. Spontaneous CSF leaks: low CSF volume syndromes. Neurol Clin. 2014;32(2):397422.CrossRefGoogle ScholarPubMed
63.Brill, CB, Gutierrez, J, Mishkin, MM. Chiari I malformation: association with seizures and developmental disabilities. J Child Neurol. 1997;12(2):101–6.CrossRefGoogle ScholarPubMed
64.Arnautovic, A, Splavski, B, Boop, FA, Arnautovic, KI. Pediatric and adult Chiari malformation Type I surgical series 1965–2013: a review of demographics, operative treatment, and outcomes. J Neurosurg Pediatr. 2015;15(2):161–77.CrossRefGoogle Scholar
65.Loch-Wilkinson, T, Tsimiklis, C, Santoreneaos, S. Trigeminal neuralgia associated with Chiari 1 malformation: symptom resolution following craniocervical decompression and duroplasty: case report and review of the literature. Surg Neurol Int. 2015;6(Suppl. 11):S327–9.CrossRefGoogle ScholarPubMed
66.Solomon, GD, Kunkel, RS, Jr, Frame, J. Demographics of headache in elderly patients. Headache. 1990;30(5):273–6.CrossRefGoogle ScholarPubMed
67.Kermani, TA, Schmidt, J, Crowson, CS, et al. Utility of erythrocyte sedimentation rate and C-reactive protein for the diagnosis of giant cell arteritis. Semin Arthritis Rheum. 2012;41(6):866–71.CrossRefGoogle Scholar
68.Parikh, M, Miller, NR, Lee, AG, et al. Prevalence of a normal C-reactive protein with an elevated erythrocyte sedimentation rate in biopsy-proven giant cell arteritis. Ophthalmology. 2006;113(10):1842–5.CrossRefGoogle ScholarPubMed
69.Nesher, G, Rubinow, A, Sonnenblick, M. Efficacy and adverse effects of different corticosteroid dose regimens in temporal arteritis: a retrospective study. Clin Exp Rheumatol. 1997;15(3):303–6.Google ScholarPubMed
70.Moore, PM, Calabrese, LH. Neurologic manifestations of systemic vasculitides. Semin Neurol. 1994;14(4):300–6.CrossRefGoogle ScholarPubMed Groot, K, Schmidt, DK, Arlt, AC, Gross, WL, Reinhold-Keller, E. Standardized neurologic evaluations of 128 patients with Wegener granulomatosis. Arch Neurol. 2001;58(8):1215–21.CrossRefGoogle ScholarPubMed
72.Baumann, RJ, Robertson, WC, Jr. Neurosarcoid presents differently in children than in adults. Pediatrics. 2003;112(6 Pt 1):e480–6.CrossRefGoogle ScholarPubMed
73.Singhal, AB. Diagnostic challenges in RCVS, PACNS, and other cerebral arteriopathies. Cephalalgia. 2011;31(10):1067–70.CrossRefGoogle ScholarPubMed
74.Scolding, NJ, Jayne, DR, Zajicek, JP, et al. Cerebral vasculitis: recognition, diagnosis and management. QJM. 1997;90(1):6173.CrossRefGoogle ScholarPubMed
75.Behrens, MM. Headaches associated with disorders of the eye. Med Clin North Am. 1978;62(3):507–21.CrossRefGoogle Scholar
76.Vincent, AJ, Spierings, EL, Messinger, HB. A controlled study of visual symptoms and eye strain factors in chronic headache. Headache. 1989;29(8):523–7.CrossRefGoogle ScholarPubMed
77.Nesher, R, Epstein, E, Stern, Y, Assia, E, Nesher, G. Headaches as the main presenting symptom of subacute angle closure glaucoma. Headache. 2005;45(2):172–6.CrossRefGoogle ScholarPubMed
78.Antonaci, F, Fredriksen, TA, Sjaastad, O. Cervicogenic headache: clinical presentation, diagnostic criteria, and differential diagnosis. Curr Pain Headache Rep. 2001;5(4):387–92.CrossRefGoogle ScholarPubMed
79.Edmeads, J. The cervical spine and headache. Neurology. 1988;38(12):1874–8.CrossRefGoogle ScholarPubMed
80.Furlan, JC. Headache attributed to autonomic dysreflexia: an underrecognized clinical entity. Neurology. 2011;77(8):792–8.CrossRefGoogle Scholar
81.Edvardsson, B, Persson, S. Reversible cerebral vasoconstriction syndrome associated with autonomic dysreflexia. J Headache Pain. 2010;11(3):277–80.CrossRefGoogle ScholarPubMed
82.Toth, C. Medications and substances as a cause of headache: a systematic review of the literature. Clin Neuropharmacol. 2003;26(3):122–36.CrossRefGoogle ScholarPubMed
83.Sykes, OT, Walker, E. The neurotoxicology of carbon monoxide: Historical perspective and review. Cortex. 2015;74:440–8.Google ScholarPubMed
84.Katsarava, Z, Fritsche, G, Muessig, M, Diener, HC, Limmroth, V. Clinical features of withdrawal headache following overuse of triptans and other headache drugs. Neurology. 2001;57(9):1694–8.CrossRefGoogle ScholarPubMed
85.Zakrzewska, JM, Linskey, ME. Trigeminal neuralgia. BMJ. 2014;348:g474.CrossRefGoogle ScholarPubMed
86.Lain, AH, Caminero, AB, Pareja, JA. SUNCT syndrome: absence of refractory periods and modulation of attack duration by lengthening of the trigger stimuli. Cephalalgia. 2000;20(7):671–3.Google ScholarPubMed
87.Cruccu, G, Gronseth, G, Alksne, J, et al. AAN-EFNS guidelines on trigeminal neuralgia management. Eur J Neurol. 2008;15(10):1013–28.CrossRefGoogle ScholarPubMed
88.Antonini, G, Di Pasquale, A, Cruccu, G, et al. Magnetic resonance imaging contribution for diagnosing symptomatic neurovascular contact in classical trigeminal neuralgia: a blinded case-control study and meta-analysis. Pain. 2014;155(8):1464–71.CrossRefGoogle ScholarPubMed
89.Kress, B, Schindler, M, Rasche, D, et al. MRI volumetry for the preoperative diagnosis of trigeminal neuralgia. Eur Radiol. 2005;15(7):1344–8.CrossRefGoogle ScholarPubMed
90.Tate, R, Rubin, LM, Krajewski, KC. Treatment of refractory trigeminal neuralgia with intravenous phenytoin. Am J Health Syst Pharm. 2011;68(21):2059–61.CrossRefGoogle ScholarPubMed
91.Gronseth, G, Cruccu, G, Alksne, J, et al. Practice parameter: the diagnostic evaluation and treatment of trigeminal neuralgia (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the European Federation of Neurological Societies. Neurology. 2008;71(15):1183–90.CrossRefGoogle ScholarPubMed
92.Pareja, JA, Ruiz, J, de Isla, C, al-Sabbah, H, Espejo, J. Idiopathic stabbing headache (jabs and jolts syndrome). Cephalalgia. 1996;16(2):93–6.CrossRefGoogle Scholar

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