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Health Dictionary

Reliable, easy-to-read patient information on common medical conditions — written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.

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Headache

Introduction

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Synonyms and keywords: Cephalgia

Overview

Overview

Overview

A headache is a condition of pain in the head; sometimes neck or upper back pain may also be interpreted as a headache. It ranks amongst the most common local pain complaints.

Historical Perspective

The first recorded classification system that resembles the modern ones was published by Thomas Willis, in De Cephalalgia in 1672. In 1787 Christian Baur generally divided headaches into idiopathic (primary headaches) and symptomatic (secondary ones), and defined 84 categories.

Pathophysiology

The brain in itself is not sensitive to pain, because it lacks pain-sensitive nerve fibers. Several areas of the head can hurt, including a network of nerves which extend over the scalp and certain nerves in the face, mouth, and throat. The meninges and the blood vessels do have pain perception. Headaches often result from traction to or irritation of the meninges and blood vessels. The muscles of the head may similarly be sensitive to pain.

Causes

The vast majority of headaches are benign and self-limiting. Common causes are tension, Neck pain, migraine, eye strain, dehydration, low blood sugar, and sinusitis. The vast majority of chronic headaches are multifactoral in nature. Much rarer are headaches due to life-threatening conditions such asmeningitis, encephalitis, cerebral aneurysms, extremely high blood pressure, and brain tumors. When the headache occurs in conjunction with a head injury the cause is usually quite evident. A large percentage of headaches among females are caused by ever-fluctuating estrogen during menstrual years. This can occur prior to, during or even midcycle menstruation.

Natural History, Complications and Prognosis

The prognosis of headache depends on the underlying cause.

Diagnosis

Laboratory Findings

Blood tests may help narrow down the differential diagnosis, but are rarely confirmatory of specific headache forms.

CT

Computed tomography (CT/CAT) scans of the brain or sinuses are commonly performed.

MRI

Magnetic resonance imaging (MRI) of the brain and sinuses are done in specific settings.

Treatment

Medical Therapy

Headaches may be successfully treated through medical therapies such as analgesisa and, in some cases, a tandem approach with implanted electrodes.

Primary Prevention

Some forms of headache, such as migraine, may be amenable to preventative treatment.

References

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Editor-In-Chief: Robert G. Schwartz, M.D. [1], Piedmont Physical Medicine and Rehabilitation, P.A.; : Cafer Zorkun, M.D., Ph.D. [2]

Historical Perspective

Historical Perspective

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Overview

The first record of human headache has been known for 6000 years ago.In 17th Century migraine was recognized by Willis.The first recorded classification system that resembles the modern ones was published by Thomas Willis, in De Cephalalgia in 1672. In 1787 Christian Baur generally divided headaches into idiopathic (primary headaches) and symptomatic (secondary ones), and defined 84 categories.The idea of migraine may be a vascular disease revisited by Wolff and colleaguse in the 1940s.

Historical Perspective

Discovery

  • The first record of human headache has been known for 6000 years ago.[1]
  • The first recorded classification system that resembles the modern ones was published by Thomas Willis, in De Cephalalgia in 1672.
  • In 1787 Christian Baur generally divided headaches into idiopathic (primary headaches) and symptomatic (secondary ones), and defined 84 categories.[2]
  • In 17th Century migraine was recognized by Willis.
  • The idea of migraine may be a vascular disease revisited by Wolff and colleagues in the 1940s.[3]

References

  1. ↑ Goadsby PJ, Holland PR, Martins-Oliveira M, Hoffmann J, Schankin C, Akerman S (2017). “Pathophysiology of Migraine: A Disorder of Sensory Processing”. Physiol Rev. 97 (2): 553–622. doi:10.1152/physrev.00034.2015. PMC 5539409. PMID 28179394.
  2. ↑ Schmoldt A, Benthe HF, Haberland G (1975). “Digitoxin metabolism by rat liver microsomes”. Biochem Pharmacol. 24 (17): 1639–41. PMID https://doi.org/10.1212/01 Check |pmid= value (help).
  3. ↑ “Reorganized text”. JAMA Otolaryngol Head Neck Surg. 141 (5): 428. 2015. doi:10.1001/jamaoto.2015.0540. PMID 25996397.

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Editor-In-Chief: Robert G. Schwartz, M.D. [1], Piedmont Physical Medicine and Rehabilitation, P.A.; : Cafer Zorkun, M.D., Ph.D. [2]

Pathophysiology

Pathophysiology

Overview

The brain in itself is not sensitive to pain, because it lacks pain-sensitive nerve fibers. Several areas of the head can hurt, including a network of nerves which extend over the scalp and certain nerves in the face, mouth, and throat. The meninges and the blood vessels do have pain perception. Headaches often result from traction to or irritation of the meninges and blood vessels. The muscles of the head may similarly be sensitive to pain.

Pathophysiology

Physiology

  • The normal pathophysiology of cluster can be understood as follows:
  • vascular dilation,trigeminal nerve stimulation and histamine release.[1]

Pathogenesis

  • The exact pathophysiology of cluster headache is not completely understood.
  • It is understood that cluster headache is caused by either vascular dilation,trigeminal nerve stimulation and histamine release.[1]
  • Previously thought cluster headache was a type of vascular headache, but current proof implies that pathophysiology of cluster headache includes the brain, trigeminovascular and cranial parasympathetic system.[2]
  • One of the theories of migraine pain in patients without aura is extracranial arterial dilatation.[3]

Genetics

Genes involved in the pathogenesis of migraine include:

  • MTDH
  • LRP1
  • TRPM8

The development of familial hemiplegic migraine is the result of multiple genetic mutations such as:

  • CACNA1A
  • ATP1A2
  • SCN1A[4]

References

  1. ↑ 1.0 1.1 Weaver-Agostoni J (2013). “Cluster headache”. Am Fam Physician. 88 (2): 122–8. PMID 23939643.
  2. ↑ May A, Schwedt TJ, Magis D, Pozo-Rosich P, Evers S, Wang SJ (2018). “Cluster headache”. Nat Rev Dis Primers. 4: 18006. doi:10.1038/nrdp.2018.6. PMID 29493566.
  3. ↑ Amin FM, Asghar MS, Hougaard A, Hansen AE, Larsen VA, de Koning PJ; et al. (2013). “Magnetic resonance angiography of intracranial and extracranial arteries in patients with spontaneous migraine without aura: a cross-sectional study”. Lancet Neurol. 12 (5): 454–61. doi:10.1016/S1474-4422(13)70067-X. PMID 23578775.
  4. ↑ Andreou AP, Edvinsson L (2019). “Mechanisms of migraine as a chronic evolutive condition”. J Headache Pain. 20 (1): 117. doi:10.1186/s10194-019-1066-0. PMC 6929435 Check |pmc= value (help). PMID 31870279.

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Editor-In-Chief: Robert G. Schwartz, M.D. [1], Piedmont Physical Medicine and Rehabilitation, P.A.; : Cafer Zorkun, M.D., Ph.D. [2]

Causes

Causes

Overview

The vast majority of headaches are benign and self-limiting. Common causes are tension,Neck pain, migraine, eye strain, dehydration, low blood sugar, and sinusitis. Much rarer are headaches due to life-threatening conditions such as meningitis, encephalitis, cerebral aneurysms, extremely high blood pressure, and brain tumors. When the headache occurs in conjunction with a head injury the cause is usually quite evident. A large percentage of headaches among females are caused by ever-fluctuating estrogen during menstrual years. This can occur prior to, during or even midcycle menstruation.

Causes

Common Causes

Causes by Organ System[1][2]

Cardiac Hypotension, Hypertension, Malignant hypertension,
Chemical / Poisoning Amnesic shellfish poisoning, Anadenanthera peregrina, Antimony, Arsenic poisoning, Artemisia afra, Carbon monoxide, Copper, Cyanide, Heavy metal ingestion, Hemlock, Hydrogen sulfide, Lead poisoning, Manganese, Marine toxins, Monocrotophos, Nicotine poisoning, Radiation poisoning, Soil contamination, Thallium, Toxic headache, Water intoxication,
Dermatologic Linear immunoglobulin A dermatosis,
Drug Side Effect Acamprosate, Acetaminophen, Acyclovir, Agalsidase beta, Alatrofloxacin Injection, Albendazole, Alogliptin, Alosetron, Amantadine, Ambrisentan, Aminophylline, Amiodarone, Amlodipine, Amobarbital sodium, Amoxicillin, Amphotericin B, Anagrelide, Apremilast, Aprepitant, Armodafinil, Articaine, Atorvastatin, Atropine, bedaquiline fumarate, Benazepril, Benzphetamine, Bepotastine Besilate, Bepridil, Besifloxacin, Bexarotene, Bisoprolol, Blinatumomab, Bosentan, Botulinum toxin, Bromocriptine, Busulfan, Butabarbital, Butorphanol, Cabergoline, Caffeine, Candesartan, Capecitabine, Carbamazepine, Carbidopa and Levodopa, Carbimazole, Carisoprodol, Carmustine, Carteolol, Carvedilol, Caspofungin, Cetrorelix, Cilansetron, Cilostazol, Cimetidine, Clomethiazole, Combined oral contraceptive pill, Cortisone, Cycloserine, Cyclosporin, Cefaclor, Cefamandole Nafate Injection, Cefotetan, Cefdinir, Cetirizine hydrochloride, Cefoperazone Sodium Injection, Ceftibuten, Calcitriol, Chelation therapy, Chlorothiazide, Chlorthalidone, Clomifene, Cilostazol, Cimetidine, Clopidogrel, Clozapine, Coagulation factor IX, Conjugated estrogens, Cycloserine, Cyclosporine Injection, Dalfampridine, Deferasirox, Denileukin diftitox, Desmopressin, Dexamethasone, Dexamfetamine, Digoxin, dabrafenib mesylate, Didanosine, Diltiazem, Dimercaprol, Dinoprostone, Dipivefrine, Dipyridamole, Disopyramide, Docosanol, Dolasetron, Dofetilide, Doripenem, Drospirenone and Ethinyl estradiol, Doxazosin, Ecallantide, Eculizumab, Eliglustat, Emtricitabine, Rilpivirine Hydrochloride,Tenofovir Disoproxil Fumarate, Efavirenz, Emedastine Difumarate, Enalapril, Epinephrine (aerosol), Eslicarbazepine acetate, Estradiol valerate and estradiol valerate/dienogest, Ethynodiol diacetate and ethinyl estradiol, Elosulfase alfa, Epinephrine, Eplerenone, Epoprostenol, Eribulin, Ergotamine, Etanercept Injection, Ethacrynic Acid, Ethanol, Ethosuximide, Etidronic acid, Etidronate, Etodolac, Etonogestrel, Exemestane, Ezetimibe, Felbamate, Felodipine, Fenofibrate, Fenoldopam, Fesoterodine, Flavoxate . Florbetapir F-18 . Flutemetamol F 18, Flu vaccine, Flunisolide, Flurbiprofen, Fluorouracil, Fluoxetine, Fluvastatin, Epinephrine, Ethosuximide, Flucytosine, Fosinopril, Fulvestrant, Furosemide, Gadoterate, Ganciclovir, Ganirelix, Gemeprost, Glimepiride, Glipizide, Glucarpidase, Glyburide and Metformin, Glyceryl trinitrate, Granisetron, Griseofulvin, Gyromitrin, Histrelin, Hydrocortisone, Hydroxocobalamin, Hydroxyzine, Ibuprofen, Idursulfase, Imiglucerase, Imiquimod, Indinavir, Indomethacin, Insulin lispro, Influenza vaccine, Imatinib mesylate, Interferon beta- 1b, Interferon gamma, Interleukin 2, Isoproterenol (aerosol), Isotretinoin, Isosorbide dinitrate, Isosorbide mononitrate, Ivacaftor, Ketorolac tromethamine, Lacosamide, lamivudine, Lansoprazole, Lerisetron, Lenvatinib, Levocabastine, Levofloxacin, Levonorgestrel, Levosimendan, Lisinopril and Hydrochlorothiazide, Lofepramine, Lomotil, Loratadine, Lorcaserin, Lidocaine (cream), Lisuride, Lomefloxacin hydrochloride, Mebendazole, Medroxyprogesterone, Mefloquine Memantine Meropenem, Metaxalone, Metipranolol, Metformin, Methimazole, Metronidazole, Methacholine, Methotrexate, Methylphenidate, Methyprylon, Micafungin sodium, Mifepristone, Milnacipran hydrochloride, Mirabegron, Misoprostol, Modafinil• Monosodium glutamate, Moricizine, Nafarelin, Naproxen sodium, Natalizumab, Niacin/simvastatin, Nicorandil, Nifedipine, Nitrendipine, Nitroglycerine, Nizatidine, Non-steroidal anti-inflammatory drugs, Norethindrone acetate and Ethinyl estradiol, Norgestimate and Ethinyl estradiol, Norgestrel and Ethinyl estradiol, Ofloxacin, Olaparib, Olsalazine, Oprelvekin, Oxtriphylline, Oxytocin injection, Omalizumab, Ondansetron, Oritavancin, Palonosetron, Pasireotide,, pazopanib hydrochloride, permethrin, Pantoprazole, Paroxetine, Pegylated interferon alfa-2a, Pemirolast, Pergolide, Pirfenidone, Pimecrolimus, Piribedil, Pirbuterol, Piroxicam, Plerixafor, Praziquantel, Progesterone , Prednisone, Propylthiouracil, Potassium iodide, Pyrantel pamoate, Quazepam* Quinidine, Quinine, Rabeprazole, Rasagiline, Rasburicase, Reproterol, Ribavirin, Rimexolone, Roflumilast, Ropinirole, roflumilast, Romiplostim, Ruxolitinib, Salbutamol, Saxagliptin, Saxagliptin hydrochloride and Metformin hydrochloride, Selective serotonin reuptake inhibitor, Sildenafil, Siltuximab, Sipuleucel-T, Sodium nitrite, Sulprostone, Sumatriptan, Spironolactone, Stavudine, Sunitinib, Tacrolimus, Tamsulosin, Tadalafil, tedizolid* Temozolomide, Teniposide, Tigecycline, Tocilizumab, Trabectedin, Tretinoin, Trimeprazine, Trimethobenzamide, Tribavirin, Trimethadione, Triptorelin pamoate, Tropisetron, Trospium, Trovafloxacin mesylate, Tolbutamide, Valacyclovir, Vardenafil, Varenicline, Venlafaxine, Vitamin A, Von Willebrand factor• Voriconazole, Vytorin, Zafirlukast, Zaleplon, Zidovudine, Zileuton, Zomepirac, Zopiclone, vandetanib
Ear Nose Throat Angina tonsillaris, Nasal polyp, Otitis externa, Otitis media, Pharyngitis, Rhinolith , Peritonsillar abscess, Strep throat, Sinusitis, Trochleitis, Tonsillitis, Upper respiratory tract infection,
Endocrine Acromegaly, Addison’s disease, Conn syndrome, Diabetes mellitus, Hypoglycemia, Hyperaldosteronism, Hyperparathyroidism, Hyperpituitarism, Insulinoma, Menopause, Multiple endocrine neoplasia type 1, Pituitary tumour (growth hormone secreting), Polycystic Ovarian Syndrome,
Environmental Conditions Airsickness, Altitude sickness, Brain freeze, Diesel particulate matter, Heat stroke, Ice cream headache, Multiple chemical sensitivity, Second-hand smoke,
Gastroenterologic Crohn’s disease, Inflammatory Bowel Disease,
Genetic No underlying causes,
Hematologic Anemia, Blood transfusion, Leukemia, Multiple myeloma,
Infectious Disease Acute Disseminated Encephalomyelitis, Acute viral nasopharyngitis (common cold), Adenoiditis, AIDS, Alkhurma virus, Anaplasmosis, Aseptic meningitis, Aspergillus clavatus, Astrovirus, Blastomycosis, Bolivian hemorrhagic fever, Byssinosis, Brucellosis, Bruxism, Boutonneuse fever, Campylobacteriosis, California encephalitis virus, Chagas disease, Chikungunya, Cladosporium, Cotton fever, Coxsackie B, Cryptococcosis, Cysticercosis, Dengue fever, Dental infection, Ebola, Encephalitis, Fever, Feverfew, Freshers’ Flu, Giardia lamblia, Glioblastoma multiforme, Gradenigo’s syndrome, Group A streptococcal infection, Haemophilus influenzae serotype B infection, Hangover, Hantavirus, Hay fever, Harvest mite, Henipavirus, Herpes zoster, Hepatitis, Herpesviridae, HIV, Japanese encephalitis[, Hymenolepis infection, Influenza, Intracranial abscess / granuloma, Lábrea fever, Legionellosis, Lenvatinib , Leptospirosis, Listeriosis, Lyme disease, Malaria, Marburg virus, Mansonelliasis, Meningococcemia, Meningoencephalitis, Metabolic acidosis, Metal fume fever, Mononucleosis, Micropolyspora faeni, Monkeypox virus, Mucormycosis, Mumps, Mycoplasma pneumoniae, Naegleria fowleri, Naegleria infection, Neisseria meningitidis, Nipah virus encephalitis, Nocardiosis, Norovirus, Oropouche fever, Pityriasis rosea, Psittacosis, Q fever, Ramsay Hunt syndromes, Rat-bite fever, Relapsing fever, Rhinovirus, Rickettsial infections, Rift valley fever, Ross River Fever, Rocky Mountain spotted fever, Rubella, Saccharopolyspora rectivirgula, Snakebite, Scarlet fever, Scrumpox, Shingles, Siraitia grosvenorii, Sitophilus granarius, Sodoku, St. Louis encephalitis, Staphylococcal enteritis, Streptobacillus, Syphilis, Thermoactinomyces sacchari, Thermoactinomyces vulgaris, Trench fever, Trichinosis, Tuberculous meningitis, Tularemia, Typhoid fever, Viral Gastroenteritis, Viral Hepatitis C, West Nile Virus, Yellow fever, Yersinia Pestis Infection, Zika fever,
Musculoskeletal / Ortho Cervical spondylosis, Temporomandibular joint disorder,
Neurologic Acoustic neuroma, Apoplexy, Arachnoid cyst, Arcuate foramen, Acute disseminated encephalomyelitis, Arnold nerve cough syndrome, Epilepsy, Idiopathic intracranial hypertension, Multiple sclerosis, Pituitary apoplexy, Posterior cervical sympathetic syndrome, Posterior leucoencephalopathy syndrome, Raised intracranial pressure, Spinal autonomic dysreflexia, West syndrome,
Nutritional / Metabolic Thiamine (Vitamin B1) deficiency,
Obstetrics & Gynecology Eclampsia, Pre-eclampsia, Pregnancy, Premenstrual syndrome,
Oncologic Acoustic neuroma, Adrenal carcinoma, Adrenal tumor, Astrocytoma, Atypical Teratoid Rhabdoid Tumor, Brain tumor, Brain Stem Gliomas, Carcinoid tumours and carcinoid syndrome, Craniopharyngioma, Ependymoma, Gliomatosis cerebri, Medulloblastoma, Meningioma, Oligoastrocytoma, Phaeochromocytoma, Polycythaemia rubra vera, Subdural hygroma, Tongue cancer,
Opthalmologic Acute posterior multifocal placoid pigment epitheliopathy, Aneisokonia, Asthenopia, Computer vision syndrome, Ocular Neurosis, Oculogyric crisis, Progressive lenses,
Overdose / Toxicity Acute alcohol intoxication, Alcohol withdrawal, Alcoholism, Medication overuse,
Psychiatric Anxiety disorder, Functional disorders, Primary affective disorder, Chronic stress, Clinical depression, Workplace stress, Gulf War syndrome,
Pulmonary Acute bronchitis, Bird breeder’s lung, Bird fancier’s lung, Cheese worker’s lung, Chemical worker’s lung, Cough, Community-acquired pneumonia, Grain handler’s lung, Hot tub lung, Humidifier lung, Hypersensitivity pneumonitis, Lower respiratory tract infection, Malt worker’s lung, Nylon worker’s lung, Obesity hypoventilation syndrome, Paprika splitter’s lung,
Renal / Electrolyte Diabetic nephropathy, Hypercalcemia, Hyponatremia,
Rheum / Auto Immune / Allergy Antiphospholipid syndrome, Polymyalgia rheumatica, Systemic lupus erythematosus, Takayasu arteritis, Temporal arteritis, Wegener’s granulomatosis,
Trauma Cervical spine trauma, Dental trauma,
Vascular Diseases & Malformations Arteriovenous malformation, Berry aneurysm, Carotid artery dissection, Cavernous angioma, Cavernous Sinus Thrombosis, Cerebral venous sinus thrombosis, Cerebellar infarction, Cerebral aneurysm, Cerebral arteriovenous malformation, Cerebrovascular accident, Cerebrovascular disease, Epidural hematoma, Intracranial haemorrhage, Migraine, Posterior communicating artery aneurysm, Subarachnoid haemorrhage, Superior vena cava syndrome, Vascular headache, Vertebral artery dissection, Vertebro-basilar artery syndrome,
Miscellaneous Agastache rugosa, Bearberry, Cluster headache, Colloid cyst of third ventricle, Hepatic failure, Intracranial space-occupying lesion, Paroxysmal hemicrania, chronic, Parry-Romberg syndrome, Reversible posterior leukoencephalopathy syndrome, Spontaneous intracranial hypotension, Standing (position), Thunderclap headache,

Causes by alphabetical order

References

  1. ↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
  2. ↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X

Editor-In-Chief: Robert G. Schwartz, M.D. [1], Piedmont Physical Medicine and Rehabilitation, P.A.; : Cafer Zorkun, M.D., Ph.D. [2]

Differentiating Headache from other Diseases

Differentiating Headache from other Diseases

Differential diagnosis of headache includes: Migraine, tension-type headache, cluster headache, seizure, meningitis, encephalitis, neurosyphilis, SAH, subdural hematoma, brain tumor, hypertensive encephalopathy, brain abscess, multiple sclerosis, hemorrhagic stroke, Wernickes encephalopathy, and drug toxicity etc.[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]

Disease History and Physical Examination PMHx Diagnostic approach
Bilateral Throbbing character Autonomic symptoms Fever Photophobia Aphasia LOC Aura Nause/

Vomiting

Rash Neck stiffness Vision changes Neurologic deficits Labs and CSF findings CT/MRI Gold standard test
Migraine – + – – + – – + + – – + – Trigger factors, family hx – – Clinical assesment
Tension-type headache (TTH) + – – – – – – – – – – – – stress, genetics – – Clinical assesment
Cluster headache – – + – – – – – – – – + – episodic history – – Clinical assesment
Seizure + – – – – +/- + +/- – – – – +/- Hx of seizures prolactin level +/- mass lesion EEG [20]
Meningitis + – – + +/- +/- – – +/- +/- + – + Hx of fever, malaise <math>\uparrow</math>WBC

<math>\uparrow</math>Protein

<math>\downarrow</math>glucose

+/- CSF analysis[21]
Encephalitis + +/- – + +/- +/- – – – +/- + – + Hx of fever, malaise elevated WBC, low glucose + CSF PCR
Brain tumor[22] + – – – – +/- – – +/- – – +/- +/- weight loss, fatigue neuromarkers,

Cancer cells[23]

+/- mass MRI
Subdural hemorrhage -/+ +/- – – – +/- – – – – – +/- +/- Trauma, fall Xanthochromia + CT w/o contrast
Subarachnoid hemorrhage -/+ +/- – – +/- +/- – – – – +/- +/- +/- thunderclap headache <math>\uparrow</math>opening pressure, xanthochromia + CT w/o contrast
Hypertensive encephalopathy + +/- – – +/- – – – – – – +/- – Hypertension UA +/- +/- clinical assessment
CNS abscess -/+ – – + – +/- – – +/- +/- +/- +/- +/- History of drug abuse, endocarditis, immunosupression ↑ leukocytes, ↓ glucose and ↑ protien + MRI
Conversion disorder -/+ – – – – +/- – – – – +/- +/- +/- History of emotional stress – – Diagnosis of exclusion
Multiple sclerosis -/+ – – – – – – – – – – + +/- History of relapses and remissions ↑ CSF IgG levels

(monoclonal bands)

+ MRI
Hemorrhagic stroke -/+ +/- – – – +/- – – – – – +/- +/- HTN – + CT scan without contrast[24][25]
Neurosyphilis[26][27] -/+ – – – – – +/- – – +/- – +/- +/- STIs ↑ Leukocytes and protein + CSF VDRL-specifc

CSF FTA-Ab -sensitive[28]

Wernicke’s encephalopathy -/+ – – – – +/- – – – – – +/- +/- History of alcohal abuse blood ethanol levels +/- Clinical assesment and lab findings
Drug toxicity -/+ – – +/- – – +/- – +/- – +/- +/- +/- Medication hx Drug levels – Drug screen test
Metabolic disturbances -/+ – – – – – – – +/- – – +/- +/- Underlying CKD, CLD Hypoglycemia, hypo and hypernatremia, hypo and hyperkalemia – Cause dependent
Sinusitis -/+ – – +/- – – – – – – – – – allergies, seasonal leukocytosis + CT

Diagnsotic Labs For Meningitis

Diagnosis of meningitis, is based on clinical presentation in combination with CSF analysis. CSF analysis has major role for diagnosis and rule out other possibilities. The following table summarizes the CSF findings in different types of meningitis.[2][3][4][5][6]

Cerebrospinal fluid level Normal level Bacterial meningitis[5] Viral meningitis[5] Fungal meningitis Tuberculous meningitis[29] Neoplastic meningitis[2]
Cells/ul < 5 >300 10-1000 10-500 50-500 >4
Cells Lymphocyte Leukocyte > Lymphocyte Lymphocyte > Leukocyte Lymphocyte > Leukocyte Lymphocyte > Leukocyte Lymphocyte > Leukocyte
Total protein (mg/dl) 45-60 Typically 100-500 Normal or slightly high High Typically 100-200 >50
Glucose ratio (CSF/plasma)[3] > 0.5 < 0.3 > 0.6 <0.3 < 0.5 <0.5
Lactate (mmols/l)[4] < 2.1 > 2.1 < 2.1 >3.2 > 2.1 >2.1
Others Intra-cranial pressure (ICP) = 6-12 (cm H2O) CSF gram stain, CSF culture, CSF bacterial antigen PCR of HSV-DNA, VZV CSF gram stain, CSF india ink PCR of TB-DNA CSF tumour markers such as alpha fetoprotein, CEA

References

  1. ↑ “National guidelines for analysis of cerebrospinal fluid for bilirubin in suspected subarachnoid haemorrhage”. Ann. Clin. Biochem. 40 (Pt 5): 481–8. September 2003. doi:10.1258/000456303322326399. PMID 14503985.
  2. ↑ 2.0 2.1 2.2 Le Rhun E, Taillibert S, Chamberlain MC (2013). “Carcinomatous meningitis: Leptomeningeal metastases in solid tumors”. Surg Neurol Int. 4 (Suppl 4): S265–88. doi:10.4103/2152-7806.111304. PMC 3656567. PMID 23717798.
  3. ↑ 3.0 3.1 3.2 Chow E, Troy SB (2014). “The differential diagnosis of hypoglycorrhachia in adult patients”. Am J Med Sci. 348 (3): 186–90. doi:10.1097/MAJ.0000000000000217. PMC 4065645. PMID 24326618.
  4. ↑ 4.0 4.1 4.2 Leen WG, Willemsen MA, Wevers RA, Verbeek MM (2012). “Cerebrospinal fluid glucose and lactate: age-specific reference values and implications for clinical practice”. PLoS One. 7 (8): e42745. doi:10.1371/journal.pone.0042745. PMC 3412827. PMID 22880096.
  5. ↑ 5.0 5.1 5.2 5.3 Negrini B, Kelleher KJ, Wald ER (2000). “Cerebrospinal fluid findings in aseptic versus bacterial meningitis”. Pediatrics. 105 (2): 316–9. PMID 10654948.
  6. ↑ 6.0 6.1 Brouwer MC, Tunkel AR, van de Beek D (2010). “Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis”. Clin Microbiol Rev. 23 (3): 467–92. doi:10.1128/CMR.00070-09. PMC 2901656. PMID 20610819.
  7. ↑ Vermeulen M, Hasan D, Blijenberg BG, Hijdra A, van Gijn J (July 1989). “Xanthochromia after subarachnoid haemorrhage needs no revisitation”. J. Neurol. Neurosurg. Psychiatry. 52 (7): 826–8. doi:10.1136/jnnp.52.7.826. PMC 1031927. PMID 2769274.
  8. ↑ Wasay M, Mekan SF, Khelaeni B, Saeed Z, Hassan A, Cheema Z, Bakshi R (June 2005). “Extra temporal involvement in herpes simplex encephalitis”. Eur. J. Neurol. 12 (6): 475–9. doi:10.1111/j.1468-1331.2005.00999.x. PMID 15885053.
  9. ↑ Glaser CA, Honarmand S, Anderson LJ, Schnurr DP, Forghani B, Cossen CK, Schuster FL, Christie LJ, Tureen JH (December 2006). “Beyond viruses: clinical profiles and etiologies associated with encephalitis”. Clin. Infect. Dis. 43 (12): 1565–77. doi:10.1086/509330. PMID 17109290.
  10. ↑ Meltzer EO, Hamilos DL (May 2011). “Rhinosinusitis diagnosis and management for the clinician: a synopsis of recent consensus guidelines”. Mayo Clin. Proc. 86 (5): 427–43. doi:10.4065/mcp.2010.0392. PMC 3084646. PMID 21490181.
  11. ↑ Rasmussen BK, Jensen R, Schroll M, Olesen J (1991). “Epidemiology of headache in a general population–a prevalence study”. J Clin Epidemiol. 44 (11): 1147–57. doi:10.1016/0895-4356(91)90147-2. PMID 1941010.
  12. ↑ Kelman L (October 2004). “The premonitory symptoms (prodrome): a tertiary care study of 893 migraineurs”. Headache. 44 (9): 865–72. doi:10.1111/j.1526-4610.2004.04168.x. PMID 15447695.
  13. ↑ Laurell K, Artto V, Bendtsen L, Hagen K, Häggström J, Linde M, Söderström L, Tronvik E, Wessman M, Zwart JA, Kallela M (September 2016). “Premonitory symptoms in migraine: A cross-sectional study in 2714 persons”. Cephalalgia. 36 (10): 951–9. doi:10.1177/0333102415620251. PMID 26643378.
  14. ↑ Charlotte E. Grayson and The Cleveland Clinic Neuroscience Center (October 2004). “Cluster Headaches”. WebMD. Retrieved 2006-09-22.
  15. ↑ Drummond PD (October 1994). “Sweating and vascular responses in the face: normal regulation and dysfunction in migraine, cluster headache and harlequin syndrome”. Clin. Auton. Res. 4 (5): 273–85. doi:10.1007/BF01827433. PMID 7888747.
  16. ↑ Drummond PD (June 2006). “Mechanisms of autonomic disturbance in the face during and between attacks of cluster headache”. Cephalalgia. 26 (6): 633–41. doi:10.1111/j.1468-2982.2006.01106.x. PMID 16686902.
  17. ↑ Ekbom K (August 1990). “Evaluation of clinical criteria for cluster headache with special reference to the classification of the International Headache Society”. Cephalalgia. 10 (4): 195–7. doi:10.1046/j.1468-2982.1990.1004195.x. PMID 2245469.
  18. ↑ Sandrini G, Antonaci F, Pucci E, Bono G, Nappi G (December 1994). “Comparative study with EMG, pressure algometry and manual palpation in tension-type headache and migraine”. Cephalalgia. 14 (6): 451–7, discussion 394–5. doi:10.1046/j.1468-2982.1994.1406451.x. PMID 7697707.
  19. ↑ Jensen R, Fuglsang-Frederiksen A (June 1994). “Quantitative surface EMG of pericranial muscles. Relation to age and sex in a general population”. Electroencephalogr Clin Neurophysiol. 93 (3): 175–83. doi:10.1016/0168-5597(94)90038-8. PMID 7515793.
  20. ↑ Manford M (2001). “Assessment and investigation of possible epileptic seizures”. J Neurol Neurosurg Psychiatry. 70 Suppl 2: II3–8. PMC 1765557. PMID 11385043.
  21. ↑ Carbonnelle E (2009). “[Laboratory diagnosis of bacterial meningitis: usefulness of various tests for the determination of the etiological agent]”. Med Mal Infect. 39 (7–8): 581–605. doi:10.1016/j.medmal.2009.02.017. PMID 19398286.
  22. ↑ Morgenstern LB, Frankowski RF (1999). “Brain tumor masquerading as stroke”. J Neurooncol. 44 (1): 47–52. PMID 10582668.
  23. ↑ Weston CL, Glantz MJ, Connor JR (2011). “Detection of cancer cells in the cerebrospinal fluid: current methods and future directions”. Fluids Barriers CNS. 8 (1): 14. doi:10.1186/2045-8118-8-14. PMC 3059292. PMID 21371327.
  24. ↑ Birenbaum D, Bancroft LW, Felsberg GJ (2011). “Imaging in acute stroke”. West J Emerg Med. 12 (1): 67–76. PMC 3088377. PMID 21694755.
  25. ↑ DeLaPaz RL, Wippold FJ, Cornelius RS, Amin-Hanjani S, Angtuaco EJ, Broderick DF; et al. (2011). “ACR Appropriateness Criteria® on cerebrovascular disease”. J Am Coll Radiol. 8 (8): 532–8. doi:10.1016/j.jacr.2011.05.010. PMID 21807345.
  26. ↑ Liu LL, Zheng WH, Tong ML, Liu GL, Zhang HL, Fu ZG; et al. (2012). “Ischemic stroke as a primary symptom of neurosyphilis among HIV-negative emergency patients”. J Neurol Sci. 317 (1–2): 35–9. doi:10.1016/j.jns.2012.03.003. PMID 22482824.
  27. ↑ Berger JR, Dean D (2014). “Neurosyphilis”. Handb Clin Neurol. 121: 1461–72. doi:10.1016/B978-0-7020-4088-7.00098-5. PMID 24365430.
  28. ↑ Ho EL, Marra CM (2012). “Treponemal tests for neurosyphilis–less accurate than what we thought?”. Sex Transm Dis. 39 (4): 298–9. doi:10.1097/OLQ.0b013e31824ee574. PMC 3746559. PMID 22421697.
  29. ↑ Caudie C, Tholance Y, Quadrio I, Peysson S (2010). “[Contribution of CSF analysis to diagnosis and follow-up of tuberculous meningitis]”. Ann Biol Clin (Paris). 68 (1): 107–11. doi:10.1684/abc.2010.0407. PMID 20146981.

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Epidemiology and Demographics

Epidemiology and Demographics

Overview

The prevalence of cluster headache is approximately 3 to 150 per 100,000 individuals worldwide.*Worldwide Prevalence of patient with secondary headache is approximately 18%. The prevalence of Migraine headache is estimated to be 12 to 15 percent of general population.The prevalence of frequent episodic tension type headache is 21.6 percent.Patients of all age groups may develop headache.Cluster headache commonly affects individuals between 20 to 40years of age.Cluster headache usually affects women of the Aferican -American and Caucasians.women are more commonly affected by migraine than men. Men are more commonly affected by cluster than women. The male to female ratio is approximately 2.5 to 1.

Epidemiology and Demographics

Prevalence

  • The prevalence of cluster headache is approximately 3 to 150 per 100,000 individuals worldwide.[1]
  • Worldwide Prevalence of patient with secondary headache is approximately 18%.[2]
  • The prevalence of Migraine headache is estimated to be 12 to 15 percent of general population.[3]
  • The prevalence of frequent episodic tension type headache is 21.6 percent.[4]

Age

  • Patients of all age groups may develop headache.
  • Cluster commonly affects individuals between 20 to 40years of age. [5]
  • The incidence of tension type headache peaked in the fourth decade.[4]

Race

  • Cluster headache usually affects women of the Aferican -American and Caucasians.[6]

Gender

  • women are more commonly affected by migraine than men.
  • Men are more commonly affected by cluster than women. The male to female ratio is approximately 2.5 to 1.[1]

References

  1. ↑ 1.0 1.1 Wei DY, Yuan Ong JJ, Goadsby PJ (2018). “Cluster Headache: Epidemiology, Pathophysiology, Clinical Features, and Diagnosis”. Ann Indian Acad Neurol. 21 (Suppl 1): S3–S8. doi:10.4103/aian.AIAN_349_17. PMC 5909131. PMID 29720812.
  2. ↑ Do TP, Remmers A, Schytz HW, Schankin C, Nelson SE, Obermann M; et al. (2019). “Red and orange flags for secondary headaches in clinical practice: SNNOOP10 list”. Neurology. 92 (3): 134–144. doi:10.1212/WNL.0000000000006697. PMC 6340385. PMID 30587518.
  3. ↑ Lipton RB, Stewart WF, Diamond S, Diamond ML, Reed M (2001). “Prevalence and burden of migraine in the United States: data from the American Migraine Study II”. Headache. 41 (7): 646–57. doi:10.1046/j.1526-4610.2001.041007646.x. PMID 11554952.
  4. ↑ 4.0 4.1 Russell MB, Levi N, Saltyte-Benth J, Fenger K (2006). “Tension-type headache in adolescents and adults: a population based study of 33,764 twins”. Eur J Epidemiol. 21 (2): 153–60. doi:10.1007/s10654-005-6031-3. PMID 16518684.
  5. ↑ Weaver-Agostoni J (2013). “Cluster headache”. Am Fam Physician. 88 (2): 122–8. PMID 23939643.
  6. ↑ Reed C, Gordon S (1966). “Anaemia and polycythaemia in haemorrhagic telangiectasia”. Med J Aust. 1 (11): 449–51. doi:10.5694/j.1326-5377.1966.tb72472.x. PMID 5909131.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Risk Factors

Risk Factors

Overview

Common risk factors in the development of headache may be occupational, environmental, and genetic.Common risk factors in the development of migraine divided in three categories: non-modifiable, modifiable, and putative. Non-modifiable risk factors include female gender, age, white race, low educational level, socioeconomic status, and genetic factors.Modifiable risk factors include,obesity, medication overuse,stressful life events, caffeine overuse, other pain syndromes.

Risk Factors

The most risk factors in the development of headache are: [1][2]

Common Risk Factors

  • Common risk factors in the development of headache may be occupational, environmental, and genetic.
  • Common risk factors in the development of migraine include:
    • age
    • female gender
    • white race
    • genetic factors
    • Obesity
    • Medication overuse
    • Stressful life events

Less Common Risk Factors

  • Less common risk factors in the development of migraine include:
    • Caffeine overuse
    • Snoring
    • Other pain syndromes[1]

References

  1. ↑ 1.0 1.1 Bigal M (2009). “Migraine chronification–concept and risk factors”. Discov Med. 8 (42): 145–50. PMID 19833063.
  2. ↑ Bentley RE (1971). “The on-line applications of a small digital computer to a gamma scintillation camera”. Br J Radiol. 44 (517): 77. PMID 5539409.

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Editor-In-Chief: Robert G. Schwartz, M.D. [1], Piedmont Physical Medicine and Rehabilitation, P.A.; : Cafer Zorkun, M.D., Ph.D. [2]

Natural History, Complications and Prognosis

Natural History, Complications and Prognosis

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Overview

The symptoms of cluster headache usually decreased with age.13% of patients with initial episodic cluster headache may progress to develop chronic cluster headache.33% of patients with initial episodic cluster headache may progress to episodic pattern.

Natural History, Complications, and Prognosis

Natural History

  • The symptoms of cluster headache usually decreased with age.
  • 13% of patients with initial episodic cluster headache may progress to develop chronic cluster headache.
  • 33% of patients with initial episodic cluster headache may progress to episodic pattern.[1]

Complications

  • Status migrainosus: The migraine episode lasts more than 72 hours.
  • Persistent aura without infarction: The symptoms of aura last for more than a week in the absence of any neuroimaging findings suggestive of infarction.
  • Migrainous infarction: The symptoms of aura last for more than a week in the context of any neuroimaging findings suggestive of infarction in the corresponding brain territory.
  • Seizure triggered by a migrainous aura[2]

Prognosis

  • 13% of patients with initial episodic cluster headache may progress to develop chronic cluster headache.
  • 33% of patients with initial episodic cluster headache may progress to episodic pattern.[1]

References

  1. ↑ 1.0 1.1 Wei DY, Yuan Ong JJ, Goadsby PJ (2018). “Cluster Headache: Epidemiology, Pathophysiology, Clinical Features, and Diagnosis”. Ann Indian Acad Neurol. 21 (Suppl 1): S3–S8. doi:10.4103/aian.AIAN_349_17. PMC 5909131. PMID 29720812.
  2. ↑ Headache Classification Committee of the International Headache Society (IHS) (2013). “The International Classification of Headache Disorders, 3rd edition (beta version)”. Cephalalgia. 33 (9): 629–808. doi:10.1177/0333102413485658. PMID 23771276.

References

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Editor-In-Chief: Robert G. Schwartz, M.D. [1], Piedmont Physical Medicine and Rehabilitation, P.A.; : Cafer Zorkun, M.D., Ph.D. [2]

Diagnosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | | CT | MRI | Ultrasound | Other Imaging Findings | Other Diagnostic Studies

Treatment

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case Studies

Case #1

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Editor-In-Chief: Robert G. Schwartz, M.D. [1], Piedmont Physical Medicine and Rehabilitation, P.A.; :Niloofarsadaat Eshaghhosseiny, MD[2] Cafer Zorkun, M.D., Ph.D. [3]

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