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Chapter 7: Headaches

Michael O'Donnell

Description of the Symptom

This chapter describes pathology that may lead to headaches. Local causes are defined as pathology occurring within the cranial vault, as well as the temporomandibular joint (Fig. 7-1). Remote causes are defined as occurring outside this region. Each symptom description in this chapter is followed by a brief summary of clinical presentation.

FIGURE 7-1

Local causes of headache include cranium, contents of the cranial vault, articular and periarticular structures of the temporomandibular joint, and nasal sinuses. (A) Anterior lateral view; (B) posterior lateral view.

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Special Concerns

Headache with:

  • Awakening from sleep

  • History of head trauma inside of 2 weeks

  • Neurological symptoms, such as dizziness, paresthesias, or weakness

  • New onset after age 50

  • New onset of headache in patient with risk factors for cancer or HIV infection

  • Progressing intensity or frequency

  • Signs of illness, such as fever, nuchal rigidity, or rash

  • Signs of papilledema

  • Sudden onset of headache

  • Worsening with exertion or Valsalva maneuver

CHAPTER PREVIEW: Conditions That May Lead to Headache
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CHAPTER PREVIEW: Conditions That May Lead to Headache
T  Trauma
REMOTE LOCAL
COMMON
Cervicogenic headache 57 Post-traumatic headache 67
UNCOMMON
Not applicable Temporomandibular dysfunction 71
RARE
Not applicable Not applicable
I  Inflammation
REMOTE LOCAL
COMMON
Not applicable

Aseptic

Not applicable

Septic

Fever-induced headache 63

Meningitis 66

Sinusitis 68
UNCOMMON
Not applicable

Aseptic

Encephalitis 62

Temporal arteritis 70

Septic

Not applicable
RARE
Not applicable Not applicable
M Metabolic
REMOTE LOCAL
COMMON
Not applicable

Hypoglycemia 63

Medication overuse headache 65
UNCOMMON
Not applicable Not applicable
RARE
Not applicable

Benign exertional headache 60

Benign sexual headache 61

Hypoxia 64
Va  Vascular
REMOTE LOCAL
COMMON
Not applicable Not applicable
UNCOMMON
Not applicable

Arterial dissection (carotid and vertebral) 60

Carotid artery dissection 60

Idiopathic intracranial hypertension (pseudotumor cerebri) 64

Idiopathic intracranial hypotension 65

Stroke or transient ischemic attack 68

Subdural hematoma 69
RARE
Not applicable

Arterial dissection (carotid and vertebral) 60

Subarachnoid hemorrhage 69

Vertebral artery dissection 60
De  Degenerative
REMOTE LOCAL
COMMON
Not applicable Not applicable
UNCOMMON
Not applicable Not applicable
RARE
Not applicable Not applicable
Tu  Tumor
REMOTE LOCAL
COMMON
Not applicable Not applicable
UNCOMMON
Not applicable Not applicable
RARE
Not applicable

Tumors (brain) 72

Tumors leading to headaches:

  • Acoustic neuroma 72

  • Central nervous system 72

  • Leptomeningeal metastasis 72

  • Meningeal tumors 72

  • Primary brain tumors 72

  • Skull base tumors 72
Co Congenital
REMOTE LOCAL
COMMON
Not applicable Not applicable
UNCOMMON
Not applicable Not applicable
RARE
Not applicable Not applicable
Ne Neurogenic/Psychogenic
REMOTE LOCAL
COMMON
Not applicable

Migraine 66

Tension-type headache 71
UNCOMMON
Not applicable Not applicable
RARE
Not applicable Cluster headaches 61

Note: These are estimates of relative incidence because few data are available for the less common conditions.

Overview of Headache

The International Headache Society ...

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