Secondary Headache Syndromes

Denise E. Chou, MD Headache p. 1179-1191 August 2018, Vol.24, No.4 doi: 10.1212/CON.0000000000000640
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PURPOSE OF REVIEW This article is intended to assist clinicians in distinguishing benign primary headache syndromes from serious headache presentations that arise from exogenous causes.

RECENT FINDINGS Although most cases of severe headache are benign, it is essential to recognize the signs and symptoms of potentially life-threatening conditions. Patients with primary headache disorders can also acquire secondary conditions that may present as a change in their baseline headache patterns and characteristics. Clinical clues in the history and examination can help guide the diagnosis and management of secondary headache disorders. Furthermore, advances in the understanding of basic mechanisms of headache may offer insight into the proposed pathophysiology of secondary headaches.

SUMMARY Several structural, vascular, infectious, inflammatory, and traumatic causes of headache are highlighted. Careful history taking and examination can enable prompt identification and treatment of underlying serious medical disorders causing secondary headache syndromes.

Address correspondence to Dr Denise E. Chou, 1 Amgen Center Dr, Thousand Oaks, CA 91320, [email protected].

RELATIONSHIP DISCLOSURE: Dr Chou has received personal compensation for serving on the advisory boards of Allergan, Amgen Inc, Eli Lilly and Company, Pernix Therapeutics, and Teva Pharmaceutical Industries Ltd; as a speaker for the American Academy of Neurology, Medscape Inc, and the PeerView Institute; and has received research/grant support as a principal investigator for Alder BioPharmaceuticals, Inc; Capnia, Inc; CEFALY Technology; and Teva Pharmaceutical Industries Ltd. Dr Chou is an employee of Amgen Inc.

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Dr Chou discusses the unlabeled/investigational use of glucocorticoids for the treatment of giant cell arteritis and Tolosa-Hunt syndrome, indomethacin for the treatment of hemicrania continua, and nonsteroidal anti-inflammatory drugs and oral or locally injected steroids for the treatment of primary trochlear headache (trochleitis).

CONTINUUM AUDIO INTERVIEW AVAILABLE ONLINE

© 2018 American Academy of Neurology.