Acute Generalized Headache

Aka: Acute Generalized Headache, Acute Secondary Headache, Generalized Headache

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II. Causes: Acute Secondary Headache

  1. Infection
    1. Systemic infection
    2. Viral Encephalitis
    3. Meningitis
      1. Fever with neck stiffness
  2. Metabolic
    1. Electrolyte disturbance
    2. Hypoglycemia
    3. Hypoxia
    4. Hypercapnia
  3. Toxins
    1. Lead Poisoning
    2. Carbon Monoxide Poisoning
      1. Flu-like symptoms in multiple house mates
      2. Progressively worse each morning
    3. Chemical Dependency or withdrawal
  4. Vascular causes
    1. Subarachnoid Hemorrhage
      1. Sudden onset, new worst Headache
    2. Cerebrovascular Accident (CVA or TIA)
    3. Cerebellar infarction
      1. Headache with Dizziness
    4. Vascular Malformation (not ruptured)
    5. Temporal Arteritis
      1. Headache with localized pain, tenderness, and nodularity over temporal region
      2. Jaw Claudication is pathognomonic
    6. Arterial Hypertension
      1. Blood Pressure over 180-200/120
    7. Cerebral Venous Sinus Thrombosis
      1. Associated with Hypercoagulable state and head and neck infections
    8. Venous thrombosis or Thromboembolism
    9. Cervical Artery Dissection (Carotid Artery Dissection, Vertebral Artery Dissection)
      1. Similar presentation to Subarachnoid Hemorrhage with facial or Neck Pain
      2. Associated with Cranial Nerve abnormalities
    10. Collagen Vascular disease
    11. Reversible Cerebral Vasoconstriction Syndrome
  5. Cerebrospinal fluid pressure
    1. Spinal Headache or Idiopathic Intracranial Hypotension (low CSF Pressure)
    2. Pseudotumor Cerebri (high CSF Pressure)
      1. Overweight, young women
  6. Miscellaneous causes
    1. Post-Seizure
    2. Preeclampsia
    3. Intracranial Mass
      1. New, progressively worse Headache in age over 50 or malignancy history
      2. Worse in mornings and in head down position
    4. Pituitary Apoplexy
      1. Pituitary Adenoma with bleeding and localized swelling
      2. Thunderclap Headache with Vomiting and Visual Field Deficits
    5. Acute Post-Traumatic Headache
      1. High risk for Subdural Hematoma in Coagulopathy or Anticoagulation
    6. Acute Angle-Closure Glaucoma
      1. Painful Red Eye with fixed pupil, light sensitivity and cloudy Cornea

III. Evaluation

  1. See Headache Red Flags
  2. See Headache History
  3. See Headache Examination
  4. See Headache Diagnostic Testing
  5. See Neuroimaging in Headache

IV. References

  1. Edlow and Weinstock (2013) EM:Rap 13(12): 7-8
  2. Dalessio (1994) Neurology 44:S6-12 [PubMed]
  3. Diamond (1997) Postgrad Med 101(1):169-79 [PubMed]
  4. Dodlick (1997) Postgrad Med 101(5):46-64 [PubMed]
  5. Newman (1998) Neurol Clin 16:285-303 [PubMed]
  6. Tabatabai (2021) Emerg Med Clin North Am 39(1): 67-85 [PubMed]

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