Chronic Progressive Headache

Aka: Chronic Progressive Headache, Organic Headache, Secondary Headache

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II. Risk Factors

  1. See See Headache Red Flag
  2. Primary Headache onset over age 50 years (esp. age >65 years)
  3. Known malignancy (esp. Lung Cancer, Breast Cancer, malignant Melanoma)
  4. Cluster Headache

III. Causes

  1. Acute
    1. See Acute Generalized Headache
  2. Chronic
    1. Increased Intracranial Pressure (e.g. mass effect)
      1. Intracranial Tumor
      2. Pseudotumor Cerebri
      3. Brain Abscess
      4. Subdural Hematoma
      5. Hydrocephalus
      6. Arachnoid cyst (rare)
    2. Vascular disorder
      1. Arteriovenous Malformation
      2. Giant Cell Arteritis (Temporal Arteritis)
      3. Carotid dissection
      4. Vasculitis

IV. Findings: Symptoms and Signs

  1. See Headache Red Flag
  2. See Headache History
  3. See Headache Examination
  4. Exertional Headache (or Headache worse with Valsalva Maneuver)

V. Exam: Focus Areas

  1. Careful Neurologic Exam (focus on symmetry)
    1. Brain Tumors presenting with neurologic change: 92%
    2. Vasquez-Barquero (1994) Cephalalgia 14:270-2 [PubMed]
  2. Altered Level of Consciousness
  3. Cognitive changes
  4. Nonspecific Vital Sign changes
  5. Meningismus (e.g. Nuchal Rigidity)
  6. Fever
  7. Careful Eye Neurologic Exam
    1. Asymmetric pupils or other abnormal pupil changes
    2. Papilledema
    3. Retinal Hemorrhage
  8. Deep Tendon Reflexes
  9. Pronator Drift
    1. Eyes closed with arms extended in front of patient

VI. Imaging

  1. See Headache Diagnostic Testing
  2. Head CT or MRI Head

VII. References

  1. Coutin (1996) Am Fam Physician 54(7):2247-52 [PubMed]
  2. Dodlick (1997) Postgrad Med 101(5):46-64 [PubMed]
  3. Ryan (1996) Am Fam Physician 54(3):1051-7 [PubMed]
  4. Viera (2022) Am Fam Physician 106(3): 260-8 [PubMed]

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Related Studies

Ontology: Headache Disorders, Secondary (C1565107)

Definition (MSH) Conditions with HEADACHE symptom that can be attributed to a variety of causes including BRAIN VASCULAR DISORDERS; WOUNDS AND INJURIES; INFECTION; drug use or its withdrawal.
Concepts Disease or Syndrome (T047)
MSH D051271
Swedish Huvudvärksproblem, sekundära
Finnish Sekundaariset päänsäryt
Russian GOLOVNAIA BOL', VYZVANNAIA CHREZMERNYM PRIMENENIEM ANAL'GETIKOV, GOLOVNOI BOLI SINDROMY VTORICHNYE, ГОЛОВНАЯ БОЛЬ, ВЫЗВАННАЯ ЧРЕЗМЕРНЫМ ПРИМЕНЕНИЕМ АНАЛЬГЕТИКОВ, ГОЛОВНОЙ БОЛИ СИНДРОМЫ ВТОРИЧНЫЕ
English Headache Disorders, Secondary [Disease/Finding], Disorder, Secondary Headache, Disorders, Secondary Headache, Headache Disorder, Secondary, Headache Disorders, Secondary, Secondary Headache Disorders, Secondary Headache Disorder
Japanese 二次性頭痛, 二次性頭痛障害, 鎮痛剤過剰服用性頭痛, 頭痛障害-二次性, 頭痛障害-鎮痛剤過剰服用性, 頭痛-二次性
Czech bolesti hlavy sekundární, sekundární bolesti hlavy
Polish Objawowe bóle głowy, Bóle głowy objawowe, Wtórne bóle głowy
Norwegian Sekundære hodepinesykdommer, Sekundære hodeverksykdommer
Portuguese Transtornos da Cefaleia Secundários, Cefaleias Secundárias, Cefalgia por Uso Excessivo de Analgésicos, Cefalalgia por Uso Excessivo de Analgésicos, Transtornos Secundários da Cefaleia, Transtornos da Cefalgia Secundários, Cefaleia por Uso Excessivo de Analgésicos
Spanish Cefalalgia por Sobreuso de Analgésicos, Cefaleas Secundarias
German Kopfschmerz, sekundärer, Sekundärer Kopfschmerz
Italian Cefalee secondarie, Disturbi da cefalea secondaria
French Céphalées secondaires
Derived from the NIH UMLS (Unified Medical Language System)

Related Topics in Headache Disorders

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