II. Risk Factors
- See See Headache Red Flag
- Primary Headache onset over age 50 years (esp. age >65 years)
- Known malignancy (esp. Lung Cancer, Breast Cancer, malignant Melanoma)
- Cluster Headache
III. Causes
- Acute
- Chronic
- Increased Intracranial Pressure (e.g. mass effect)
- Intracranial Tumor
- Pseudotumor Cerebri
- Brain Abscess
- Subdural Hematoma
- Hydrocephalus
- Arachnoid cyst (rare)
- Vascular disorder
- Arteriovenous Malformation
- Giant Cell Arteritis (Temporal Arteritis)
- Carotid dissection
- Vasculitis
- Increased Intracranial Pressure (e.g. mass effect)
IV. Findings: Symptoms and Signs
- See Headache Red Flag
- See Headache History
- See Headache Examination
- Exertional Headache (or Headache worse with Valsalva Maneuver)
V. Exam: Focus Areas
- Careful Neurologic Exam (focus on symmetry)
- Brain Tumors presenting with neurologic change: 92%
- Vasquez-Barquero (1994) Cephalalgia 14:270-2 [PubMed]
- Altered Level of Consciousness
- Cognitive changes
- Nonspecific Vital Sign changes
- Meningismus (e.g. Nuchal Rigidity)
- Fever
- Careful Eye Neurologic Exam
- Asymmetric pupils or other abnormal pupil changes
- Papilledema
- Retinal Hemorrhage
- Deep Tendon Reflexes
- Pronator Drift
- Eyes closed with arms extended in front of patient