Headache

Chronic Progressive Headache

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Chronic Progressive Headache, Organic Headache, Secondary Headache

  • 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
      3. Carotid dissection
      4. Vasculitis
  • Examination 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
  6. Careful Eye Neurologic Exam
    1. Asymmetric pupils or other abnormal pupil changes
    2. Papilledema
    3. Retinal Hemorrhage
  7. Deep Tendon Reflexes
  8. Pronator Drift
    1. Eyes closed with arms extended in front of patient