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Key Chapter Points

Possible secondary headaches need to be considered initially for all patients presenting to the ED with acute headache (see Chap.  2 for assessment strategies). Always consider trauma as a possible cause of acute headache. Brain injury severity, demographic features, and examination findings help determine the need for additional testing in patients with headache after trauma. Headache due to arterial dissection in the neck may occur after seemingly insignificant neck trauma (e.g., whiplash injury, spinal manipulation, or prolonged abnormal posture). Meningitis may be considered in patients with nontraumatic headache plus fever, neck stiffness, or altered mental status. Idiopathic intracranial hypertension may be considered in obese females with headache, transient visual loss, and papilledema. Imaging studies will fail to show intracranial mass lesions in these patients. Thunderclap headaches must always be evaluated fully before the diagnosis of primary thunderclap headache is assigned.

Keywords

Carotid dissection Concussion Meningitis Idiopathic intracranial hypertension Thunderclap headache Trauma 

References

  1. 1.
    Ruff RM, Iverson GL, Barth JT, et al. Recommendations for diagnosing a mild traumatic brain injury: a National Academy of Neuropsychology Education paper. Arch Clin Neuropsychol. 2009;24:3–10.PubMedCrossRefGoogle Scholar
  2. 2.
    Jagoda AS, Bazarian JJ, Bruns JJ, et al. Clinical Policy: Neuroimaging and decisionmaking in adult mild traumatic brain injury in the acute setting. Ann Emerg Med. 2008;52:714–48.PubMedCrossRefGoogle Scholar
  3. 3.
    McCrory P, Meeuwisse W, Johnston K, et al. Consensus statement on concussion in sport: the 3rd International Conference on Concussion in Sport held in Zurich, November 2008. Br J Sports Med. 2009;43 Suppl 1:i76–84.PubMedCrossRefGoogle Scholar
  4. 4.
    Randolph C. Baseline neuropsychological testing in managing sport-related concussion: does it modify risk? Curr Sports Med Rep. 2011;10:21–6.PubMedGoogle Scholar
  5. 5.
    Covassin T, Elbin RJ, Stiller-Ostrowski JL, Kontos AP. Immediate post-concussion assessment and cognitive testing (ImPACT) practices of sports medicine professional. J Athl Train. 2009;44:639–44.PubMedCrossRefGoogle Scholar
  6. 6.
    Jensen MB, Chacon MR, Aleu A. Cervicocerebral arterial dissection. Neurologist. 2008;14:5–6.PubMedCrossRefGoogle Scholar
  7. 7.
    Caso V, Paciaroni M, Bogousslavsky J. Environmental factors and cervical artery dissection. Front Neurol Neurosci. 2005;20:44–53.PubMedCrossRefGoogle Scholar
  8. 8.
    Dharmasaronja P, Dharmasaroja P. Sports-related internal carotid artery dissection. Pathogenesis and therapeutic point of view. Neurologist. 2008;14:307–11.CrossRefGoogle Scholar
  9. 9.
    Haneline M, Triano J. Cervical artery dissection. A comparison of highly dynamic mechanisms: manipulation versus motor vehicle collision. J Manipulative Physiol Ther. 2005;28:57–63.PubMedCrossRefGoogle Scholar
  10. 10.
    Schievink WI. Spontaneous dissection of the carotid and vertebral arteries. N Engl J Med. 2001;344:898–906.PubMedCrossRefGoogle Scholar
  11. 11.
    Shah Q, Messé SR. Cervicocranial arterial dissection. Curr Treat Options Neurol. 2007;9:55–62.PubMedCrossRefGoogle Scholar
  12. 12.
    Huang Y, Chen Y, Wang Y, et al. Cervicocranial arterial dissection: experience of 73 patients in a single center. Surg Neurol. 2009;72 Suppl 2:S20–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Shah Q, Messé SR. Cervicocranial arterial dissection. Curr Treat Option Neurol. 2007;9:55–62.CrossRefGoogle Scholar
  14. 14.
    Linn FH, Rinkel GE, Algra A, van Gijn J. Headache characteristics in subarachnoid haemorrhage and benign thunderclap headache. J Neurol Neurosurg Psychiatry. 1998;65:791–3.PubMedCrossRefGoogle Scholar
  15. 15.
    Landtblom AM, Fridriksson S, Boivie J, et al. Sudden onset headache: a prospective study of features, incidence and causes. Cephalalgia. 2002;22:354–60.PubMedCrossRefGoogle Scholar
  16. 16.
    Perry JJ, Stiell IG, Wells GA, et al. Attitudes and judgment of emergency physicians in the management of patients with acute headache. Acad Emerg Med. 2005;12:33–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Perry JJ, Stiell IG, Sivilotti ML, et al. High risk clinical characteristics for subarachnoid haemorrhage in patients with acute headache: prospective cohort study. BMJ. 2010;341:c5204.PubMedCrossRefGoogle Scholar
  18. 18.
    Pascual J, González-Mandly A, Martín R, Oterino A. Headaches precipitated by cough, prolonged exercise or sexual activity: a prospective etiological and clinical study. J Headache Pain. 2008;9:259–66.PubMedCrossRefGoogle Scholar
  19. 19.
    Durand ML, Calderwood SB, Weber DJ, et al. Acute bacterial meningitis in adults. A review of 493 episodes. N Engl J Med. 1993;328:21–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Chaudhuri A, Martin PM, Kennedy GE, et al. EFNS guideline on the management of community acquired bacterial meningitis: report of an EFNS Task Force on acute bacterial meningitis in older children and adults. Eur J Neurol. 2008;15:649–59.PubMedCrossRefGoogle Scholar
  21. 21.
    Kurth T. The association of migraine with ischemic stroke. Curr Neurol Neurosci Rep. 2010;10:133–9.PubMedCrossRefGoogle Scholar
  22. 22.
    Bigal ME, Kurth T, Santanello N, et al. Migraine and cardiovascular disease: a population-based study. Neurology. 2010;74:628–35.PubMedCrossRefGoogle Scholar
  23. 23.
    Saposnik G, Barinagarrementeria F, Brown RD, et al. Diagnosis and management of cerebral venous thrombosis. A statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42:1158–92.CrossRefGoogle Scholar
  24. 24.
    Wasay M, Kojan S, Dai AI, Bobustuc G, Sheikh Z. Headache in cerebral venous thrombosis: incidence, pattern and location in 200 consecutive patients. J Headache Pain. 2010;11:137–9.PubMedCrossRefGoogle Scholar
  25. 25.
    McBane RD, Tafur A, Wysokinski WE. Acquired and congenital risk factors associated with cerebral venous sinus thrombosis. Thromb Res. 2010;126:81–7.PubMedCrossRefGoogle Scholar
  26. 26.
    Valentinis L, Tuniz F, Valent F, et al. Headache attributed to intracranial tumours: a prospective study. Cephalalgia. 2010;30:389–98.PubMedGoogle Scholar
  27. 27.
    Asensio-Sánchez VM, Merino-Angulo J, Martínez-Calvo S, Calvo MJ, Rodríguez R. Epidemiology of pseudotumor cerebri. Arch Soc Esp Oftalmol. 2007;82:219–21.PubMedGoogle Scholar
  28. 28.
    Galvin JA, Van Stavern GP. Clinical characterization of idiopathic intracranial hypertension at the Detroit Medical Center. J Neurol Sci. 2004;223:157–60.PubMedCrossRefGoogle Scholar
  29. 29.
    Baldwin MK, Lobb B, Tanne E, Egan R. Weight and visual field deficits in women with idiopathic intracranial hypertension. J Womens Health (Larchmt). 2010;19:1893–8.CrossRefGoogle Scholar
  30. 30.
    Rangwala LM, Liu GT. Pediatric idiopathic intracranial hypertension. Surv Ophthalmol. 2007;52:597–617.PubMedCrossRefGoogle Scholar
  31. 31.
    González-Gay MA, Garcia-Porrua C, Rivas MJ, Rodriguez-Ledo P, Llorca J. Epidemiology of biopsy proven giant cell arteritis in northwestern Spain: trend over an 18 year period. Ann Rheum Dis. 2001;60:367–71.PubMedCrossRefGoogle Scholar
  32. 32.
    Salvarani C, Corwson CS, O’Fallon M, Hunder GG, Gabriel SE. Reappraisal of the epidemiology of giant cell arteritis in Olmsted County, Minnesota, over a fifty-year period. Arthritis Rheum. 2004;51:264–8.PubMedCrossRefGoogle Scholar
  33. 33.
    Adams Jr HP, Kassell NF, Torner JC, Sahs AL. CT and clinical correlations in recent aneurysmal subarachnoid hemorrhage: a preliminary report of the Cooperative Aneurysm Study. Neurology. 1983;33:981–8.PubMedGoogle Scholar
  34. 34.
    van der Wee N, Rinkel GE, Hasan D, van Gijn J. Detection of subarachnoid haemorrhage on early CT: is lumbar puncture still needed after a negative scan? J Neurol Neurosurg Psychiatry. 1995;58:357–9.PubMedCrossRefGoogle Scholar
  35. 35.
    McCormack RF, Hutson A. Can computed tomography angiography of the brain replace lumbar puncture in the evaluation of acute-onset headache after a negative noncontrast cranial computed tomography scan. Acad Emerg Med. 2010;17:444–51.PubMedCrossRefGoogle Scholar
  36. 36.
    Ambika S, Arjundas D, Noronha V, Anshuman. Clinical profile, evaluation, management and visual outcome of idiopathic intracranial hypertension in a neuro-ophthalmology clinic of a tertiary referral ophthalmic center in India. Ann Indian Acad Neurol. 2010;13(1):37–41.Google Scholar
  37. 37.
    Uchihara T, Tsukagoshi H. Jolt accentuation of headache: the most sensitive sign of CSF pleocytosis. Headache. 1991;31:167–71.PubMedCrossRefGoogle Scholar
  38. 38.
    Fitch MT, van de Beek D. Emergency diagnosis and treatment of adult meningitis. Lancet Infect Dis. 2007;7:191–200.PubMedCrossRefGoogle Scholar
  39. 39.
    Schull MJ. Diagnostic dilemmas and subarachnoid hemorrhage subtleties: What to do when the evidence gives you a headache. CJEM. 2002;4:106–7.Google Scholar
  40. 40.
    Liebenberg WA, Worth R, Firth GB, Olney J, Norris JS. Aneurysmal subarachnoid haemorrhage: guidance in making the correct diagnosis. Postgrad Med J 2005;81:470–3.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department of AnesthesiologyUniversity of PittsburghPittsburghUSA
  2. 2.Dean Health SystemsMadisonUSA

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