Secondary Headaches in the Rehabilitation Patient

Abstract

While approximately 90% of headaches are considered primary or without an underlying secondary cause to explain their etiology (see previous chapter), close to 10% of headaches are symptomatic of another condition. They are then referred to as secondary headaches. The actual percentage of one type versus the other is subject to referral bias; hence, the chance of finding an underlying headache-inducing pathologic process is far higher in the neurosurgeon’s clinic than it is in the primary care clinician’s facility. The possibility of missing an underlying cause creates anxiety in patients and clinicians alike. This chapter provides an overview of the approach to such workups and a summary of the more likely causes of head pain also touching upon anatomical findings that might incorrectly be assumed to be generating headaches. It is important to avoid unnecessary and especially invasive workups or treatments since risk may outweigh benefit in some cases. Imaging guidelines, etc., are provided, but for more detailed and newer options and overviews, please see the reading list at the end of the chapter.

As with the accompanying chapter, the philosophical and psychosocial underpinnings are integrated into the medical framework in hope that compassionate and not merely medically accurate diagnoses are made before discussing the findings with the patient. A more detailed overview is beyond the scope of this chapter and textbook. While much of that contained herein is beyond that needed in the rehabilitation setting, it is vital that the rehabilitation specialist be aware of the more common scenarios so that he or she can help the patient’s primary care clinician conduct a through evaluation pre or post discharge from the rehabilitation setting. Vascular anomalies, changes in cerebrospinal fluid pressure, brain tumors, stroke, intracranial bleeds, seizures, and meningeal infection and irritation are discussed, along with a sampling of imaging protocols and mention of a non-exhaustive list of pharmacotherapeutic approaches, behavioral intervention, and acupuncture.

Note: This chapter was originally published as Goodwin, J Bajwa, Z Headaches Associated with Organic Pathology in: Warfield, C.A. and Bajwa, Z (Eds.) Principles and Practice of Pain Medicine (2nd Ed.) McGraw-Hill. New York (pub.) 2004.