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Chronic Secondary Headaches

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Chronic Headache

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Abstract

Although the majority of chronic headaches are primary in nature, secondary underpinnings must be first considered to limit morbidity and mortality. Some may develop abruptly, while others will progress gradually over several weeks to months. Perhaps the most common chronic secondary headache in clinical practice is that following injury to the head or neck. Intracranial vascular malformations may cause headaches, and chronic headache may result from prior stroke, venous occlusion, arterial dissection, or intracranial hemorrhage. Giant cell arteritis should be considered in all subjects over age 50 with chronic headaches. Disorders of cerebrospinal fluid pressure such as intracranial hypertension or hypotension often present with chronic head pain. Brain tumors may aggravate an underlying primary headache condition or provoke a new headache profile. A key complaint from those with symptomatic Chiari malformations is headache. Systemic conditions such as hypothyroidism and local disease of the eye, ear, or paranasal sinuses may also cause headaches often in association with other physical examination abnormalities. Imaging of the head and/or neck, typically with MRI, is the most valuable diagnostic tool in the evaluation of secondary causes of chronic headache. Vascular imaging, lumbar puncture, and serum studies (thyroid function tests, ESR, CRP) may be valuable in select circumstances. Management is dictated by the underlying pathology.

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Authors and Affiliations

  1. Headache Division, Department of Neurology, UPMC Headache Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Robert Kaniecki

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  1. Robert Kaniecki
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Correspondence to Robert Kaniecki .

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Editors and Affiliations

  1. Department of Headache and Pain Medicine, Icahn School of Medicine at Mt. Sinai, Department of Headache and Pain Medicine, New York, NY, USA

    Mark W. Green

  2. Neurology & Neurological Sciences, Stanford School of Medicine Neurology & Neurological Sciences, Stanford, CA, USA

    Robert Cowan

  3. Department of Neurology, Medical College of Wisconsin, Department of Neurology, Milwaukee, WI, USA

    Frederick G. Freitag

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Kaniecki, R. (2019). Chronic Secondary Headaches. In: Green, M., Cowan, R., Freitag, F. (eds) Chronic Headache. Springer, Cham. https://doi.org/10.1007/978-3-319-91491-6_8

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  • DOI: https://doi.org/10.1007/978-3-319-91491-6_8

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