Pathophysiology of Secondary Headache

Hello everyone, In my last post, I talked about primary headache, which is a type of headache developed as a result of the tightening, and stiffness of the muscles in the head and neck, which allows the blood vessels in the cranial nerves to inflame. I went further to explain the different types of primary headaches; Tension headache, cluster headache, and Migraine headaches. I will be putting the link to my last post at the end of this post, you can do well to read, I can tell you that it is a very interesting post to read. In today's post, I will be looking into the secondary type of headache.

Secondary Headaches

According to the International Headache Society (IHS), Secondary headaches are aches in the head attributed to an underlying disorder.. Secondary headaches can be sight threatening or life-threatening, with less than 10% of the entire headache case being secondary headache.. There are certain factors that trigger and allows for the identification of secondary headaches, they are called red flags. These red flags includes; Old age (above the age of 50 years), Systemic symptoms (such as fever, Arthralgia, Myalgia), Diseases (HIV, Malignant Growth), Neurological Deficits/Neoplasm, Papilledema, when the headache is abrupt and acute, Positional (headache is worse when lying down and reduced when sitting upwards) usually as a result of intracranial hypertension or hypotension, pattern change of headache, Precipitation by Valsava Maneuver, Painkiller overuse, and pregnancy or puerperium..

Secondary Headache Pathophysiology

After identifying the triggers or red flags that could lead to a secondary headache, knowing the pathophysiology of secondary headaches would be great. There are three types of secondary headaches, which are; Mass/space-occupying lesions of the brain

• Space-Occupying Lesions

Space Occupying Lesions are known as intracranial neoplasm occupying the cranium. These lesions are as a result of non-malignant tumors, malignant tumors, and/or abscesses. With non-malignant tumors, it usually isn't cancerous but as a result of growths, it starts to put intracranial pressure on the tissue of the brain. Abscesses caused by microbial infection like bacteria infection can lead to Space-Occupying Lesions. The infection by the microorganism causing inflammation would trigger the white blood cell to be present in the cranial area, generating pus which would exact pressure on the cranial sorrounding. This underlying pathology could lead to headache. . Patients will have classic triad of headaches, neural deficit, fever, and high risk of Seizure.

• Infections of the central nervous system

Irritations of the brain tissues (meninges) as a result of infection such as Meningitis, or Encephalitis, and empyema. These infections are usually accompanied by headaches, fever, meningeal signs (phonophobia, photophobia, neck stiffness), and altered level of consciousness. .

Also, in this class is the Cerebral venous sinus thrombosis, is a stroke which occurs as a result of a clot, or blockage in the cerebral veins, thereby increasing intracranial pressure and causing headaches, Papilledema, reduced neural function, encephalopathy, and Isolated Intracranial Hypertension. .

• Subarachnoid Hemorrhage

This is as a result of blood vessel rupture into the subarachnoid space due to aneurysm. This often leads to a sudden and abrupt headache, referred to as thunderclap headache. This usually leads to loss of consciousness, seizure, fever, and Papilledema.

• Acute Angle Closure Glaucoma

With increase in intraocular pressure due to outflow obstruction of aqueous humor, usually presents with acute headache, Ocular Hyperemia, and mid-fixed pupil.

• Trigeminal Neuragia

Trigeminal Neuralgia is a severe facial sharp pain in the jaw, teeth and gums. This causes headache, with simple touch, chewing, or even wind blow..

Diagnosis of Secondary Headache

Diagnosing the Headache is equal to diagnosing the underlying disease or disorder.

To diagnose Subarachnoid Hemorrhage, understanding the intense of the headache, and how long it took for the headache to worsen. If it took a very short time, within minutes, then it is a sign. CT scan, MRI, Cerebral angiography, Lumbar puncture to determine Xanthochromia.

In the case of Diagnosing Meningitis would be jolt accentuation of headache (rotate the head to see the intensity of the headache), Non-Contrast CT-head, Lumbar Puncture, Cerebrospinal fluid cell count

Diagnosing Cerebral venous sinus thrombosis is a condition more associated with women to men. Radiological investigation, which includes computerized tomography(CT), Magnetic resonance imaging (MRI), Magnetic resonance venography (MR-V) are important in diagnosing Cerebral venous sinus thrombosis.

To Diagnose Acute Angle Closure Glaucoma, a gonioscopic examination is done by an ophthalmologist, slit lamp examination, and automatic static perimetry..

Treatment and Management

In treating and managing of the headache often starts with treating the underlying diseases or the cause of the headache. Also, over-the-counter pain/prescription medications can be given for the headache.

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Reference

• BioMed Central Journal - Secondary headaches: secondary or still primary?
• National Library of Medicine - The art of history-taking in a headache patient
• NCBI - Red and orange flags for secondary headaches in clinical practice
• Space-Occupying Lesions: Causes & Symptoms
• Study.com - Space-Occupying Lesions: Causes & Symptoms
• Headache Medicine - Headache and infections of the central nervous system: neuroradiology
• The Journal of Headache and Pain - Headache in cerebral venous thrombosis: incidence, pattern and location in 200 consecutive patients
• National Library of Medicine - Headache Patterns in Cerebral Venous Sinus Thrombosis
• NHS.UK - Trigeminal neuralgia
• Mayo Clinic - Subarachnoid hemorrhage
• Management of acute meningitis
• Internal Medicine Journal - Meningitis in adults: diagnosis and management
• NCBI - Acute Closed Angle Glaucoma
• WebMD - What Is a Secondary Headache?

Image Reference

• https://commons.wikimedia.org/wiki/File:Headache

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• Pathophysiology of Primary Headache

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• The Heart and its Association with Exercise