Lviv clinical bulletin 2023, 2(42): 96-104

https://doi.org/10.25040/lkv2023.02.096

Headache: Classification, Diagnostics, and Principles of Treatment (Literature Review; Description of a Clinical Case)

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N. Bozhenko, T. Nehrych, N. Negrych, M. Bozhenko

Danylo Halytsky Lviv National Medical University

Introduction. Headache (cephalgia) is one of the most common neurological disorders and is among the 20 most disabling diseases in the world. Most cases of headaches are benign, while others require constant monitoring and treatment, and some are life-threatening. For individuals with a history of headaches, the physician must determine whether the current headache is a well-known primary headache disorder, an exacerbation of their primary headache disorder due to another medical condition, or a new secondary headache.

The aim of the study is to conduct an analysis of a vascular event in a patient with secondary headache, who was diagnosed by the department of neurology in 2023.

Materials and methods. The method of systematic and comparative analysis, the biblio-semantic method of studying the results of current scientific research, and the modern view of the problem of secondary headache were used. Eighteen English-language literary sources were analyzed. The results of my own clinical experience are presented, and a clinical case of a patient with secondary headache is described.

Results. A review of the literature regarding modern data on secondary headache was carried out, and a clinical case was described. An analysis of the clinical case of a patient with secondary headache, diagnosed at the Department of Neurology in 2023, was conducted. Diagnostic aspects of secondary headache and treatment options were discussed.

Conclusions. Secondary headache occurs much less often than primary, but it can be life-threatening. A clinician must be able to distinguish between primary and secondary headaches, and be able to make a specific diagnosis for a patient with a headache. For this, the doctor must know the criteria for each type of headache and “red flags” of secondary headache. Secondary headaches occur much less often than primary headaches, but they can be life-threatening. The most important aspect of the diagnosis of headache is the history and medical examination. Primary headache is not a diagnosis of exclusion, but rather is based on clinical findings obtained during examination. The presence of atypical signs or red flags should raise concern about secondary headache. The SNOOP A mnemonic is useful for ensuring that red flags are not missed. The clinician must be able to distinguish between primary and secondary headaches and be able to give a specific diagnosis to a patient with a headache. For this, the doctor must know the criteria for each type of headache. Many types of primary headaches can be diagnosed based on a thorough history and physical examination without additional examination methods. Neuroimaging is not necessary if the patient has migraines or other primary headaches with normal neurological status and the absence of red flags and signs of secondary headache. If there are red flags, signs of secondary headache, neuroimaging, or other additional diagnostic tests should be used. An MRI of the brain is preferred.

References

  1. Bozhenko MI, Negrych TI, Bozhenko NL, Negrych NO. Tutorial. Ed. 2, suppl. Kyiv: Professional publications; 2021. 84 p. (Ukrainian)
  2. Conicella E, Raucci U, Vanacore N, Vigevano F, Reale A, Pirozzi N et al. The child with headache in a pediatric emergency department. Headache. 2008;48(7):1005-1011. https://doi.org/10.1111/j.1526-4610.2007.01052.x
  3. Do TP, Remmers A, Schytz HW, Schankin, Nelson SE, Obermann M et al. Red and orange flags for secondary headaches in clinical practice: SNNOOP10 list. 2019;92(3):134-144. https://doi.org/10.1212/WNL.0000000000006697
  4. Dodick DW. Clinical clues and clinical rules: primary vs secondary headache. Adv Stud Med. 2003;3(6C):S550-S555.
  5. Dodick DW. Pearls: headache. Semin Neurol. 2010;30(1):74-81. https://doi.org/10.1055/s-0029-1245000
  6. Finley CR, Chan DS, Garrison S, Korownyk Ch, Kolber MR, Campbell S et al. What are the most common conditions in primary care? Systematic Review. Can Fam Physician. 2018;64(11):832-840.
  7. Hainer BL, Matheson EM. Approach to acute headache in adults. Am Fam Physician. 2013;87(10):682-687.
  8. Headache Classification Committee of the International Headache Society (IHS) the International Classification of Headache Disorders, 3rd ed. 2018;38(1):1-211. https://doi.org/10.1177/0333102417738202
  9. Kato Y, Hayashi T, Sano H, Kato R, Tanahashi N, Takao M. Cough headache presenting with reversible cerebral vasoconstriction syndrome. Intern Med. 2018;57(10):1459-1461. https://doi.org/10.2169/internalmedicine.0061-17
  10. Kranz PG, Gray L, Amrhein TJ. Spontaneous intracranial hypotension: 10 myths and misperceptions. 2018;58(7):948-959. https://doi.org/10.1111/head.13328
  11. Locker TE, Thompson C, Rylance J, Mason SM. The utility of clinical features in patients presenting with nontraumatic headache: an investigation of adult patients attending an emergency department. 2006;46(6):954-961. https://doi.org/10.1111/j.1526-4610.2006.00448.x
  12. 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(5):259-266. https://doi.org/10.1007/s10194-008-0063-5
  13. Raieli V, Eliseo M, Pandolfi E, Vecchia M, Franca G, Puma D et al. Recurrent and chronic headaches in children below 6 years of age. J Headache Pain. 2005;6(3):135-142. https://doi.org/10.1007/s10194-005-0168-z
  14. Ramirez-Lassepas M, Espinosa CE, Cicero JJ, Johnston KL, Cipolle RJ, Barber DL. Predictors of intracranial pathologic findings in patients who seek emergency care because of headache. Arch Neurol. 1997;54(12):1506-1509. https://doi.org/10.1001/archneur.1997.00550240058013
  15. Ravishankar K. WHICH Headache to Investigate, WHEN, and HOW? 2016;56(10):1685-1697. https://doi.org/10.1111/head.12998
  16. Schwedt TJ. Thunderclap headache. Continuum (Minneap Minn). 2015;21(4):1058-1071. https://doi.org/10.1212/CON.0000000000000201
  17. Sobri M, Lamont AC, Alias NA, Win MN. Red flags in patients presenting with headache: clinical indications for neuroimaging. Br J Radiology. 2003;76(908):532-535. https://doi.org/10.1259/bjr/89012738
  18. Song TJ, Kim YJ, Kim BK, Kim BS, Kim JM, Kimet SK et al. Characteristics of elderly-onset (≥65 years) headache diagnosed using the International classification of headache disorders, third edition beta version. J Clin Neurol. 2016;12(4):419-425. https://doi.org/10.3988/jcn.2016.12.4.419
  19. Tabatabai RR, Swadron SP. Headache in the emergency department: avoiding misdiagnosis of dangerous secondary causes. Emerg Med Clin North Am. 2016;34(4):695-716. https://doi.org/10.1016/j.emc.2016.06.003