Chapter 16 HEADACHE
The majority of patients with headache experience migraine, tension-type, or medication rebound headaches. Serious or anatomic causes of headaches are uncommon but have to be considered when a patient presents with a severe headache. Headaches, particularly migraines, occur more frequently in women and can be disabling.
In evaluating a patient with a headache, it is essential to rule out a serious cause of headache by assessing any ominous findings in the history and physical examination. These findings include neurologic symptoms or signs, older age at onset, systemic illness or symptoms (such as fever, cancer, pregnancy or postpartum status, and use of anticoagulants), sudden onset of headache, new type of headache, different or progressive headache, headache that awakens the patient from sleep, and occipital headache. Headaches that can have severe consequences if they remain undiagnosed include those associated with subarachnoid hemorrhage (sudden onset) and other intracranial bleeds, IIH, meningitis (associated with fever and neck rigidity) and other infections, brain neoplasm (which may be associated with seizures), and giant cell arteritis (associated with temporal artery tenderness, diminished temporal artery pulse, jaw claudication, polymyalgia rheumatica, and visual changes).
