Secondary headache syndromes: Risk factors, clinical features, and associated causes

Characteristic clinical feature or risk factor	Suspected etiology	Supportive associated features	Common alternative underlying causes
History
Anticoagulant medication use	Subdural hematoma	Neurologic deficits (eg, hemiparesis)	Other forms of intracranial hemorrhage (eg, intracerebral hemorrhage, epidural hemorrhage, subarachnoid hemorrhage)
Analgesic medication use	Medication overuse headache		Other primary and secondary headache syndromes^*
Pregnancy	Preeclampsia	Elevated blood pressure Blurred vision Epigastric/retrosternal pain	Reversible posterior leukoencephalopathy syndrome Cerebral venous thrombosis
Onset at age >50 years	Tumor	Neurologic deficits (eg, hemiparesis, vision loss)	Giant cell arteritis Cerebral abscess
Immunosuppressive state	Infectious meningitis		Reversible posterior leukoencephalopathy syndrome
Carbon monoxide exposure	Carbon monoxide toxicity	Dizziness Nausea	Other primary and secondary headache syndromes^*
Symptoms
Sudden-onset severe headache	Aneurysmal subarachnoid hemorrhage	Meningismus Progressive neurologic deterioration	Reversible cerebral vasoconstriction syndrome Primary headache associated with sexual activity Intracerebral hemorrhage
Visual disturbances	Glaucoma	Halos appear around light Blurred vision	Migraine Idiopathic intracranial hypertension (pseudotumor cerebri) Giant cell arteritis
Orthostatic headache	Spontaneous intracranial hypotension	Worsens with Valsalva maneuvers Tinnitus/hearing loss	Cervicogenic headache Postural orthostatic tachycardia syndrome
Signs
Fever and/or meningismus	Infectious meningitis		Subarachnoid hemorrhage Giant cell arteritis
Elevated BP	Reversible cerebral vasoconstriction syndrome	Confusion Neurologic deficits (eg, hemiparesis, vision loss)	Reversible cerebral vasoconstriction syndrome Intracerebral hemorrhage Ischemic stroke Preeclampsia
Papilledema	Idiopathic intracranial hypertension (pseudotumor cerebri)	Visual field defects Nausea/vomiting	Tumor Optic neuritis Nonarteritic ischemic optic neuropathy
Horner syndrome	Carotid artery dissection	Ischemic stroke symptoms Lower cranial nerve deficits	Cluster headache Migraine
Drowsiness	Intracerebral hemorrhage	Neurologic deficits (eg, hemiparesis, vision loss)	Ischemic stroke Tumor or abscess Infectious meningitis Migraine with brainstem aura Seizure (postictal state)
Hemiplegia	Intracerebral hemorrhage or ischemic stroke	Associated cranial nerve and/or sensory deficits	Migraine Tumor or abscess

BP: blood pressure.

* Primary headache syndromes include migraine and related conditions, tension-type headaches, trigeminal autonomic cephalalgias (cluster headache, paroxysmal hemicrania, short-lasting unilateral neuralgiform headache attacks, and hemicrania continua), and less common primary headache disorders (eg, new persistent daily headache, primary cough headache, primary exercise headache). Refer to UpToDate topics for additional details.

Graphic 141069 Version 4.0

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Secondary headache syndromes: Risk factors, clinical features, and associated causes