By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

SECONDARY HEADACHES REQUIRE PROMPT MEDICAL TREATMENT

Question: Could you tell me about how to tell when a headache is a serious one? A friend of mine, who is a nurse, told me that these are called secondary headaches. What causes them and what should people watch out for?

Answer: Headache is one of the most common complaints that people seek medical attention for. About 90 percent of these headaches are what doctors call primary headaches. This means that the headache itself is the malady that is affecting the person. Primary headaches include migraines, tension headaches and cluster headaches.

The remaining 10 percent of headaches fall into the category we call secondary headaches. In these cases, the headache is not the illness, but is a symptom of an underlying medical problem. Often this underlying illness can be a very serious medical condition.

When a physician sees a patient with a headache, it is imperative that a proper history and physical be done so that the type of headache can be determined. Since most patients with a headache have a normal neurological exam, the history can be the major key to determining the type of headache. There are several “red flags” that a physician looks for when assessing a headache, especially in a hospital emergency department.

Here are some of these red flags:

• The worst headache of a person’s life or the first major headache ever.

• A headache that’s accompanied by double vision, dim vision, fever, pain in or behind the eye, one-sided weakness or disorientation.

• In a person that has a history of headaches, a headache that is decidedly different from his or her typical pattern.

• Headaches that awaken a person from sleep.

• An atypical headache that is associated with vomiting, sensitivity to light and sound, especially after head trauma.

Some of the underlying causes of secondary headaches are brain tumors, infection in the central nervous system, head trauma, metabolic illnesses such as diabetes, carbon monoxide poisoning, and kidney failure. Bleeding into the cranium from an aneurysm or other vascular malformation can also cause secondary headaches. Temporal arteritis, a condition that untreated can cause loss of vision, is a fairly common cause of secondary headache in older people. Also, substance abuse should always be considered.

Finally, you should seek prompt medical attention if any of the following are true: You have more than three headaches a week or need pain relievers almost daily. Your headache is accompanied by signs of illness, like fever, dizziness, slurred speech, stiff neck or mental confusion. Your headache is associated with loss of physical function or decreased level of consciousness. You have a persistent headache after a head injury. Your headache keeps getting worse and won't go away. You're over fifty and are bothered by more frequent headaches or have your "first and/or worst" headache of your life.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.