Abstract
Severe headache is usually primary, but secondary causes must be ruled out. History and physical examinations are essential. Neuroimaging, laboratory analysis, and imaging may also be necessary. Diagnosis and therapy for primary and secondary headaches are discussed.
Similar content being viewed by others
References
Barton CW. Evaluation and treatment of headache in the emergency department: A survey. Headache. 1994;34:91–94.
Leblanc R. The minor leak preceding subarachnoid hemor rhage. J Neurosurg. 1987;66:35–39.
Waga S, Ohtsubo K, Handa H. Warning signs in intracranial aneurysms. Surg Neurol. 1975;3:15–20.
Vermeulen M, van Gijn J. The diagnosis of subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry. 1990;53:365–372.
Day JW, Raskin NH. Thunderclap headache: symptom of unruptured cerebral aneurysm. Lancet. 1986;2:1247–1248.
Harling DW, Peatfield RC, Van Hille PT, Abbott RJ. Thunderclap headache: Is it migraine? Cephalalgia. 1989;9:87–90.
Raps EC, Rogers JD, Galetta SL, et al. The clinical spectrum of unruptured intracranial aneurysms. Arch Neurol. 1993;50: 265–268.
Wijdicks EFM, Kerkhoff H, Van Gijn J. Long-term follow-up of 71 patients with thunderclap headache mimicking subarachnoid hemorrhage. Lancet. 1988;2:68–70.
Witham TF, Kaufmann AM. Unruptured cerebral aneurysm producing a thunderclap headache. Am J Emerg Med. 2000;18:88–90.
Ward TN. Headache in Cerebrovascular Disease. In: Samuels MA, Feske S, eds. Office Practice of Neurology. New York: Churchill Livingstone; 1996;1141–1144.
Stapf, C, Elkind, MS, Mohr, JP. Carotid artery dissection. Ann Rev Med. 2000;51:329–347.
Gorelick, PB, Hier DB, Caplan LR, Langenberg P. Headache in acute cerebrovascular disease. Neurology. 1986;36:1445–1450.
Portenoy RK, Abissi CJ, Lipton RB, et al. Headache in cere-brovascular disease. Stroke. 1984;15:1009–1012.
Sztajnkrycer M, Jauch EC. Unusual Headaches. Emerg Med Clin of North Am. 1998;16:741–760.
Hayreh SS, Podhajsky PA, Raman R, Zimmerman B. Giant cell arteritis: Validity and reliability of various diagnostic criteria. Am J Ophthalmol. 1997;123:285–296.
Goodman BW. Temporal arteritis. Am J Med. 1997;67:839–852.
Vilaseca J, Gonzalez A, Cid MC, Lopez-Vivancos J, Ortega A. Clinical usefulness of temporal artery biopsy. Ann Rheum Dis. 1987;46:282–285.
McKissock W. Subdural hematoma. A review of 389 cases. Lancet. 1960;1:1365–1369.
Davis LE. Acute viral meningitis and encephalitis. In: Kennedy PGE, Johnson RT, eds. Infections of the Nervous System. London: Butterworths; 1985:155–176.
Whitley RJ, Lakeman P. Herpes simplex virus infections of the central nervous system: Therapeutic and diagnostic considerations. Clin Infect Dis. 1995;20:414–420.
Forsyth PA, Posner JB. Headaches in patients with brain tumors: A study of 111 patients. Neurology. 1993;43:1678–1683.
Pfund Z, Szapary L, Jaszberenyi O, Nagy F, Czopf J. Headache in intracranial tumors. Cephalalgia. 1999;19:787–790.
Wall M. The headache profile of idiopathic intracranial hypertension. Cephalalgia. 1990;10:331–335.
Mathew NT, Ravishankar K, Sanin LC. Coexistence of migraine and idiopathic intracranial hypertension without papilledema. Neurology. 1996;46:1226–1230.
Mokri B, Krueger BR, Miller GM, et al. Syndrome of orthostatic headaches and diffuse pachymeningeal gadolinium enhancement. Mayo Clin Proc. 1997;72:400–413
Camann WR, Murray RS, Mushlin PS, Lambert DH. Effects of oral caffeine on postdural puncture headache. A double-blind, placebo-controlled trial. Anesth Analg. 1990;70:181–184.
Lance JW. Headaches related to sexual activity. J Neurol Neurosurg Psychiatry. 1976;39:1226–1230.
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;54:1506–1509.
Rapoport AM, Sheftell FD. Headache associated with medication and substance withdrawal. In: Tollison CD, Kunkel RS, eds. Headache, Diagnosis & Treatment. Baltimore, MD: Williams & Wilkins; 1993:227–231.
Belgrade MJ, Ling LJ, Schleevogt MB, Ettinger MG, Ruiz E. Comparison of single dose meperidine, butorphanol and dihydroergotamine in the treatment of vascular headache. Neurology. 1989;39:590–592.
Edwards K, Santarcangelo V, Shea P, et al. Intravenous valproate for acute treatment of migraine headaches [Abstract]. Cephalalgia. 1999;19:356 (II-G1-7).
Mathew NT, Kailasam J, Meadors L et al. Intravenous valproate sodium (Depacon) aborts migraine rapidly: A preliminary report [Abstract]. Cephalalgia. 1999;19:373(II-G1-58).
Seymour JJ, Moscati RM, Jehle DV. Response of headaches to nonnarcotic analgesics resulting in missed intracranial hemorrhage. Am J Emerg Med. 1995;13:43–45.
Ducharme J, Beveridge RC, Lee JS, Beaulieu S. Emergency management of migraine: Is the headache really over? Acad Emerg Med. 1998;5:899–905.
Author information
Authors and Affiliations
Additional information
The author has stated that he does not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article.
About this article
Cite this article
Levin, M. The acute severe headache— Assessment and treatment. Compr Ther 28, 235–243 (2002). https://doi.org/10.1007/s12019-002-0023-y
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s12019-002-0023-y