Abstract
Millions of patients see physicians each year for headache, most of which are primary headaches. However, serious secondary headaches, such as meningitis, represent about 5% of children and 1% to 2% of adults seen in the emergency department for headache. A primary care or emergency department physician may initially miss individuals with bacterial meningitis. Considering meningitis as a headache cause is important because delay in the diagnosis may have adverse consequences. A careful history and physical examination are central in identifying individuals at high risk for meningitis. This article lists information that can be obtained from the patient that may be indicative of meningitis. Performing a lumbar puncture with appropriate examination of the cerebrospinal fluid (CSF) is the key to establishing the diagnosis of meningitis. This article also includes the types of meningitis that should be considered when the CSF demonstrates a pleocytosis.
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References and Recommended Reading
Newland CA, Illis LS, Robinson PK, et al.: A survey of headache in an English city. Res Clin Stud Headache 1978, 5:1–20.
Ziegler DK, Hassanein RS, Couch JR: Characteristics of life headache histories in a nonclinic population. Neurology 1977, 27:265–269.
Schappert SM, Burt CW: Ambulatory care visits to physicians offices, hospital outpatient departments, and emergency departments: United States 2001–02. National Center for Health Statistics. Vital Health Stat 2006, 13:159.
Barton CW: Evaluation and treatment of headache patients in the emergency department: a survey. Headache 1994, 34:91–94.
Joubert J: Diagnosing headache. Aust Fam Physician 2005, 34:621–625.
Ward TN, Levin M, Phillips JM: Evaluation and management of headache in the emergency department. Med Clin North Am 2001, 85:971–985.
Davis LE: Subacute and chronic meningitis. Continuum 2006, 12:27–57.
Kan L, Nagelberg J, Maytal J: Headache in a pediatric emergency department: etiology, imaging and treatment. Headache 2000, 40:25–29.
Nowak DA, Boehmer R, Fuchs HH: A retrospective clinical, laboratory and outcome analysis in 43 cases of acute aseptic meningitis. Eur J Neurol 2003, 10:271–280.
Valmari P: Primary diagnosis in a life-threatening childhood infection. A nationwide study on bacterial meningitis. Ann Clin Res 1985, 17:310–315.
Fitch MT, van de Beek D: Emergency diagnosis and treatment of adult meningitis. Lancet Infect Dis 2007, 7:191–200.
Tepper SJ, Dahlof CG, Dowson A, et al.: Prevalence and diagnosis of migraine in patients consulting their physician with a complaint of headache: data from the Landmark Study. Headache 2004, 44:856–864.
Lipton RB, Stewart WF, Diamond S, et al.: Prevalence and burden of migraine in the United States: data from the American Migraine study II. Headache 2001, 41:646–657.
Evans RW: Diagnostic testing for the evaluation of headaches. Neurol Clin 1996, 14:1–26.
Ferrera PC, Reicho PR: Acute confusional migraine and trauma-triggered migraine. Am J Emerg Med 1996, 14:276–278.
Kirchmann M, Thomsen LL, Olesen J: Basilar-type migraine: clinical, epidemiologic, and genetic features. Neurology 2006, 66:880–886.
Lance JW: Mechanism and Management of Headache. Oxford: Butterworth Heinemann; 1993:1268.
Schobitz E, Qureshi F, Lewis D: Pediatric headaches in the emergency department. Curr Pain Headache Rep 2006, 10:391–396.
Lewis DW, Qureshi F: Acute headache in children and adolescents presenting to the emergency department. Headache 2000, 40:200–203.
Burton LJ, Quinn B, Pratt-Cheney JL, Pourani M: Headache etiology in a pediatric emergency department. Pediatr Emerg Care 1997, 13:1–4.
Talan DA, Guterman JJ, Overturf GD, et al.: Analysis of emergency department management of suspected bacterial meningitis. Ann Emerg Med 1989, 18:856–862.
Talan DA, Hoffman JR, Yoshikawa TT, Overturf GD: Role of empiric parenteral antibiotics prior to lumbar puncture in suspected bacterial meningitis: state of the art. Rev Infect Dis 1988, 10:365–376.
Tuncer O, Caksen H, Arslan S, et al.: Cranial computed tomography in purulent meningitis of childhood. Int J Neurosci 2004, 114:167–174.
Chadwick DR: Viral meningitis. Br Med Bull 2005, 75–76:1–14.
DeBiasi RL, Tyler KL: Recurrent aseptic meningitis. In Infectious Diseases of the Nervous System. Edited by Davis LE, Kennedy PGE. Oxford: Butterworth-Heimann; 2000:445–479.
van de Beek D, de Gans J, Tunkel AR, Wijdicks EF: Community-acquired bacterial meningitis in adults. N Engl J Med 2006, 354:44–53.
Schuchat A, Robinson K, Wenger JD, et al.: Bacterial meningitis in the United States in 1995. Active Surveillance Team. N Engl J Med 1997, 337:970–976.
Durand ML, Calderwood SB, Weber DJ, et al.: Acute bacterial meningitis in adults. A review of 493 episodes. N Engl J Med 1993, 328:21–28.
Shalabi M, Whiteley RJ: Recurrent benign lymphocytic meningitis. Clin Infect Dis 2006, 43:1194–1197.
Hopkins S, Jolles S: Drug-induced aseptic meningitis. Expert Opin Drug Saf 2005, 4:285–297.
Chamberlain MC: Neoplastic meningitis. J Clin Oncol 2005, 23:3605–3613.
Prencipe M, Cassini AR, Ferretti C, et al.: Prevalence of headache in an elderly population: attack frequency, disability, and use of medication. J Neurol Neurosurg Psychiatry 2001, 70:377–381.
Walker RA, Wadman MC: Headache in the elderly. Clin Geriatr Med 2007, 23:291–305.
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Davis, L.E., Katzman, J.G. Chronic daily headache: When to suspect meningitis. Current Science Inc 12, 50–55 (2008). https://doi.org/10.1007/s11916-008-0010-9
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DOI: https://doi.org/10.1007/s11916-008-0010-9