Treatment of Major Secondary Headaches

Abstract

There are a variety of medications that are used to treat the secondary headaches, although the evidence to support their use is often limited. Medications commonly used are often the same as those used to treat primary headache disorders such as migraine and tension-type headache. Clinicians must use caution when prescribing medications that may worsen an underlying condition or cause a recurrence of symptoms. Because secondary headaches are often daily and constant in nature, the patient is at risk for medication overuse headache. Use of opioid analgesics should be limited to the acute setting or to those patients using opioids within the context of palliative care. This chapter offers clinical advice on treatment of posttraumatic headache, stroke headache, giant cell arteritis, primary angiitis of the central nervous system (PACNS), reversible cerebral vasoconstriction syndrome (RCVS), idiopathic intracranial hypertension (IIH, pseudotumor cerebri), low cerebrospinal fluid (CSF) pressure headache, Chiari malformation type I, and cervicogenic headache.