Headache: Clinical Features

Abstract

Headache is one of the most common medical complaints of civilized humans; nevertheless severe and chronic headaches are only infrequently caused by organic disease. Although the overall headache prevalence figures vary, in most studies headache prevalence lifetime is over 70%. The current International Classification of Headache Disorder provides operational definitions for all headaches types, and it divides headaches into primary and secondary headache disorders. Most headaches seen in practice belong to the category of primary headaches, where there is no underlying structural cause identifiable. Less than 10% headaches in practice belong to the category of secondary headaches where there is an underlying condition that can sometimes be ominous and life-threatening.

There are only four main types of primary headaches; in contrast, the causes of secondary or symptomatic headaches are numerous. Quite often secondary headaches have the same characteristics as primary forms; therefore, it is sometimes difficult to determine whether the pain is secondary or primary.

The first task in evaluating a headache patient is to identify or exclude secondary headache based on the history, the general medical and the neurologic examination. In the initial evaluation, whenever faced with a primary headache that presents in atypical fashion or when the IHS criteria are not fulfilled, it is important to exclude a secondary form. In the same way, the experienced physician must look for “headache alarms” or “red flags” that suggest the possibility of a secondary headache disorder; in these cases it is imperative to investigate and rule out an underlying secondary condition that can sometimes be life-threatening.

We report the clinical features of primary headaches and the main secondary life-threatening headaches that can be found in the emergency department.