Headache — Findings Suggestive of Serious Secondary Headache — Clinical Pathway: Primary Care

Headache Clinical Pathway — Primary Care

Findings Suggestive of Serious Secondary Headache

Examples of primary headaches are tension-type and migraine, where the cause of the headache is not due to another etiology. A secondary headache occurs when the headache is a symptom of something else.

Most secondary headaches in children are associated with self-limited infections or trauma and resolve with acetaminophen/ibuprofen, hydration, rest/relaxation, or targeted treatment for specific infection.

Serious causes of headaches, such as tumor, intracranial hemorrhage or hypertension, and CNS infections are rare.

SNOOPY: Snoop for Secondary Headache

S
  • Systemic Disease
    • History of malignancy or tumor
    • History of congenital heart disease
    • Immunosuppression or immune deficiency
    • Hematologic – thrombophilia, thrombocytopenia, coagulopathy or sickle-cell disease
    • Genetic disease with predisposition
    • Recent history of head trauma
  • Signs of Systemic Disease
    • Constitutional – weight loss, fever, fatigue, malaise, morning vomiting or recurrent vomiting without cause
    • Infectious – sinusitis, encephalitis/meningitis, tickborne
    • Rheumatologic – arthritis, rash
N
  • Neurologic Signs
    • Altered mental status
    • Papilledema
    • Focal neurologic findings
    • New seizure
O
  • Onset Sudden
    • Thunderclap headache – may signal vascular cause
O
  • Occipital Location
    • May be risk factor for secondary headache
P
  • Progressive
    • Chronic or acutely progressive pattern
  • Precipitated by Valsalva
    • Cough or sneeze triggering a headache may signal increased or decreased ICP
  • Positional
    • Worse lying down, awakens patient at night when previously no headache or severe upon awakening may signal increased ICP
    • Persistently worse with standing may be dehydration, decondition, low blood pressure, or low ICP
Y
  • Years < 6
    • Risk factor for secondary headache (may be due to limited ability to describe headache)