Benjamin Wedro, MD, FACEP, FAAEM
Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
In this Article
- Headache facts
- What is a headache?
- How are headaches classified?
- What are primary headaches?
- What are secondary headaches?
- What are cranial neuralgias, facial pain, and other headaches?
- What causes tension headaches?
- What are the symptoms of tension headaches?
- How are tension headaches diagnosed?
- How are tension headaches treated?
- What causes cluster headaches?
- What are the symptoms of cluster headaches?
- How are cluster headaches diagnosed?
- How are cluster headaches treated?
- Can cluster headaches be prevented?
- What diseases cause secondary headaches?
- How are secondary headaches diagnosed?
- What are the exams and tests for secondary headaches?
- When should I seek medical care for a headache?
- Headache & Migraine Triggers - Slideshow
- A Visual Guide to Migraine Headaches - Slideshow
- Take the Headaches Quiz!
- Headaches FAQs
- Find a local Neurologist in your town
How are secondary headaches diagnosed?
If there is time, the diagnosis of secondary headache begins with a complete patient history followed by a physical examination and laboratory and radiology tests as appropriate.
However, some patients present in crisis with a decreased level of consciousness or unstable vital signs. In these situations, the health care professional may decide to treat a specific cause without waiting for tests to confirm the diagnosis.
For example, a patient with headache, fever, stiff neck, and confusion may have symptoms that suggest meningitis. Since meningitis can be rapidly fatal, antibiotic therapy may be started before blood tests and a lumbar puncture are performed to confirm the diagnosis. It may be that the diagnosis is found to be a brain tumor or subarachnoid hemorrhage, but the benefit of early antibiotics outweighs the risk of not giving them promptly.
What are the exams and tests for secondary headaches?
The patient history and physical examination provide the initial direction for determining the cause of secondary headaches. Therefore, it is extremely important that a patient with new, severe headache seeks medical care and gives their health care professional an opportunity to assess their condition. Tests that may be useful in making the diagnosis of the underlying disease causing the headaches will depend upon the doctor's evaluation and what specific disease, illness, or injury is being considered as the cause of the headaches (the differential diagnosis). Common tests that are considered include the following:
- blood tests;
- computerized tomography (CT scan);
- magnetic resonance imaging (MRI) scans of the head; and
- lumbar puncture (spinal tap).
Specific tests will depend upon what potential issues the health care professional and patient want to address.
Blood tests provide helpful information in association with the history and physical examination in pursuing a diagnosis. For example, an infection or inflammation in the body may cause a rise in the white blood cell count, the erythrocyte sedimentation rate (ESR), or C-reactive protein (CRP). These two tests are very nonspecific; that is, they may be abnormal with any infection or inflammation, and abnormalities do not point to a specific diagnosis of the cause of the infection or inflammation. The ESR is often used to make the tentative diagnosis of temporal arteritis, a condition that affects an older patient, usually over the age of 65, who presents with a sharp, stabbing temporal headache.
Blood tests may be used to assess electrolyte disturbances, and a variety of organ dysfunctions including liver, kidney, and thyroid.
Toxicology tests may be helpful if the patient is suspected of abusing alcohol, prescription, or other drugs of abuse.
Computerized tomography of the head
Computerized tomography (CT scan) is able to detect bleeding, swelling, and some tumors within the skull and brain. It can also show evidence of previous stroke. With intravenous contrast injection, it may also be used to look at the arteries of the brain.
Magnetic resonance imaging (MRI) of the head
MRI is able to better look at the anatomy of the brain and meninges (the layers that cover the brain and the spinal cord). While it is more precise, the time to perform the scan is significantly longer than for computerized tomography. This type of scan is not available at all hospitals. Moreover, it takes much longer to perform, requires the patient to cooperate by holding still, and requires that the patient have no metal in their body (for example, a heart pacemaker or metal foreign objects in the eye).
Cerebrospinal fluid, the fluid that surrounds the brain and spinal cord, can be obtained with a needle that is inserted into the spine in the lower back. Examination of the fluid looks for infection (such as meningitis due to bacteria, virus, fungus, or tuberculosis) or blood from hemorrhage. In almost all cases, computerized tomography is done prior to lumbar puncture to make certain there is no bleeding, swelling, or tumor within the brain. Pressure within the space can be measured when the lumbar puncture needle is inserted. Elevated pressures may make the diagnosis of idiopathic intracranial hypertension in combination with the appropriate history and physical examination.
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