Headache

Headache: Excerpt from Professional Guide to Signs & Symptoms (Fifth Edition)

The most common neurologic symptom, headaches may be localized or generalized, producing mild to severe pain. About 90% of all headaches are benign and can be described as vascular, muscle-contraction, or a combination of both. (See Comparing benign headaches, page 390.) Occasionally, though, headaches indicate a severe neurologic disorder associated with intracranial inflammation, increased intracranial pressure (ICP), or meningeal irritation. They may also result from an ocular or sinus disorder, tests, drugs, or other treatments.

Other causes of headache include fever, eyestrain, dehydration, and systemic febrile illnesses. Headaches may occur in certain metabolic disturbances—such as hypoxemia, hypercapnia, hyperglycemia, and hypoglycemia—but they aren’t a diagnostic or prominent symptom in these disorders. Some individuals get headaches after seizures or from coughing, sneezing, heavy lifting, or stooping.

History and physical examination

If the patient reports a headache, ask him to describe its characteristics and location. How often does he get a headache? How long does a typical headache last? Try to identify precipitating factors, such as eating certain foods or exposure to bright lights. Ask what helps to relieve the headache. Is the patient under stress? Has he had trouble sleeping?

Take a drug and alcohol history, and ask about head trauma within the last 4 weeks. Has the patient recently experienced nausea, vomiting, photophobia, or visual changes? Does he feel drowsy, confused, or dizzy? Has he recently developed seizures, or does he have a history of seizures?

Begin the physical examination by evaluating the patient’s level of consciousness (LOC). Then check his vital signs. Be alert for signs of increased ICP—widened pulse pressure, bradycardia, altered respiratory pattern, and increased blood pressure. Check pupil size and response to light, and note any neck stiffness. (See Differential diagnosis: Headache, pages 392 and 393.)

Medical causes

Anthrax, cutaneous

Along with a macular or papular lesion that develops into a vesicle and finally a painless ulcer, this disorder may produce a headache, lymphadenopathy, fever, and malaise.

Brain abscess

In this disorder, the headache is localized to the abscess site; it usually intensifies over a few days and is aggravated by straining. Accompanying the headache may be nausea, vomiting, and focal or generalized seizures. The patient’s LOC varies from drowsiness to deep stupor. Depending on the abscess site, associated signs and symptoms may include aphasia, impaired visual acuity, hemiparesis, ataxia, tremors, and personality changes. Signs of infection, such as fever and pallor, usually develop late; however, if the abscess remains encapsulated, these signs may not appear.

Brain tumor

Initially, a tumor causes a localized headache near the tumor site; as the tumor grows, the headache eventually becomes generalized. The pain is usually intermittent, deep seated, and dull and is most intense in the morning. It’s aggravated by coughing, stooping, Valsalva’s maneuver, and changes in head position, and it’s relieved by sitting and rest. Associated signs and symptoms include personality changes, altered LOC, motor and sensory dysfunction, and eventually signs of increased ICP, such as vomiting, increased systolic blood pressure, and widened pulse pressure.

Cerebral aneurysm (ruptured)

Cerebral aneurysm is a life-threatening disorder that’s characterized by a sudden excruciating headache, which may be unilateral and usually peaks within minutes of the rupture. The patient may lose consciousness immediately or display a variably altered LOC. Depending on the severity and location of the bleeding, he may also exhibit nausea and vomiting; signs and symptoms of meningeal irritation, such as nuchal rigidity and blurred vision; hemiparesis; and other features.

Ebola Virus

A sudden headache commonly occurs on the 5th day of this deadly illness. Additionally, the patient has a history of malaise, myalgia, high fever, diarrhea, abdominal pain, dehydration, and lethargy. A maculopapular rash develops between the 5th and 7th days of the illness. Other possible findings include pleuritic chest pain; a dry, hacking cough; pronounced pharyngitis; hematemesis; melena; and bleeding from the nose, gums, and vagina. Death usually occurs in the 2nd week of the illness, preceded by massive blood loss and shock.

Encephalitis

A severe, generalized headache is characteristic with this disorder. Within 48 hours, the patient’s LOC typically deteriorates—perhaps from lethargy to coma. Associated signs and symptoms include fever, nuchal rigidity, irritability, seizures, nausea and vomiting, photophobia, cranial nerve palsies such as ptosis, and focal neurologic deficits, such as hemiparesis and hemiplegia.

Epidural hemorrhage (acute)

Head trauma and a sudden, brief loss of consciousness usually precede this hemorrhage, which causes a progressively severe headache that’s accompanied by nausea and vomiting, bladder distention, confusion, and then a rapid decrease in LOC. Other signs and symptoms include unilateral seizures, hemiparesis, hemiplegia, high fever, decreased pulse rate and bounding pulse, widened pulse pressure, increased blood pressure, a positive Babinski’s reflex, and decerebrate posture.

If the patient slips into a coma, his respirations deepen and become stertorous, then shallow and irregular, and eventually cease. Pupil dilation may occur on the same side as the hemorrhage.

Glaucoma, acute angle-closure

This type of glaucoma is an ophthalmic emergency that may cause an excruciating headache as well as acute eye pain, blurred vision, halo vision, nausea, and vomiting. Assessment reveals conjunctival injection, a cloudy cornea, and a moderately dilated, fixed pupil.

Hantavirus pulmonary syndrome

Noncardiogenic pulmonary edema distinguishes this viral disease, which was first reported in the United States in 1993. Common reasons for seeking treatment include flulike signs and symptoms—headache, myalgia, fever, nausea, vomiting, and a cough—followed by respiratory distress. Fever, hypoxia, and (in some patients) serious hypotension typify the hospital course. Other signs and symptoms include a rising respiratory rate (28 breaths/minute or more) and an increased heart rate (120 beats/minute or more).

Hypertension

This disorder may cause a slightly throbbing occipital headache on awakening that decreases in severity during the day. However, if the patient’s diastolic blood pressure exceeds 120 mm Hg, the headache remains constant. Associated signs and symptoms include an atrial gallop, restlessness, confusion, nausea and vomiting, blurred vision, seizures, and altered LOC.

Influenza

A severe generalized or frontal headache usually begins suddenly with the flu. Accompanying signs and symptoms may last for 3 to 5 days and include stabbing retro-orbital pain, weakness, diffuse myalgia, fever, chills, coughing, rhinorrhea and, occasionally, hoarseness.

Intracerebral hemorrhage

In some patients, this hemorrhage produces a severe generalized headache. Other signs and symptoms vary with the size and location of the hemorrhage. A large hemorrhage may produce a rapid, steady decrease in LOC, perhaps resulting in a coma. Other common findings include hemiplegia, hemiparesis, abnormal pupil size and response, aphasia, dizziness, nausea, vomiting, seizures, decreased sensation, irregular respirations, positive Babinski’s reflex, decorticate or decerebrate posture, and increased blood pressure.

Listeriosis

If this infection spreads to the nervous system, it may cause meningitis, whose signs and symptoms include headache, nuchal rigidity, fever, and change in LOC. Earlier signs and symptoms of listeriosis include fever, myalgia, abdominal pain, nausea, vomiting, and diarrhea.

Gender Cue: Listeriosis during pregnancy may lead to premature delivery, infection of the neonate, or stillbirth.

Meningitis

This disorder is marked by the sudden onset of a severe, constant, generalized headache that worsens with movement. Fever and chills are other early signs. As meningitis progresses, it also causes nuchal rigidity, positive Kernig’s and Brudzinski’s signs, hyperreflexia, altered LOC, seizures, ocular palsies, facial weakness, hearing loss, vomiting and, possibly, opisthotonos and papilledema.

Plague

The pneumonic form of this lethal bacterial infection causes a sudden onset of headache, chills, fever, and myalgia. Pulmonary findings include a productive cough, chest pain, tachypnea, dyspnea, hemoptysis, respiratory distress, and cardiopulmonary insufficiency.

Postconcussion syndrome

A generalized or localized headache may develop 1 to 30 days after head trauma and last for 2 to 3 weeks. This characteristic symptom may be described as an aching, pounding, pressing, stabbing, or throbbing pain. The patient’s neurologic examination is normal, but he may experience giddiness or dizziness, blurred vision, fatigue, insomnia, inability to concentrate, and noise and alcohol intolerance.

Q fever

Signs and symptoms of this disease include severe headaches, fever, chills, malaise, chest pain, nausea, vomiting, and diarrhea. The fever may last for up to 2 weeks, and in severe cases, the patient may develop hepatitis or pneumonia.

Severe acute respiratory syndrome (SARS)

SARS is an acute infectious disease of unknown etiology; however, a novel coronavirus has been implicated as a possible cause. Although most cases have been reported in Asia (China, Vietnam, Singapore, Thailand), cases have cropped up in Europe and North America. After an incubation period of 2 to 7 days, the illness generally begins with a fever (usually greater than 100.4° F [38° C]).  Other symptoms include headache, malaise, a nonproductive cough, and dyspnea. SARS may produce only mild symptoms, or it may progress to pneumonia and, in some cases, even respiratory failure and death.

Sinusitis (acute)

This disorder is usually marked by a dull periorbital headache that’s usually aggravated by bending over or touching the face and is relieved by sinus drainage. Fever, sinus tenderness, nasal turbinate edema, sore throat, malaise, cough, and nasal discharge may accompany the headache.

Smallpox (variola major)

Initial signs and symptoms of this virus include a severe headache, backache, abdominal pain, high fever, malaise, prostration, and a maculopapular rash on the mucosa of the mouth, pharynx, face, and forearms and then on the trunk and legs. The rash becomes vesicular, then pustular. After 8 or 9 days, the pustules form a crust, which later separates from the skin, leaving a pitted scar. Death may result from encephalitis, extensive bleeding, or secondary infection.

Subarachnoid hemorrhage

This hemorrhage commonly produces a sudden, violent headache along with nuchal rigidity, nausea and vomiting, seizures, dizziness, ipsilateral pupil dilation, and altered LOC that may rapidly progress to coma. The patient also exhibits positive Kernig’s and Brudzinski’s signs, photophobia, blurred vision and, possibly, a fever. Focal signs and symptoms (such as hemiparesis, hemiplegia, sensory or vision disturbances, and aphasia) and signs of elevated ICP (such as bradycardia and increased blood pressure) may also occur.

Subdural hematoma

Typically associated with head trauma, both acute and chronic subdural hematomas may cause headache and decreased LOC. An acute subdural hematoma also produces drowsiness, confusion, and agitation that may progress to coma. Later findings include signs of increased ICP and focal neurologic deficits such as hemiparesis.

A chronic subdural hematoma produces a dull, pounding headache that fluctuates in severity and is located over the hematoma. Weeks or months after the initial head trauma, the patient may experience giddiness, personality changes, confusion, seizures, and progressively worsening LOC. Late signs may include unilateral pupil dilation, sluggish pupil reaction to light, and ptosis.

Temporal arteritis

A throbbing unilateral headache in the temporal or frontotemporal region may be accompanied by vision loss, hearing loss, confusion, and fever. The temporal arteries are tender, swollen, nodular, and sometimes erythematous.

Tularemia

Signs and symptoms following inhalation of the bacterium Francisella tularensis include abrupt onset of headache, fever, chills, generalized myalgia, a nonproductive cough, dyspnea, pleuritic chest pain, and empyema.

Typhus

In typhus, initial symptoms of headache, myalgia, arthralgia, and malaise are followed by an abrupt onset of chills, fever, nausea, and vomiting. A maculopapular rash may also occur.

West Nile encephalitis

This brain infection is caused by West Nile virus, a mosquito-borne flavivirus commonly found in Africa, West Asia, the Middle East and, rarely, in North America. Most patients have mild signs and symptoms, including fever, headache, body aches, rash, and swollen lymph glands. More severe infection is marked by high fever, headache, neck stiffness, stupor, disorientation, coma, tremors, and paralysis.

Other causes

Diagnostic tests

A lumbar puncture or myelogram may produce a throbbing frontal headache that worsens on standing.

Drugs

A wide variety of drugs can cause headaches. For example, indomethacin produces headaches—usually in the morning—in many patients. Vasodilators and drugs with a vasodilating effect, such as nitrates, typically cause a throbbing headache. Headaches may also follow withdrawal from vasopressors, such as caffeine, ergotamine, and sympathomimetics.

Herb Alert

Traction

Cervical traction with pins commonly causes a headache, which may be generalized or localized to pin insertion sites.

Special considerations

Continue to monitor the patient’s vital signs and LOC. Watch for any change in the headache’s severity or location. To help ease the headache, administer an analgesic, darken the patient’s room, and minimize other stimuli. Explain the rationale of these interventions to the patient.

Prepare the patient for diagnostic tests, such as skull X-rays, computed tomography scan, lumbar puncture, or cerebral arteriography.

Pediatric pointers

If a child is too young to describe his symptom, suspect a headache if you see him banging or holding his head. In an infant, a shrill cry or bulging fontanels may indicate increased ICP and headache. In a school-age child, ask the parents about the child’s recent scholastic performance and about any problems at home that may produce a tension headache.

Twice as many young boys have migraine headaches as girls. In children older than age 3, headache is the most common symptom of a brain tumor.

Pictures

Book Source Details

• Book Title: Professional Guide to Signs & Symptoms (Fifth Edition)
• Author(s): Springhouse
• Year of Publication: 2006
• Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2006 Lippincott Williams & Wilkins.

More About Japanese encephalitis

• Back to disease: Japanese encephalitis: Introduction
• Next Book Extract About Japanese encephalitis: Headache (The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
• More Book Extracts: All Online Books for Japanese encephalitis

More Medical Textbooks Online about Japanese encephalitis

Review other book chapters online related to Japanese encephalitis:

Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Professional Guide to Signs & Symptoms (Fifth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2006 ISBN: 1-58255-510-9

 » Next page: Headache (The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)

Rate This Website

What do you think about the features of this website? Take our user survey and have your say:

Website User Survey

Medical Tools & Articles:

Next articles:

• Headache (The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
• Headache (Field Guide to Bedside Diagnosis)
• Encephalitis (Handbook of Diseases)
• Headache (Handbook of Diseases)
• West Nile encephalitis (Handbook of Diseases)

Tools & Services:

• Bookmark this page
• Symptom Search
• Symptom Checker
• Medical Dictionary
• Give your feedback

Medical Articles:

• Disease & Treatments Search
• Misdiagnosis Center
• Full list of interesting articles

Forums & Message Boards

• Ask or answer a question at the Boards:
• I cannot get a diagnosis. Please help.
• Tell us your medical story.
• Share your misdiagnosis story.
• What is the best treatment for my condition?
• See all the Boards.

Enter your search terms Submit search form
Search The Web Search wrongdiagnosis.com

Common Health Mistakes

Symptom
Checker

Search Specialists by State and City