Title: Secondary Headaches Trauma, Neoplasm, and LP
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2Secondary Headaches Trauma, Neoplasm, and LP
- E.FAKHARIAN, M.D.
- Associate Professor of Neurosurgery
- Kashan University of Medical Sciences
- Kashan-Iran
- 11.8.1388
- fakharian-e_at_kaums.ac.ir
- efakharian_at_gmail.com
-
3Reference/s
- The Headache Cooperative of New England
Comprehensive Review of Headache Medicine - MORRIS LEVIN
- Oxford University Press
- 2008
4Secondary HeadachesTrauma
- Head trauma, neck trauma, and whiplash
injuries are all recognized causes of acute and
chronic headache presentations - The typical headache after trauma is similar to
tension-type, migraine and even cluster headache.
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6Secondary HeadachesTrauma
- The IHS recognizes headaches as
post-traumatic only when they begin within 1
week after the trauma. We believe that the
official criteria should be changed to between 1
and 3 months after trauma. - Women have a greater chance of
developing post-traumatic headache. Older
individuals tend to have more permanent headaches
after trauma than younger ones or children.
Children usually experience very brief headaches
after trauma and are headache-free in 24 to 48
hours.
7Diagnostic Criteria for Acute Post-traumatic
Headache Attributed to Mild Head Injury
- Headache, no typical characteristics known,
fulfilling criteria C and D - B. Head trauma with all the following
- 1. Either no loss of consciousness, or loss of
consciousness of lt30 minutes duration - 2. Glasgow Coma Scale (GCS) gt13
- 3. Symptoms and/or signs diagnostic of concussion
- C. Headache develops within 7 days after head
trauma - D. One or other of the following
- 1. Headache resolves within 3 months after head
trauma - 2. Headache persists but 3 months have not yet
passed since head trauma
8Diagnostic Criteria for Acute Post-traumatic
Headache Attributed to Moderate or Severe Head
Injury
- A. Headache, no typical characteristics known,
fulfilling criteria C and D - B. Head trauma with at least one of the
following - 1. Loss of consciousness for gt30 minutes
- 2. Glasgow Coma Scale (GCS) lt13
- 3. Post-traumatic amnesia for gt48 hours
- 4. Imaging demonstration of a traumatic brain
lesion (cerebral hematoma, intracerebral and/or
subarachnoid hemorrhage, brain contusion and/or
skull fracture) - C. Headache develops within 7 days after head
trauma or after regaining consciousness following
head trauma - D. One or other of the following
- 1. Headache resolves within 3 months after head
trauma - 2. Headache persists but 3 months have not yet
passed since head trauma
9Diagnostic Criteria for Chronic Post-traumatic
Headache Attributed to Mild Head Injury
- A. Headache, no typical characteristics known,
fulfilling criteria C and D - B. Head trauma with all the following
- 1. Either no loss of consciousness, or loss of
consciousness of lt30 minutes duration - 2. Glasgow Coma Scale (GCS) gt13
- 3. Symptoms and/or signs diagnostic of concussion
- C. Headache develops within 7 days after head
trauma - D. Headache persists for gt3 months after head
trauma
10Diagnostic criteria for Chronic Post-traumatic
Headache Attributed to Moderate or Severe Head
Injury
- A. Headache, no typical characteristics known,
fulfilling criteria C and D - B. Head trauma with at least one of the
following - 1. Loss of consciousness for gt30 minutes
- 2. Glasgow Coma Scale (GCS) lt13
- 3. Post-traumatic amnesia for gt48 hours
- 4. Imaging demonstration of a traumatic brain
lesion (cerebral hematoma, ICH and/or SAH, brain
contusion and/or skull fracture) - C. Headache develops within 7 days after head
trauma or after regaining consciousness following
head trauma - D. Headache persists for gt3 months after head
trauma
11HEADACHE ATTRIBUTED TO INTRACRANIAL NEOPLASM
- Headache occurs in 50 to 70 of those with brain
tumors, but the presence of early morning severe
headache with nausea and vomiting occurs in no
more than 20 of patients. - Rapidly growing tumors and those located in the
posterior fossa are more likely to be associated
with headache
12Mechanisms of Headache in Brain Tumors
- Traction of dura and large vessels
- Direct pressure on cranial and cervical nerve
fibers - The release of inflammatory/hormonal mediators
- Raised intracranial pressure
13Diagnostic Criteria for Headache Attributed to
Increased Intracranial Pressure or Hydrocephalus
Caused by Neoplasm
- A. Diffuse non-pulsating headache with at least
one of the following characteristics and
fulfilling criteria C and D - 1. Associated with nausea and/or vomiting
- 2. Worsened by physical activity and/or maneuvers
known to increase intracranial pressure (such as
Valsalva maneuvers, coughing or sneezing) - 3. Occurring in attack-like episodes
- B. Space-occupying intracranial tumor
demonstrated by CT or MRI and causing
hydrocephalus - C. Headache develops and/or deteriorates in close
temporal relation to the hydrocephalus - D. Headache improves within 7 days after surgical
removal or volume-reduction of tumor
14Diagnostic criteria for Headache Attributed
Directly to Neoplasm
- A. Headache with at least one of the following
characteristics and fulfilling criteria C and D - 1. Progressive
3. Worse in the morning - 2. Localized
4. Aggravated by coughing
or bending forward - B. Intracranial neoplasm shown by imaging
- C. Headache develops in temporal relation to the
neoplasm - D. Headache resolves within 7 days after surgical
removal of neoplasm or treatment with
corticosteroids
15Pain-Sensitive Structures of the Head
- Dura
- Dural veins and arteries
- Intracranial arteries
- Cranial nerves V, VII, IX, X
- Cervical root C13
- Periosteum of the skull
- Scalp
- Scalp muscles
- Scalp vessels
- Sinuses
- Eyes
- Ears
- Teeth and gums
- Carotid and vertebral arteries
- Cervical spine
- Cervical muscles and tendons
- Pain-Insensitive Structures
- Parenchyma
- Pia, ventricles
- Skull, cervical spine
16Intracranial Pressure and Herniation
17POST-DURAL (POST-LUMBAR) PUNCTURE HEADACHE
- Bier in 1898 first reported post-LP headaches.
- Headache occurs in as many as 60 of patients who
undergo LP. - Most post-LP headaches are gone in a week or
two they commonly occur the day after the LP
18In 1891 Heinrich Quincke, of Kiel, Germany,
introduced Lumbar Puncture as we know it today
19Risk Factors for Post-LP Headache
- Headache before LP
- Patients with a lower body mass index
- Younger female patients
- Length of recumbency following LP does not
influence the chance, neither does opening
pressure, LP position, and the amount of CSF
removed. - Small-gauge atraumatic needles reduce the risk of
post-LP headache.
20Post-dural (Post-lumbar) Puncture Headache
Diagnostic criteria
- A. Headache that worsens within 15 minutes after
sitting or standing and improves within15 minutes
after lying, with at least one of the following
and fulfilling criteria C and D - 1. Neck stiffness
4. Photophobia - 2. Tinnitus
5. Nausea - 3. Hypacusia
- B. Dural puncture has been performed
- C. Headache develops within 5 days after dural
puncture - D. Headache resolves either
- 1. Spontaneously within 1 week
- 2. Within 48 hours after effective treatment of
the spinal fluid leak (usually by epidural blood
patch)