Headache

Chronic Progressive Headache

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Chronic Progressive Headache, Organic Headache, Secondary Headache

  • Risk Factors
  1. See See Headache Red Flag
  2. Primary Headache onset over age 50 years (esp. age >65 years)
  3. Known malignancy (esp. Lung Cancer, Breast Cancer, malignant Melanoma)
  4. Cluster Headache
  • Exam
  • Focus Areas
  1. Careful Neurologic Exam (focus on symmetry)
    1. Brain Tumors presenting with neurologic change: 92%
    2. Vasquez-Barquero (1994) Cephalalgia 14:270-2 [PubMed]
  2. Altered Level of Consciousness
  3. Cognitive changes
  4. Nonspecific Vital Sign changes
  5. Meningismus (e.g. Nuchal Rigidity)
  6. Fever
  7. Careful Eye Neurologic Exam
    1. Asymmetric pupils or other abnormal pupil changes
    2. Papilledema
    3. Retinal Hemorrhage
  8. Deep Tendon Reflexes
  9. Pronator Drift
    1. Eyes closed with arms extended in front of patient