Headache

Chronic Progressive Headache

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Chronic Progressive Headache, Organic Headache, Secondary Headache

  • See Also
  1. Headache
  2. Headache Causes
  3. Acute Generalized Headache
  4. Acute Localized Headache
  5. Acute Recurrent Headache
  6. Chronic Non-Progressive 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
  • Causes
  1. Acute
    1. See Acute Generalized Headache
  2. Chronic
    1. Increased Intracranial Pressure (e.g. mass effect)
      1. Intracranial Tumor
      2. Pseudotumor Cerebri
      3. Brain Abscess
      4. Subdural Hematoma
      5. Hydrocephalus
      6. Arachnoid cyst (rare)
    2. Vascular disorder
      1. Arteriovenous Malformation
      2. Giant Cell Arteritis (Temporal Arteritis)
      3. Carotid dissection
      4. Vasculitis
  • Findings
  • Symptoms and Signs
  1. See Headache Red Flag
  2. See Headache History
  3. See Headache Examination
  4. Exertional Headache (or Headache worse with Valsalva Maneuver)
  • 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
  • Imaging
  1. See Headache Diagnostic Testing
  2. Head CT or MRI Head
  • References
  1. Coutin (1996) Am Fam Physician 54(7):2247-52 [PubMed]
  2. Dodlick (1997) Postgrad Med 101(5):46-64 [PubMed]
  3. Ryan (1996) Am Fam Physician 54(3):1051-7 [PubMed]
  4. Viera (2022) Am Fam Physician 106(3): 260-8 [PubMed]