Secondary headaches - red and green flags and their significance for diagnostics

Q3 Neuroscience eNeurologicalSci Pub Date : 2023-09-01 DOI:10.1016/j.ensci.2023.100473
Tissa Wijeratne , Chanith Wijeratne , Nadja Korajkic , Stefanie Bird , Carmela Sales , Franz Riederer
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引用次数: 1

Abstract

A small percentage of patients suffer from a secondary headache syndrome. It is imperative that clinicians are able to differentiate primary headache syndromes from secondary headache syndromes, as failure to do so significantly worsens morbidity and mortality. Recent advances in our understanding of pathobiological mechanisms offer useful information on these enigmatic disorders. We now understand that the causes of secondary headache syndromes can vary significantly – these may be infectious, inflammatory, vascular, traumatic or structural in origin.

A well-taken history and targeted physical examination coupled with appropriate investigations can enable these syndromes to be recognized consistently and thus allow their timely and appropriate treatment. Along with their epidemiology, some of their key characteristics shall thus be discussed in this review so as to aid the busy clinician at the bedside. Red flags including sudden onset, high pain intensity, pattern of change of a preexisting headache, focal neurological signs or seizure, systemic signs and precipitation by physical activity can guide the clinician to suspect a secondary headache. Importantly a preexisting headache is not an exclusion of a secondary headache – it might even be a predisposition in certain cases.

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继发性头痛——红色和绿色标志及其诊断意义
一小部分患者患有继发性头痛综合征。临床医生必须能够区分原发性头痛综合症和继发性头痛综合症,因为不能这样做会显著恶化发病率和死亡率。我们对病理生物学机制的理解的最新进展为这些神秘的疾病提供了有用的信息。我们现在了解到,继发性头痛综合征的病因可能有很大差异——这些病因可能是传染性的、炎症性的、血管性的、创伤性的或结构性的。良好的病史和有针对性的体检,再加上适当的调查,可以使这些综合征得到一致的识别,从而使其得到及时和适当的治疗。因此,在这篇综述中,除了他们的流行病学外,还将讨论他们的一些关键特征,以帮助床边忙碌的临床医生。危险信号包括突然发作、高疼痛强度、先前存在的头痛的变化模式、局灶性神经体征或癫痫发作、全身体征和身体活动引起的沉淀,可以引导临床医生怀疑是继发性头痛。重要的是,先前存在的头痛并不是继发性头痛的排除——在某些情况下,它甚至可能是一种易感性。
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来源期刊
eNeurologicalSci
eNeurologicalSci Neuroscience-Neurology
CiteScore
3.50
自引率
0.00%
发文量
45
审稿时长
62 days
期刊介绍: eNeurologicalSci provides a medium for the prompt publication of original articles in neurology and neuroscience from around the world. eNS places special emphasis on articles that: 1) provide guidance to clinicians around the world (Best Practices, Global Neurology); 2) report cutting-edge science related to neurology (Basic and Translational Sciences); 3) educate readers about relevant and practical clinical outcomes in neurology (Outcomes Research); and 4) summarize or editorialize the current state of the literature (Reviews, Commentaries, and Editorials). eNS accepts most types of manuscripts for consideration including original research papers, short communications, reviews, book reviews, letters to the Editor, opinions and editorials. Topics considered will be from neurology-related fields that are of interest to practicing physicians around the world. Examples include neuromuscular diseases, demyelination, atrophies, dementia, neoplasms, infections, epilepsies, disturbances of consciousness, stroke and cerebral circulation, growth and development, plasticity and intermediary metabolism. The fields covered may include neuroanatomy, neurochemistry, neuroendocrinology, neuroepidemiology, neurogenetics, neuroimmunology, neuroophthalmology, neuropathology, neuropharmacology, neurophysiology, neuropsychology, neuroradiology, neurosurgery, neurooncology, neurotoxicology, restorative neurology, and tropical neurology.
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