A review of medical conditions that can cause secondary headaches

Learn about some of the unexpected medical conditions that cause secondary headaches. Read the article now.
Last update26th Nov 2020

There are a number of other medical conditions that can cause secondary headaches. Let’s take a look at three of the most common:

  1. Cerebral sinus thrombosis
  2. Head injury
  3. Infection

Cerebral venous sinus thrombosis

Cerebral venous sinus thrombosis (CVST) involves clots within the brain’s venous system which slow or halt the flow of venous blood. Although rare, obstruction of venous outflow can lead to bilateral venous infarcts with hemorrhage and focal neurologic deficit.

Women who are postpartum or pregnant, and those taking estrogen or oral birth control pills, are more prone to CVST.

Figure 1. Cerebral sinus thrombosis (CVST), or clot formation within the brain’s venous system, is more common in women who are pregnant, postpartum, taking estrogen, or oral birth control and can cause hemorrhage, focal neurological deficit, and an associated secondary headache.

Cerebral venous sinus thrombosis is treated with anticoagulants. This sounds counterintuitive since hemorrhages can occur from the condition, but the system is one of low pressure, so bleeding does not worsen.

Head injury

Over 70% of patients with moderate to severe head injury, and over 90% of patients with mild head injury report post-traumatic headaches.

A post-traumatic headache is defined as one of the following:

  • A headache that occurs within seven days of injury.
  • A headache that occurs within seven days of regaining consciousness.
  • A headache that occurs within seven days of stopping medications which might alter perceptions.

Risk factors include a prior history of headache, milder injury, and being less than 60 years old.

Figure 2. Post-traumatic headache is very common after head injury, particularly mild head injury, and can present with migraine headache characteristics, tension headache characteristics, dizziness, cognitive changes, anxiety, insomnia, and / or personality changes.

Migraine headache characteristics are most common with post-traumatic headaches, but tension-type headache characteristics also occur. Other symptoms include dizziness, cognitive changes, anxiety, insomnia, and personality changes.

Treatments are identical to those used for the primary headache type that the post injury headache mimics. In other words, if it resembles a migraine, we treat it like a migraine.

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Patients presenting with headache due to infection will have associated fever and nuchal rigidity.

Nuchal rigidity is demonstrated with the Brudzinski or Kernig signs. The Brudzinski sign is elicited if the stretching of the meninges achieved while flexing the head forward produces pain. The Kernig sign is elicited if extension of the knees while the hips are flexed up produces pain.

Figure 3. Secondary headaches occurring as the result of infection will be accompanied by fever and nuchal rigidity.

Imaging with computed tomography (CT) or magnetic resonance imaging (MRI) is necessary. Lumbar puncture should also be performed, unless contraindicated due to the presence of a mass (e.g., an abscess).

Empiric antibiotic therapy should be started while awaiting the results of a lumbar puncture.

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Recommended reading

  • Armand, CE, Masters-Israilov, A, and Lipton, RB. 2019. Migraine mimics. Practical Neurology. 18: 32–39. https://practicalneurology.com/articles/2019-may/migraine-mimics
  • Chou, DE. 2018. Secondary headache syndromes. Continuum (Minneap Minn). 24: 1179–1191.PMID: 30074555
  • Ferguson, LW and Gerwin, R. 2005. Clinical Mastery in the Treatment of Myofascial Pain. Baltimore: Lippincott Williams & Wilkins.
  • Fernández-de-las-Peñas, C, Arendt-Nielsen, L, and Gerwin, R. 2010. Tension-Type and Cervicogenic Headache—Pathophysiology, Diagnosis and Management. Sudbury: Jones and Bartlett Publishers.
  • Goadsby, PJ and Silberstein, SD. 1997. Headache. Boston: Butterworth-Heinemann.
  • Goadsby, PJ, Silberstein, SD, and Dodick, DW. 2005. Chronic Daily Headache for Clinicians. Hamilton: BC Decker.
  • Green, MW. 2012. Secondary headaches. Continuum (Minneap Minn). 18: 783–795. PMID: 22868541
  • Silberstein, SD, Lipton, RB, and Goadsby, PJ. 2002. Headache in Clinical Practice. 2nd edition. London: Martin Dunitz.

About the author

Robert Coni, DO EdS
Robert is Neurohospitalist, Medical Director, and Coordinator at the Grand Strand Medical Center, and Clinical Assistant Professor at the University of South Carolina.
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