Clinical features of nontraumatic headaches associated with underlying causes

Characteristic clinical feature	Suspected etiology	Supportive associated features	Common alternative underlying causes
History
Anticoagulant medication use	Subdural hematoma	Neurologic deficits (eg, hemiparesis)	Other forms of intracranial hemorrhage (eg, ICH, EDH, SAH)
Analgesic medication use	Medication overuse headache		Other primary and secondary headache syndromes*
Pregnancy	Preeclampsia	Elevated blood pressure Blurred vision Epigastric/retrosternal pain	RPLS CVT
Onset at age >50 years	Tumor	Neurologic deficits (eg, hemiparesis, vision loss)	GCA Cerebral abscess
Immunosuppressive state	Infectious meningitis		RPLS
Carbon monoxide exposure	Carbon monoxide toxicity	Dizziness Nausea	Other primary and secondary headache syndromes*
Symptoms
Sudden-onset severe headache	Aneurysmal SAH	Meningismus Progressive neurologic deterioration	RCVS Primary headache associated with sexual activity ICH
Visual disturbances	Glaucoma	Halos appear around light Blurred vision	Migraine IIH (Pseudotumor cerebri) GCA
Orthostatic headache	Spontaneous intracranial hypotension	Worsens with Valsalva maneuvers Tinnitus/hearing loss	Cervicogenic headache Postural orthostatic tachycardia syndrome
Signs
Fever and meningismus	Infectious meningitis		SAH GCA
Elevated BP	RCVS	Confusion Neurologic deficits (eg, hemiparesis, vision loss)	RPLS ICH Ischemic stroke Preeclampsia
Papilledema	IIH (Pseudotumor cerebri)	Visual field defects Nausea/vomiting	Tumor Optic neuritis Nonarteritic ischemic optic neuropathy
Horner syndrome	Carotid artery dissection	Ischemic stroke symptoms Lower cranial nerve deficits	Cluster headache Migraine
Drowsiness	ICH	Neurologic deficits (eg, hemiparesis, vision loss)	Ischemic stroke Tumor or abscess Migraine with brainstem aura Seizure (postictal state)
Hemiplegia	ICH or ischemic stroke	Associated cranial nerve and/or sensory deficits	Migraine Tumor or abscess

ICH: intracerebral hemorrhage; EDH: epidural hematoma; SAH: subarachnoid hemorrhage; RPLS: reversible posterior leukoencephalopathy syndrome; CVT: cerebral venous thrombosis; GCA: giant cell arteritis; IIH: idiopathic intracranial hypertension; BP: blood pressure; RCVS: reversible cerebral vasoconstriction syndrome.

* Primary headache syndromes include migraine and related conditions, tension-type headaches, trigeminal autonomic cephalalgias (cluster headache, paroxysmal hemicrania, short-lasting unilateral neuralgiform headache attacks, and hemicrania continua), and less common primary headache disorders (eg, new persistent daily headache, primary cough headache, primary exercise headache). Refer to UpToDate topics for additional details.

Graphic 141069 Version 1.0

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Clinical features of nontraumatic headaches associated with underlying causes