Secondary headaches

Abstract

A new headache occurring simultaneously with another disorder recognized as capable of causing headache is always diagnosed as secondary. Secondary headache is usually expected to improve or go away within 3 months spontaneously or after successful treatment of the cause. Finding the secondary cause is critical for treating symptomatic or sinister headaches. It is useful to differentiate secondary headaches into vascular and nonvascular secondary types. Primary headache disorders can coexist with, worsen, or transform into secondary headache disorders. Secondary headaches are less common than primary headaches in pain medicine practices. It is essential to be familiar with secondary headaches and have a game plan to pursue evaluation of etiologies. The International Classification of Headache Disorders Third Edition, beta version (ICHD-3) (Headache Classification Committee of the International Headache Society (IHS), Cephalalgia 33:629-808, 2013) that classified headache disorders should be used as a guide to categorize and diagnose secondary headaches. Medications used to treat secondary headache are generally those matched to primary headache disorders. However, many commonly used headache medicines, such as triptans or ergots, are contraindicated in secondary vascular headaches.