Secondary Headaches, Red Flag Pathologies and Cranial Neuralgias

This part covers headaches with an underlying cause. Vascular causes include subarachnoid hemorrhage, subdural hematoma in older patients on anticoagulant or antiplatelet medication, cerebral venous sinus thrombosis, cervical artery dissection and posterior fossa stroke, which CT can miss. Raised intracranial pressure gives headache that is worse lying down, with nausea, vomiting and visual obscurations. Low CSF pressure from a dural tear gives headache that is worse upright and eases lying down. About half of young patients with occipital cough headache have a Chiari malformation and need a craniocervical MRI. About 50% of people with daily headache have a medication overuse component. Sudden rises in blood pressure, sleep apnea and altitude can also cause headache, so blood pressure should be tested. Cervicogenic, temporomandibular and vestibular headaches are where physiotherapists have most to offer. Cranial neuralgias cause brief paroxysmal pain in a nerve's distribution, triggered by things like shaving or chewing. Trigeminal neuralgia sits in the lower trigeminal branches, which helps tell it apart from the trigeminal autonomic cephalalgias.