Neurologic clinics
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The association between stroke and headache is complex, ranging from highly nonspecific, wherein headache is largely irrelevant to diagnosis and therapeutic management, to highly specific and even causative. In short, acute headache may accompany the acute stroke process, chronically complicate stroke, or, in rare instances, serve as the primary cause of stroke. With the first instance, the incidence of acute headache is highly dependent on the stroke sub-type and etiology. In this article, the headaches accompanying or causing acute stroke are addressed in some detail.
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A careful history and physical examination remain the most important aspects of headache assessment. enabling the neurologist to decide if any further studies are necessary. Only a minority of patients who have headaches have brain tumors; however, recognition of the headaches characteristically associated with tumors is most important. Some locations are more likely to produce headache (eg, a posterior fossa tumor causes headache more often than a supratentorial tumor). ⋯ Imaging of headache patients for tumors, if they have primary headache disorders, such as migraine and typical cluster, generally is not cost effective but is necessary if there are any atypical features. Treatment of headache in patients who have metastatic brain tumors should be aggressive in terms of pain and symptoms control. Treatment of primary CNS tumors is dictated by the kind of neoplasm and site, but control of headache should not be ignored.
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Cough, exertional, and sex headaches are three relatively rare and distinct but related syndromes, all of which are triggered in the context of rapid rises in intra-abdominal pressure. Cough headache occurs after single or brief series of such rises, whereas exertional and sexual headache typically arise after more prolonged provocations. ⋯ The pathophysiology of the three syndromes is poorly understood. They share several clinical features including relatively brief duration and a response to indomethacin.