When should secondary causes of migraine headache be considered?

Updated: Oct 21, 2019
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Helmi L Lutsep, MD  more...
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Other secondary causes of alarming headaches should be sought, in the proper clinical setting, in the presence of the "red flags" mentioned above. Increased ICP may result from colloid cysts, ventricular tumors (such as ependymomas), or Chiari malformations. Other features needing further diagnostic workup include positional headaches, which may result from low CSF pressure.

Headaches after age 50 years must be investigated to consider temporal or giant cell arteritis. Headaches associated with systemic disease require consideration of infectious and noninfectious inflammatory processes.

Bear in mind that response to 5-hydroxytryptamine–1 (5-HT1) agonists (sumatriptan and related compounds) is not diagnostic of a migraine headache. Because of their ability to block expression of c-fos by their action on 5-HT1 receptors, these agents may be effective in decreasing headache pain associated with meningovascular irritation from a variety of causes, such as viral and bacterial infections and subarachnoid hemorrhage.

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