What is a secondary headache?

According to patient.info, secondary headaches account for less than 10% of all headaches, and primary headaches account for the balance of 90%. 

A headache is a symptom we have all experienced in our life at one point or another. It is such a common symptom that we tend to ignore it or take an over-the-counter pill for it.

If it is a primary headache, which is very common, the matter ends there with the headache pill or the local application balm. A primary headache includes a tension headache, a migraine, or a cluster headache.

These headaches, though troublesome, have a benign cause without any long-lasting effects.

The secondary headaches, on the other hand, have an underlying medical pathology that can be serious, at times even terminal or life-threatening.

 A secondary headache is caused by medical conditions, which could be potentially dangerous and if you are “presented” with one, you have to see your doctor who will diagnose the cause and treat it.

A secondary headache is typically accompanied by certain “red flag” or warning symptoms, which come about due to the underlying cause.

Secondary headache symptoms

There are some warning symptoms, which can help the doctor to suspect the secondary headache and its cause. He then proceeds with the required investigations to confirm his suspicions.

Here are some “red flags” symptoms, which are typical of this type of headache.

  • A new or different kind of headache in someone over 50 years of age
  • The headache of sudden onset
  • Increased frequency or severity of headache
  • Mental confusion accompanying the headache
  • Headache that becomes worse on exertion or coughing or straining
  • Accompanying visual loss
  • Headache that becomes worse on chewing
  • Headache accompanied by neck stiffness
  • An accompanying systemic illness
  • Focal neurologic signs
  • Papilledema
  • Headache due to trauma to the head  

Secondary headache causes

There are many causes, which can trigger a secondary headache. Some of them are explored below.

  • A stroke occurs when blood flow to a part of the brain is interrupted either due to blockage of the blood vessel or due to bleeding through the ruptured blood vessel. This causes a severe headache
  • A cerebral aneurysm is a ballooning of the wall of an artery due to a weakness in the arterial wall. This balloon is filled with blood and exerts pressure on the adjoining areas of the brain, which causes a headache. The aneurysm can also rupture causing blood to spill. This headache is of severe intensity.
  • Tumors of structures in the skull and neck
  • Meningitis is an infection of the meninges (membranes that cover the brain).
  • Encephalitis is an inflammation of the brain.
  • Concussions occur due to injury to the head.
  • Sinus headaches occur due to pressure of the inflamed sinus on the neighboring areas namely the cheeks, nose, and forehead.
  • Trigeminal neuralgia is described as the most excruciating pain known to humanity. The trigeminal nerve arises from the brain, travels inside the skull, and divides into three smaller branches, controlling sensations throughout the face on each side. When this nerve is irritated usually due to pressure from neighboring structures, it causes pain in the corresponding side of the head and face.
  • Epileptic seizures. About 45% of people with epilepsy experience headaches. The headache associated with epilepsy is called a postictal headache, which means that the headache occurs after an epileptic seizure.
  • Pneumonia. The headache due to pneumonia can develop suddenly or gradually and gets worse within a day or two.
  • AIDS. Researchers at the University of Mississippi researched 200 patients with HIV/AIDS and found that 53.5% suffered from headaches.
  • High blood pressure. High blood pressure can cause headaches because it affects the blood-brain barrier. High blood pressure in the arteries causes extra pressure on the neighboring brain tissue and can give rise to symptoms of headache, dizziness, vomiting, blurred vision, and even seizure. Headaches caused by high blood pressure typically occur on both sides of the head.
  • Dehydration. Dehydration occurs due to the loss of water from the body through either sweat or urine or both. It causes a headache that resembles a tension headache with a tightening sensation all over the head.

Other less common causes include

When should you see the doctor for your headache?

If your headache exhibits any of the following patterns, you must seek medical help to rule out any underlying medical cause that could be potentially dangerous.

  • If you get two or more headaches  a week on a continuous basis
  • The pattern of your headache varies
  • You get headaches every day and have to take a pain reliever
  • Your headaches get more severe
  • The onset of your headache is sudden and severe
  • The headache gets worse even after taking the medication
  • Headache is accompanied by other symptoms such as fever, stiffness of the neck, delirium, seizures, difficulty in speech, vision problems such as double vision
  • Headache after trauma to the head
  • Any such symptoms as described under secondary headache symptoms above