This is the eighth and final meeting within the neurological diseases course presented by Dr. Fawzi Abu Khalil and interviewed by Prof. Dr. Eyad Qunaibi. You can find the lecture slides here: https://jpuedu-my.sharepoint.com/:b:/g/personal/eyad_aqunaibi_jpu_edu_jo/ERxgWRwekctIsM_X3Q5-poIB9Y1TosGqGdfGpDoFfBntxg?e=qZiqlt
In the name of Allah, we rely on Allah. Peace be upon you and the mercy of Allah and His blessings. This is the second lecture, God willing, on the topic of headaches. In the previous lecture, we discussed the general objectives and the warning signs (Red Flags), as well as primary headache disorders such as migraines (Migraine), tension headaches (Tension Headache), and cluster headaches (Cluster Headache).
In this lecture, God willing, we will discuss secondary headache disorders (Secondary Headache Disorders), which are headaches caused by another medical condition.
I will start with the case I sent you on the group, which is a patient I saw two days ago in the hospital. She is 65 years old and has no previous health problems. She complained of a headache on the right side, with moderate severity (7 out of 10). The neurological exam was normal; there was no weakness in the limbs or clear neurological changes.
The only observation was a slight protrusion in her right eye (Eye Bulging). When I asked her daughter, she confirmed that this protrusion was new and had appeared in the past six weeks. In medicine, there is what is called "spot diagnosis," where you build a differential diagnosis (Differential Diagnosis) just by seeing the patient.
Based on the examination, the first thought was the presence of a tumor (Tumor). Indeed, we performed an MRI (Magnetic Resonance Imaging) of the brain, and it showed a large tumor of 49 mm that was pressing on the eye and pushing it outward.
In this case, there was a very clear "red flag," which was the age (Age). Any new headache (New Onset Headache) that appears in a patient over the age of fifty is a warning sign that requires thorough examination (Workup) to ensure that there is no secondary cause.
One of the options suggested in the group was "hyperthyroidism" (Hyperthyroidism), but eye protrusion in hyperthyroidism is usually in both eyes (Bilateral), while in our case it was in one side (Unilateral), which directs us more towards neurological causes or tumors.
Secondary headaches account for about 11% of headache cases, and early diagnosis is necessary to avoid serious complications. The main causes include:
This condition typically affects young overweight women (Obese). Sometimes, it is caused by the consumption of vitamin A or certain antibiotics such as tetracycline.
This is an emergency condition as it can lead to permanent vision loss.
Characterized by being a "positional headache" (Positional Headache), meaning it worsens when standing or sitting and improves when lying down. It often occurs after the patient is exposed to a blow or after a lumbar puncture procedure (Post-LP headache). It is treated with rest, fluids, caffeine, or an "epidural blood patch" (Epidural Blood Patch).
This condition is very common among migraine patients (Migraine). When the patient starts taking painkillers such as "Tylenol" or "Ibuprofen" excessively (more than 10-15 days per month), the headache turns into a chronic daily headache.
Not every headache shows results on a regular CT scan (CT Scan). There are cases where the CT scan is normal but the patient is at risk:
A patient comes with a headache and fever (Fever) and elevated white blood cells. The first step is to rule out infection in the central nervous system (CNS Infection).
Caffeine is a double-edged sword; it is included in some headache medications (such as Excedrin or Fioricet) and helps in treating low cerebrospinal fluid pressure headaches. However, at the same time, caffeine is a trigger for migraine attacks in some patients, and sudden withdrawal from it causes "caffeine withdrawal headache."
Accurate diagnosis is the key to treatment. It is essential to link the medical history with age and clinical symptoms. Any change in the pattern of the headache, the appearance of visual symptoms, protrusion of the eye, or a headache that begins after the age of fifty, should be taken very seriously and not diagnosed as a primary headache unless secondary serious causes are ruled out.
With this, we have concluded this educational journey on the topic of headaches. We ask God to benefit us and you, and for this knowledge to be purely for His noble countenance. May God reward you for your good listening and interaction, and we will meet in future lectures, if God wills.
Peace be upon you and the mercy of God and His blessings.