If no underlying cause is identified, management of primary headache can be instituted. Secondary Headaches Headaches secondary to an underlying structural cause occur much less frequently than primary headaches. Because findings suggesting underlying life-threatening or debilitating causes are often subtle, it is important for the clinician to search for them before deciding on a diagnosis. Secondary headaches may be categorized in several different ways. One method is to attribute the pain to either an intracranial or extracranial process.
Intracranial pain can result from cerebrovascular causes, meningeal irritation, or pressure changes.
Only one-third of patients with brain tumors present with an initial complaint of headache. For practical purposes, the distinction between migraine and tension-type headaches is made in each patient according to the features of the predominant symptom pattern, rather than the underlying pathogenic process. The importance of distinguishing between the various kinds of primary headaches is to determine the best course of management. Differentiating between primary and secondary headaches is of much greater concern. Neuroimaging should be performed in patients presenting with a new onset of severe headaches, when there is a change in the usual headache pattern, or if the diagnosis is unclear.