These include cystic fibrosis, HIV infection, systemic lupus erythematosus, sarcoidosis, and renal failure. Differentiation from migraine may be problematic. According to Dr. Balmaceda, unexplained daily headaches in migraineurs may be secondary to idiopathic intracranial hypertension. Subdural hematomas, Dr. Balmaceda explained, usually result from bridging veins and cause diffuse headache without focal signs and symptoms. Epidural hematomas, on the other hand, develop after rupture of the meningeal arteries after skull fracture and progress more rapidly than do subdurals.
Temporal arteritis is important to recognize in elderly patients with headache.
Dr. Balmaceda warned that temporal arteritis occasionally occurs as part of a polymyalgia rheumatica syndrome. This is important because the treatment of both is corticosteroids, but the dosage and duration of therapy for treating temporal arteritis are much greater than those typically used in polymyalgia rheumatica. Posterior leukoencephalopathy, which subsumes hypertensive encephalopathy, is characterized by headaches, increased intracranial pressure, seizures, and eventually blindness. According to Dr. Balmaceda, the syndrome was formerly thought to be secondary to small-vessel cerebrovascular disease but involves both gray and white matter. Typically, she explained, the constellation of symptoms comprises headache, visual disturbance, seizures, confusion, and coma.