Headache Associated Signs and Symptoms
Associated symptoms may occur prior to, concurrent with, or following the headache. Inquire about redness or tearing of the eyes, nasal congestion, nausea, vomiting, teeth grinding, and neck stiffness or tenderness. Unilateral nasal congestion and tearing are associated with cluster headache. Nausea and vomiting are commonly associated with migraine. Teeth grinding and neck tenderness may be seen with tension-type headache.
Mucous Membrane Injection
Redness and swelling of the mucous membranes of the nose (with or without nose-bleeds) and conjunctival injection may occur with migraine. The mucous membrane injection and engorgement may be conspicuous and give rise to headache in those with allergic sensitivities to inhalants and those in whom the nasal mucous membranes are involved during periods of major adaptive difficulties. With the exception of headache due to neoplastic invasion of paranasal structures and antral infection via the dental route, headache associated with disease of the nasal and paranasal sinuses does not occur without obvious congestion of the turbinates and nasal mucous membranes.
Gastrointestinal Disturbances
Anorexia, nausea, and vomiting, though most commonly associated with migraine, may occur with any headache; and the more intense the headache, the more likely these symptoms are to occur. Vomiting without nausea may occur with brain tumors, especially tumors of the posterior fossa. Nausea and vomiting with little or no headache may occur with migraine. Headache associated with sinus or eye disease is seldom associated with vomiting. Although constipation is commonly associated with migraine, diarrhea may also occur. Distention and flatulence are common in migraine and tension-type headaches but are seldom associated with other headaches.
Polyuria
Polyuria is commonly associated with migraine headache; it seldom occurs with other headaches. Tension states with headaches may be linked to urinary frequency.
Signs of Depression and Cognitive Dysfunction
Insomnia, early-morning awakening, fatigue, anorexia, change in libido, and malaise all are signs of depression, which is frequently associated with long-standing headache. Ask about changes in behavior and thinking; check with a family member.
Mood
The wish to retire from people and responsibilities and a dejected, depressed, irritable, or negativistic mental state bordering on prostration or stupor are dominant aspects of the migraine attack and may in some instances be more disturbing than the pain in the head. Apathy, listlessness, or even euphoria may be associated with brain-tumor headache.
Tension-type headache may occur in a tense, irritable person; but the patient is usually willing to accept attention, massage, or medication, in contrast to the patient with a migraine headache attack, who commonly expresses the wish to be left alone. Exaltation or feelings of especial well-being are rare sequels to the migraine headache attack. The suffering experienced with the headache of fever, meningitis, or ruptured aneurysm may be very great; but the mental state is that of reaction to severe pain.
Signs of Neurologic Dysfunction
Signs of neurologic dysfunction include weakness, paresthesia, aphasia, diplopia, visual loss, vertigo, and faintness, which suggest a space-occupying lesion or aneurysm; alternatively, they may be part of the neurologic symptoms of migraine.
Visual Disturbances
Both scintillating scotomata and visual field defects, such as unilateral or homonymous hemianopia, may occur with migraine headaches. Such visual defects may occur with brain-tumor headaches when the tumor is due to a lesion of the occipital lobes or is adjacent to the visual pathways. The visual disturbances of migraine, with the exception of blurred vision and diplopia, usually precede the headache. These phenomena usually last less than 1 hour. Enlarged pupils and lacrimation may cause faulty vision during a migraine headache, but when defects in visual acuity or the field of vision outlast the headache attack, it is likely that a cerebrovascular accident or brain tumor is the cause. Defects in color vision and colored rings around lights may occur with headache associated with glaucoma.
Vertigo and Other Sensory Disturbances
Vertigo may be a forerunner of a migraine headache attack. Vertigo is sometimes associated with the headaches of brain tumors, although feelings of unsteadiness are more common. Fleeting vertigo occurring with sudden movement or rotation of the head often accompanies post-traumatic headache and tension-type headache.
MeniГЁre’s (or labyrinthine) syndrome is occasionally associated with headache. Other sensory disturbances, such as paresthesias of the hands and face, may occur as a forerunner of the migraine headache. However, paresthesias that persist during the headache attack or outlast it are more common in patients with brain tumors or epilepsy.
Editors: Silberstein, Stephen D.; Lipton, Richard B.; Dalessio, Donald J.