Abstract
The second edition of the International Classification of Headache Disorders makes a distinction between primary and secondary headaches. The diagnosis of a secondary headache is made if the underlying disease is thought to cause headache or if a close temporal relationship is present together with the occurrence of the headache. At first glance, this may allow clearly secondary headaches to be distinguished from primary headaches. However, by reviewing the available literature concerning several selected secondary headaches, we will discuss the hypothesis that some secondary headaches can also be understood as a variation of primary headaches in the sense that the underlying cause (e.g. infusion of glyceryl trinitrate [ICHD-II 8.1.1], epilepsy [7.6.2], brain tumours [7.4], craniotomy [5.7], etc.) triggers the same neurophysiologic mechanisms that are responsible for the pain in primary headache attacks.
Highlights
In the second edition of the International Classification of Headache Disorders (IHCD-II), the International Headache Society (IHS) makes a strict distinction between primary and secondary headaches [1]
By reviewing the available literature concerning several selected secondary headaches, we will discuss the hypothesis that some secondary headaches can be understood as a variation of primary headaches in the sense that the underlying cause triggers the same neurophysiologic mechanisms that are responsible for the pain in primary headache attacks
According to the ICHD-II, one of the main consequences of the rigorous separation is that the classification and diagnostic criteria differ in that they are aetiological for secondary headaches and symptom based for primary headaches
Summary
In the second edition of the International Classification of Headache Disorders (IHCD-II), the International Headache Society (IHS) makes a strict distinction between primary and secondary headaches [1]. In addition to this primary headache-like phenotype in a great proportion of patients with tumour headache, the history or family history of primary headaches is a risk factor for the occurrence of headache in association with unselected brain tumours [31, 32, 36], meningioma [35] or pituitary adenoma [37, 38] Taken together, these two findings, similar phenotype and higher prevalence in pre-disposed patients, point to a shared pathophysiological mechanism of tumour-associated headache and primary headaches. Many patients fulfil the criterion of pain in the surgical area, a significant number suffer from a headache with a primary headache-like phenotype, which is more likely to occur in patients with a history of headache
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