Chemotherapy; brain radiation used in the treatment of cancer . According to the American Cancer Society, headaches are one of the primary side effects of radiation (Side Effects of Radiation Therapy/Radiation Effects on Body, n.d.). In addition, certain drugs and types of chemotherapy can have severe headaches as a side effect. In particular, hormonal therapies used for prostate and breast cancer treatment have been known to trigger headaches or migraines (Zizinia, 2021b). This condition causes inflammation and destruction of the brain, spinal cord, and meningeal vessels. It can occur as a primary inflammation within the central nervous system or secondary to a systemic infection. It is considered a rare and severe inflammatory disease (Lu et al., 2020). According to Lu et al. (2020), headache associated with this condition is chronic, moderate, diffuse, and long lasting. Common accompanying symptoms include focal deficits, seizures, altered cognition, and disorders of consciousness (Lu et al., 2020). Arterial dissection Cerebrovascular system CNS vasculitis Cervical artery dissection is divided into internal carotid artery dissection and vertebral artery dissection. These conditions lead to blood flow into the wall of the cerebral artery, forming a hematoma which leads to stenosis, occlusion, or aneurysmal changes in the artery (Lu et al., 2020). The initial symptoms of carotid artery dissection are typically headache and neck pain. It is the cause of stroke in 20% of younger people, with average age of onset of 44 years (Lu et al., 2020). Headache with this condition mimics other headaches such as migraine, cluster headache, or thunderclap headache. The headache is often acute and continuous for days or longer and is located at the same side as the affected cervical vessel (Lu et al., 2020). Vertebrobasilar insufficiency is defined as transitory ischemia of the vertebrobasilar circulation. Atherosclerosis is the most common cause of this condition (Lima Neto et al., 2017). Headache is a common symptom of this condition, along with dizziness, vomiting, diplopia, ataxia, imbalance, and weakness on both sides of the body (Lima Neto et al., 2017). Arteriovenous malformation Arteriovenous malformations are abnormal shunts Ischemia Vertebrobasilar insufficiency between arteries and veins that bypass the capillary bed (Schimmel et al., 2021). The anatomical location and stage of development of these malformations influence the potential complications they can cause, including stroke, brain abscess, hypoxemia, or local rupture (Schimmel et al., 2021). Headache is very commonly present with arteriovenous malformation (Lai et al., 2017). According to Lai et al. (2017), occipital brain arteriovenous malformations are more likely to present with migraine-like headaches, while frontotemporal arteriovenous malformations are more likely to show tension-type headache. The mechanism of symptomatic headache and brain arteriovenous malformation remains unclear (Lai et al., 2017). Subarachnoid hemorrhage Subarachnoid hemorrhage involves bleeding in the space between the brain and the surrounding subarachnoid membrane and is considered an uncommon but potentially fatal cause of headache (Fernando et al., 2017). “Sudden, worst headache of life” or “thunderclap headache” are
Self-Assessment Quiz Question #9 The risk of metastasis to the brain as a source of headache pain is rare. The type(s) of cancer that is/are the most likely cause of metastasis to the brain include(s): a. Lung cancer and pancreatic cancer. b. Breast cancer and kidney cancer. c. Lung cancer, breast cancer, and malignant melanoma. d. Malignant melanoma and pancreatic cancer. Cerebral venous thrombosis Cerebral venous thrombosis is characterized by obstruction of cerebral venous reflux, often accompanied by intracranial hypertension. It is a common cause of cerebrovascular disease in younger people, with the onset typically between 20 and 50 years of age (Lu et al., 2020). Headache is often the heralding symptom of cerebral venous thrombosis, preceding other manifestation of the disease by days or weeks (Aliprandi et al., 2020). According to Lu et al. (2020), severe headache is the most common symptom of cerebrovascular disease and is reported by 60% to 90% of patients (Lu et al., 2020). This headache can be unilateral and sudden (even thunderclap), or mild. It often mimics migraine symptoms (Lu et al., 2020). It worsens with activities that increase intracranial pressure and is often accompanied by focal neurological symptoms (Lu et al., 2020). Mitochondrial encephalomyopathy Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episode syndrome (MELAS) is another potential source of headaches (Lu et al., 2020). It is associated with mitochondrial DNA gene mutations, with typical onset under 45 years. The headaches associated with this condition is migraine-like, short-lasting, and of mild or moderate severity. Stroke like seizures may be present (Lu et al., 2020). widely accepted predictors of subarachnoid hemorrhage (Kimura et al., 2016). The Ottawa Subarachnoid Hemorrhage Rule can be used to identify subarachnoid hemorrhage in people with acute headaches. This rule recommends further investigation if the patient presents with one or more of the following criteria:
● Age 40 years or older. ● Neck pain or stiffness. ● Witnessed loss of consciousness. ● Onset during exertion. ● Thunderclap headache. ● Limited neck flexion on examination. (Perry, 2017)
If these criteria are met and subarachnoid hemorrhage is suspected, computed tomography (CT) can rule out this condition (Fernando et al., 2017). Giant cell arteritis; vascular arteritis; temporal vasculitis Giant cell arteritis is a systemic vasculitis involving the large and medium-sized blood vessels, especially the extracranial branches of the carotid arteries (Calvo-Romero, 2003). It is most common in persons older than 50 years of age and can result in permanent vision loss, ischemic stroke, and thoracic and abdominal aortic aneurysm. New onset headache is one of the common symptoms associated with this condition and is typically but not exclusively localized to the temporal areas (Villa-Forte, 2011). Other symptoms include scalp tenderness, neck pain, malaise, weight loss, fever, and flu- like symptoms (Hayreh, 2021).
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