Headaches Attributable to Infectious Diseases

Abstract

Headache is the most common symptom that humans experience. While the vast majority of headaches are due to benign primary headache disorders, a small but important minority of headaches are due to secondary causes. Whereas significant emphasis is placed on educating physicians regarding prompt recognition of subarachnoid hemorrhage and headaches secondary to brain tumors, attention toward headaches secondary to infectious causes is often neglected. Unfortunately, a missed or delayed diagnosis of a headache secondary to meningitis, encephalitis, brain abscess, subdural empyema, or other infectious etiologies can lead to dire consequences for both the patient and physician. Accordingly, this article provides an overview of headaches attributed to systemic and intracranial infectious causes.

Characteristics of headache attributed to COVID-19 infection and predictors of its frequency and intensity: A cross sectional study

“…In general, the headaches that accompany systemic infections are typically nonspecific without any particular distinguishing or characteristic features (20). Although diffuse pain and moderate or severe intensity are listed in the ICHD-3 criteria of “Acute headache attributed to systemic viral infection”, they are not mandatory for diagnosis (15).…”

“…This is the first study that offers a detailed analysis of COVID-19 related headache in relation to history of pre-existing primary headache disorder, medical comorbidities, fever, dehydration, intake of steroids and laboratory biomarkers of SARS-COV-2 infection. In general, the headaches that accompany systemic infections are typically nonspecific without any particular distinguishing or characteristic features (20). Although diffuse pain and moderate or severe intensity are listed in the ICHD-3 criteria of "Acute headache attributed to systemic viral infection", they are not mandatory for diagnosis (15).…”

Frequency of Different Types of Diagnostic Errors in Patients with Central Nervous System Infections: A Cross-Sectional Observational Study

“…For example, while it has been suggested that any abnormal behavior should be considered as infectious encephalitis [27] until proven otherwise, about 30% of our patients with encephalitis were referred to a psychiatric hospital with the assumption that the illness originates from some psychological condition. Some of the possible contributing factors for the shortcomings in hypothesis generation in patients with CNS infection are as follows: (1) a high rate of failure in obtaining accurate history and performing physical examination as demonstrated in our patients; (2) premature closure of diagnosis which means stopping the diagnostic process, assuming the first diagnosis is correct, and failing to consider other possible differential diagnoses [28] as occurred in a significant proportion of our patients (for better clarification, Table 2 provides a few examples of diagnostic errors committed on the patients); (3) the presence of classic triad of fever, neck stiffness, and altered mental status in only less than half of meningitis patients [14] that could be one of the possible reasons for failure in hypothesis generation of meningitis despite complete physical examination [19]; (4) although in medical education programs, significant emphasis is placed on clinical clues suggestive of headaches secondary to subarachnoid hemorrhage and also brain tumors, headaches secondary to infectious etiologies are often overlooked [17]; (5) another potential underlying cause of delayed diagnosis in our patients might be high rate of inappropriate polypharmacy before making the definitive diagnosis because the effect of some medications such as corticosteroids and antibiotics could mask or change the typical symptoms and signs of CNS infection.…”

“…Central nervous system (CNS) infection is a medical emergency that may be associated with significant morbidity and mortality, often necessitating emergent diagnosis and treatment [14]. Missed or delayed diagnosis of CNS infections can lead to devastating consequences for patients, health professionals, and the healthcare system [15–17]. There are a number of case reports and series found in the literature regarding errors in diagnosis of CNS infections [18–22].…”

No increase in headache after previous intracranial infections: a historical cohort study (HUNT)

“…The study that is most often alluded to [1,4–6] as proof of the existence of chronic post‐bacterial meningitis headache, and its manifestation in up to one‐third of patients outliving bacterial meningitis, was performed in Denmark and published in 1983 [7]. There are several weaknesses of this investigation, such as the lack of a matched control group.…”