Headache: Classification, diagnostics, and principles of treatment (literature review; description of a clinical case)

Abstract

Introduction. Headache (cephalgia) is one of the most common neurological disorders and is among the 20 most disabling diseases in the world. Most cases of headaches are benign, while others require constant monitoring and treatment, and some are life-threatening. For individuals with a history of headaches, the physician should determine whether headache belongs to a well-known primary headache disorder, is an exacerbation of primary headache disorder induced by another medical condition, or a new secondary headache. The aim of the study is to conduct an analysis of a vascular events in a patient with secondary headache, who was diagnosed in the Neurology Department in 2023. Materials and methods. Systematic and comparative analysis, biblio-semantic method used for the interpretation of the obtained results were supplemented with a survey of literature including 18 articles published in the international renowned sources. Results. Secondary cephalgias are those in which the headache is a symptom of another disorder recognized as a potential underlying cause. Secondary headache occurs much less often than primary one, but it can encompass life-threatening pathology. A clinician should be able to distinguish between primary and secondary headaches, elaborating a specific diagnosis for each particular patient with a headache. For this purpose doctor should know the criteria for each type of headache and be capable to recognize "red flags" of secondary headache. The paper contains thorough analysis of the basic principles of diagnosis and diagnostic criteria of all known forms of cephalgia, as well as European principles of management of patients with the most common forms of headache disorders for general practitioners. Scaffolding of the article is consistent with International Classification of Headache Disorders, third revision (ICHD-3), developed by the International Headache Society in 2018, which currently is the main tool for diagnosing different forms headache disorders. The most important aspect in the diagnosis of different forms of cephalgia is patients history and medical examination. Primary headache is not a diagnosis of exclusion, but rather is based on clinical findings obtained during examination. The presence of atypical signs or "red flags" should raise concern about secondary headache. Conclusions. Many types of primary headaches can be diagnosed based on a thorough history and physical examination without use of additional examination methods. Neuroimaging is not necessary if the patient has migraines or other primary headaches with normal neurological status and the absence of the "red flags" or signs of secondary headache. The SNOOP mnemonic method is useful tool for ensuring that "red flags" are not missed. In case the "red flags", signs of secondary headache are detected, neuroimaging or other additional diagnostic tests should be used, out of which the preference should be given to the MRI of the brain. Keywords: primary and secondary headache, subarachnoid stroke, diagnosis, treatment.