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Headache From Metabolic Disorders
Medical conditions causing headaches include systemic infections, usually with fever; hypoxia; carbon monoxide poisoning; postconvulsive states; foreign protein reactions; hypoglycemia; hypercapnia; acute pressor reactions; and renal failure. In most of these instances, the headache is a temporary and easily diagnosed problem, but a few conditions warrant comment.
Inflammation caused by infectious agents (bacterial, viral, parasitic) or chemical or autoimmune processes and involving pain-sensitive cranial structures may produce headache. The headache is likely to be a secondary symptom, and diagnosis should be achieved on the basis of the major manifestations of the condition.
Spinal anesthetics, contrast media, antineoplastic drugs, and antibiotics can cause allergic or chemical inflammation in the CNS, with headache, stiff neck, low-grade fever, and sterile pleocytosis in the CSF. The headache is present in all positions, unlike the headache after LP. Analgesics and antihistamines or corticosteroids are helpful, as long as it is ensured that no bacterial infection is present.
Pulsatile headaches and flushing occur rarely in mastocytosis, carcinoid syndrome, and gastrointestinal conditions in which vasoactive peptides are involved. Mastocytosis looks at first like common freckles, but biopsy of new freckles may confirm the diagnosis. Carcinoid tumor may cause flushing, wheezing, diarrhea, and headache. Alcohol, epinephrine, and histamine may induce headaches in both carcinoid tumor and mastocytosis. Bronchogenic carcinoid tumor causes headache before metastasizing to the liver, but liver metastases usually are necessary for gastrointestinal carcinoid tumors to produce these symptoms.
Headaches associated with flushing or pallor, sweating, and acute hypertension require exclusion of pheochromocytoma by blood and urinary catechol tests and appropriate CT or MRI scanning. It is important to examine the patient during such episodes so that blood pressure measurements may be recorded and the physician can make sure that the urine in the patient's bladder at the time of the hypertensive episode is included in the collection to be tested for vanillylmandelic acid (VMA), catechols, and metanephrine.
Hypothyroidism, Cushing's syndrome, Addison's disease, and pituitary tumors (especially prolactinomas) may induce headaches of any type until the primary underlying condition is diagnosed and treated.
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Textbook of Primary Care Medicine, 3rd ed.
By: William Pryse-Phillips, T. Jock Murray © 2005 ELSEVIER Inc. All Rights Reserved |
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