Headache associated with intracranial infection

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By Jong-Ling Fuh MD

Headache is usually the first and the most frequently encountered symptom in intracranial infection. It is usually generalized; it may radiate down the neck and back and into the extremities, and it is severe and unremitting. Encephalitis is characterized by headache, fever, alteration of consciousness, focal neurologic deficit, and seizures (usually focal). Because the brain parenchyma has no sensory receptors, the headache of encephalitis and brain abscess may result from the meningeal inflammation that often accompanies these processes, including a nonspecific response to fever, increased intracranial pressure, or a mass-effect producing traction on pain-sensitive intracranial structures. The most common predisposing conditions of brain abscesses are otitis or mastoiditis. Physical signs of meningeal inflammation do not help clinicians rule in or rule out meningitis accurately. The headaches attributed to intracranial infection are further divided into 5 subtypes in International Classification of Headache Disorders, 3rd edition (beta version). Headache remits with resolution of the infection in most cases, and only in a few patients whose headache might persist for more than 3 months after resolution of the causative infection. However, one longitudinal study showed that the 1-year prevalence of headache suffering was not higher amongst patients with prior intracranial infection than in the general population.

Key points

  • No physical sign of meningeal irritation could accurately distinguish those with and without meningitis.
  • Headache is the most common symptom of bacterial meningitis (87%).
  • The ICHD-III requires at least 1 of the following headache characteristics in the diagnosis of headache attributed to brain abscess (code 9.1.4): intensity progressing gradually, over several hours or days, to moderate or severe; aggravated by straining or other Valsalva maneuver; and accompanied by nausea.
  • The existence of chronic post-bacterial meningitis headache is debatable.

In This Article

Historical note and nomenclature
Clinical manifestations
Clinical vignette
Pathogenesis and pathophysiology
Differential diagnosis
Diagnostic workup
Prognosis and complications
References cited