Headache associated with intracranial infection

Introduction
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By Jong-Ling Fuh MD

Headache is the most common symptom of bacterial meningitis (87%). It is often the first symptom to appear and may be the only long-term complication of the illness. It is usually generalized (but may be predominantly frontal); 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 causes of brain abscesses are otorhinogenic. Physical signs of meningeal inflammation do not help clinicians rule in or rule out meningitis accurately. Patients suspected to have meningitis should undergo a lumbar puncture regardless of the presence or absence of physical signs.

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-II requires at least one of the following headache characteristics in the diagnosis of headache attributed to brain abscess (code 9.1.4): bilateral, constant pain, intensity gradually increasing to moderate or severe, aggravated by straining and accompanied by nausea.
  • Postbacterial meningitis headache might occur.