The diagnostic evaluation of secondary headache disorders.

One of the greatest challenges within the field of headache is the identification of secondary headache disorders. Physicians are particularly fearful of missing serious causes of secondary headache disorders such as brain tumors, subarachnoid hemorrhage, temporal arteritis, meningitis, and stroke. Missing one of these disorders could result in significant morbidity to the patient and leave the physician vulnerable to costly litigation. Unfortunately, the signs and symptoms of secondary headache disorders can sometimes be subtle. Physicians must ask specific questions to identify “red flags” of secondary headache disorders, conduct a detailed neurological examination and perform appropriate diagnostic testing in order to establish a diagnosis. In following commentary, we will review articles published in the last 2 years related to the diagnostic evaluation of secondary headache disorders.