Spotlight on Headache associated with intracranial infection

In this article, Dr. Jong-Ling Fuh of Taipei Veterans General Hospital and National Yang-Ming University School of Medicine discusses headache associated with intracranial infection. Headache is usually the first and most frequently encountered symptom in intracranial infection, but it only accounts for less than 1% of acute headache presentation to the emergency department.

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. Headache remits with resolution of the infection in most cases, and headache might persist for more than 3 months after resolution of the causative infection in only a few patients. 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.

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