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Tear in the Carotid Artery. Of note, in one case a tear in the carotid artery (which leads to the brain) caused a headache that very closely resembled a cluster headache and even responded to sumatriptan, a drug used to treat a cluster attack. Doctors should consider imaging tests for patients with a first episode of cluster headache in which this event is suspected.
Orbital Myositis. An unusual condition called orbital myositis, which produces swelling of the muscles around the eye, may mimic symptoms of cluster headache. This condition should be considered in patients who have unusual symptoms such as protrusion of the eyeball, painful eye movements, or pain that does not dissipate within three hours.
Imaging Tests
Imaging tests of the brain may be recommended under the following circumstances:
- If the results of the history and physical examination suggest neurologic problems.
- If headaches wake patients during the night.
- If new headaches develop in the elderly. In this age group, it is particularly important to first rule out age-related disorders, including stroke, hypoglycemia, hydrocephalus, and head injuries (usually from falls).
- If headaches are becoming worse.
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Imaging tests are not recommended for patients with migraines and no other abnormal indications.
The following tests may be used:
- A CT (computed tomography) scan may be ordered to rule out brain disorders or headaches caused by chronic sinusitis.
- X-rays and other tests may also be used if sinusitis is strongly suspected.
- A neck x-ray can reveal arthritis or spinal problems.
- Other tests include an MRI (magnetic resonance imaging), EEG (electroencephalogram), lumbar puncture, ultrasound testing, and cerebral angiography, which are only performed if there is reason to suspect an underlying disease.
Headache Symptoms That Could Indicate Serious Underlying Disorders
Headaches indicating a serious underlying problem, such as cerebrovascular disorder or malignant hypertension, are uncommon. (It should again be emphasized that a headache is not a common symptom of a brain tumor.) People with existing chronic headaches, however, might miss a more serious condition believing it to be one of their usual headaches. Such patients should immediately call a doctor if the quality of a headache or accompanying symptoms has changed. Everyone should call a doctor for any of the following symptoms:
- Sudden, severe headache that persists or increases in intensity over the following hours, sometimes accompanied by nausea, vomiting, or altered mental states (possible hemorrhagic stroke).
- Sudden, very severe headache, worse than any headache ever experienced (possible indication of hemorrhage or a ruptured aneurysm).
- Chronic or severe headaches that begin after age 50.
- Headaches in the back of the head accompanied by other symptoms, such as memory loss, confusion, loss of balance, changes in speech or vision, or loss of strength in or numbness or tingling in arms or legs (possibility of small stroke in the base of the skull).
- Headaches after head injury, especially if drowsiness or nausea are present (possibility of hemorrhage).
- Headaches accompanied by fever, stiff neck, nausea and vomiting (possibility of spinal meningitis).
- Headaches that increase with coughing or straining (possibility of brain swelling).
- A throbbing pain around or behind the eyes or in the forehead accompanied by redness in the eye and perceptions of halos or rings around lights (possibility of acute glaucoma).
- A one-sided headache in the temple in elderly people; the artery in the temple is firm and knotty and has no pulse; scalp is tender (possibility of temporal arteritis, which can cause blindness or even stroke if not treated).
- Sudden onset and then persistent, throbbing pain around the eye possibly spreading to the ear or neck unrelieved by pain medication (possibility of blood clot in one of the sinus veins of the brain).
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