Headache as a Neurologic Manifestation of Systemic Disease

Abstract

Purpose of review: This is an update of headache attributed to systemic disease and current therapeutic strategies. Clinical scenarios are discussed.

Recent findings: The diagnosis of headache attributed to metabolic or systemic disorder appears in the Appendix of International Classification of Headache Disorders, Third Edition, and requires further evaluation and validation. However, recent studies characterizing headache appear in the literature. Specific treatment includes addressing underlying systemic disorders, managing concurrent primary headache, and treating comorbidities that may exacerbate headache. Evidence for specific treatment trials for headache as a symptom is lacking, including headaches post-COVID19 infection. Calcitonin gene-related peptide receptor antagonists and 5-HT_1F receptor agonists are attractive options for migraine with vascular comorbidities, but long-term studies are needed.

Summary: Headache is commonly encountered as a manifestation or complication of systemic disease. Further research is needed to validate headache associated with systemic disorders and to determine optimal treatment strategies.

Keywords: COVID-19; Migraine comorbidity; Neurologic manifestation; Secondary headache; Systemic disease.

Fig. 1

Headache attributed to systemic disease is best treated by addressing the underlying disorders and treating headache symptomatically. When headache persists, migraine treatments may be helpful if migraine co-exists or if the phenotype resembles migraine. The description of pain may be useful to guide treatment such as the presence of neuropathic symptoms which may indicate use of anti-convulsants, tricyclic anti-depressants, or serotonin norepinephrine reuptake inhibitors.