Headache attributed to infection

lInflammation of any pain-sensitive structures in the cranial cavity can produce headache.

lMeningitis and meningoencephalitis both have headache as a major symptom.

lThe characteristics of the head pain depend on whether the infection is acute or chronic.

lAcute meningitis produces a severe headache with neck stiffness and other signs of meningism, including photophobia and irritability.

lPain is often retro-orbital and worsened by moving the eyes.

lChronic meningitis due to fungal or tuberculous infection can also lead to headache that may be severe and unrelenting.

lThe headache of intracranial infection is nonspecific but must be considered in the differential diagnosis, especially in patients with a compromised immune system.

lThe diagnosis can be confirmed only by examination of the CSF.

l The chronic granulomatous meningitis of sarcoid may require biopsy of the basal meninges to confirm the diagnosis.

lSinusitis, mastoiditis, epidural or intraparenchymal abscess formation, and osteomyelitis of the skull can all cause focal and generalized headache. The diagnosis is usually suspected from the associated symptoms and signs.

After craniotomy, increasing pain and swelling in the operative site may be due to osteomyelitis of the bone flap. Plain skull roentgenograms reveal the typical mottled appearance of the infected bone. Removal of the flap is necessary.

lMollaret's meningitis is rare, recurrent, and sterile.

lThe CSF cellular response includes large epithelioid cells (Mollaret's cells).

lThe pathogenesis is unknown but may be related to the herpes simplex virus (Jensenius et al. 1998).

lThe condition may recur every few days or every few weeks for months or years.

lHeadache, signs of meningism, and low-grade fever accompany each attack.

Treatment is mainly symptomatic.