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  • Updated 09.07.2021
  • Released 09.02.1994
  • Expires For CME 09.07.2024

Headache attributed to disorder of homeostasis

Introduction

Overview

Homeostasis refers to the concept that organisms must adjust to external stimuli so that internal conditions remain stable. Multiple medical problems that upset this equilibrium may cause headache. This updated article on headaches attributed to disorders of homeostasis reviews both medical conditions, such as arterial hypertension or hypothyroidism, and external factors, such as high altitude or fasting, which commonly produce headache. Among the updates are new revelations for the relationship of hypoxia and migraine and treatment recommendations for the management of high-altitude headache and headache associated with hemodialysis.

Key points

Dexamethasone, analgesics, metoclopramide, and preventive acetazolamide are among the effective treatments for high-altitude headache.

Hypertensive encephalopathy may trigger headache in association with arterial hypertension (higher than 180/120 mm Hg), especially in those with pheochromocytoma.


Hemodialysis may trigger headache, especially in those with increased predialysis blood pressure or blood urea nitrogen. Adjusting dialysis frequency and timing may prevent the complication.

Fasting is a trigger for migraine, even in the absence of hypoglycemia. Preemptive frovatriptan may prevent migraine triggered by fasting.

Myocardial ischemia may trigger migraine-like headache, usually aggravated by exercise and relieved by treatment of angina.

Historical note and terminology

Headache attributed to a disorder of homeostasis as defined by classification from the International Headache Society (46) includes headaches that occur during a metabolic disturbance and resolve after normalization. The major disorders of homeostasis known to cause headache include hypoxia and/or hypercapnia, hemodialysis, arterial hypertension, hypothyroidism, fasting, and cardiac cephalalgia.

This review does not consider headaches attributed to inflammatory or autoimmune disorders, infection, vascular disorders, seizures, increased or low cerebrospinal fluid pressure, and headache related to substances that may cause headache due their use or withdrawal.

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