9.1.4 Headache attributed to brain abscess

Description:
Headache caused by brain abscess, usually associated with fever, focal neurological deficit(s) and/or altered mental state (including impaired vigilance).

Diagnostic criteria:
A. Any headache fulfilling criterion C
B. A brain abscess has been demonstrated
C. Evidence of causation demonstrated by at least two of the following:

    1. headache has developed in temporal relation to development of the abscess, or led to its discovery
    2. headache has significantly worsened in parallel with deterioration of the abscess shown by any of the following:

      a) worsening of other symptoms and/or clinical signs arising from the abscess
      b) evidence of enlargement of the abscess
      c) evidence of rupture of the abscess

    3. headache has significantly improved in parallel with improvement in the abscess
    4. headache has at least one of the following three characteristics:

      a) intensity increasing gradually, over several hours or days, to moderate or severe
      b) aggravated by straining or other Valsalva manœuvre
      c) accompanied by nausea

D. Not better accounted for by another ICHD-3 diagnosis.

Comments:
The most common organisms causing brain abscess include streptococcus, staphylococcus aureus, bacteroides species and enterobacter. Recently, brain abscesses have also been reported with aspergillosis and blastomycosis.

Predisposing factors include infections of the paranasal sinuses, ears, jaws, teeth or lungs.

Direct compression and irritation of the meningeal and/or arterial structures and increased intracranial pressure are the mechanisms causing 9.1.4 Headache attributed to brain abscess.