TABLE 59.3 LIFE-THREATENING CAUSES OF HEADACHE Vascular Hypertension Hypoxia Coarctation of the aorta Stroke Inflammatory Meningitis Encephalitis Ventricular shunt infection Traction/compression Brain tumor Intracranial hemorrhage Hydrocephalus Cerebral edema Brain abscess Arterial dissection Ventricular shunt failure Environmental Carbon monoxide poisoning Finally, hypoxia is a potent stimulus for cerebral vasodilation and can produce headaches on that basis Therefore, children who experience a hypoxic insult (e.g., carbon monoxide poisoning) or those with disease states that predispose to hypoxia (e.g., cystic fibrosis, cyanotic heart disease) may present with headaches resulting from an acute process or an exacerbation of an underlying illness Muscle Contraction Headaches can be caused by contraction of the scalp or neck muscles This is the classic “tension” headache that is common in adults These headaches usually occur when a patient has experienced prolonged mental or emotional stress or desk work with inadequate attention to ergonomic factors This leads to recurrent episodes of muscle tension and/or spasm, which cause muscle soreness The patient can often localize a specific site where the pain is felt, and the involved