Headache attributed to autonomic dysreflexia: an underrecognized clinical entity.

OBJECTIVE: The recognition and the management of headache attributed to autonomic dysreflexia after spinal cord injury (SCI) are challenging issues. Given this, I systematically reviewed the literature to establish the features of the headache attributed to autonomic dysreflexia after SCI. METHODS: This review included all articles that addressed any feature of headache attributed to autonomic dysreflexia after SCI. The literature search addressed publications from 1950 until April 2010. The literature search was conducted using MEDLINE, CINAHL, EMBASE, and PsycINFO® databases. The literature search was limited to only articles written in English. RESULTS: Of the 273 publications captured in all 4 databases, 45 articles fulfilled our inclusion and exclusion criteria. Typically, the headache attributed to autonomic dysreflexia is a sudden-onset, severe headache accompanied by several signs and symptoms including increased blood pressure, altered heart rate, and diaphoresis cranial to the level of SCI, which is triggered by different noxious and nonnoxious stimuli. However, clinicians need to be aware of other headache features and the variety of potential triggers associated with the headache attributed to autonomic dysreflexia. CONCLUSIONS: The greater awareness of this clinical entity among clinicians, in particular neurologists, is crucial for early recognition and proper management of episodes of autonomic dysreflexia to prevent its complications.