Headache of Syphilitic Origin
Although there is nothing pathognomonic about the headache which results from syphilis, this disease should be considered in the differential diagnosis of all cases in which persistent or recurring headache is a chief complaint. Since the Spirocheta pallida has a predilection for blood vessels and since many of the late manifestations of the disease occur in the central nervous system, it is not surprising that syphilis is an important cause of headache which may precede other symptoms and neurological signs by a long time.
No one would contend that headache which occurs in a syphilitic patient is necessarily related to his infection; however, the physician's responsibility to the patient makes it necessary that a thorough investigation for evidence of central nervous system syphilis be made. A careful neurologic examination and a spinal puncture are indicated. Equally important is a careful ophthalmological examination which includes examination of the visual fields for evidence of optic neuritis.
Most patients with early secondary syphilis complain of headache. It may be very slight, dull or paroxysmal, or in some instances, the pain may be severe and associated with slight stiffness of the neck. The associated cutaneous and mucous membrane lesions and positive serologic findings will simplify the diagnosis.
In late syphilis, headache results either from the involvement of the vessels of the brain or from an inflammatory reaction of the meninges, particularly the dura mater. Such cases are classified as vascular or meningovascular neurosyphilis, and the latter is the most common type. Headache may occur. . .