Experienced Migraine Neurologist California

Experienced Migraine Neurologist California

Headache Therapy

The center's team remains in touch, offering follow-up consultations and adjustments to your treatment as needed. Migraine Headache Diagnosis Let's dive into some inspiring stories from patients who've found relief through our telehealth services. Our community is here to uplift you, offering not just understanding and empathy, but practical support and resources to navigate your migraine journey more comfortably. They eliminate the need for transportation and reduce waiting times.

Migraine Prevention Therapy

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  • Migraine and Headache Clinic
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  • Migraine Specialist
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  • Headache Treatment Plan
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Now that you're familiar with the lifestyle changes necessary for managing migraines, let's explore how you can begin implementing these strategies at Haven Headache & Migraine Center. Learn more about Experienced Migraine Neurologist California here
It's not just the physical pain but the mental strain that wears you down. Learn more about Haven Headache & Migraine Center here. Our community support programs connect you with others who truly understand what you're going through. During the consultation, you'll discuss your symptoms, medical history, and any treatments you've tried. Telehealth streamlines chronic care for headache and migraine sufferers by simplifying access to ongoing support and management.
Moreover, you're advised on how to maintain your own privacy during telehealth sessions. She says, 'It's like I've got my life back. As you navigate the nuances of managing migraines or chronic headaches, it's crucial to understand how innovations in healthcare delivery can significantly impact your quality of life. Together, they work seamlessly, combining their expertise to develop treatment plans tailored just for you.
You're no longer bound by geographical limitations or the necessity to physically visit a doctor's office, which can be a significant hurdle when you're in the throes of a migraine. You'll have access to cutting-edge therapies, including Botox injections for chronic migraine prevention, CGRP monoclonal antibodies that target the proteins involved in migraine attacks, and personalized medication plans designed to reduce frequency and severity.

Headache Triggers

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Telemedicine bridges the gap between patients and healthcare providers, allowing you to receive medical consultations and care without leaving your home. Chronic Migraine Care You're about to see a shift towards personalized medicine, where treatments are tailored specifically to your genetic makeup and lifestyle.

You no longer have to endure long waits at the doctor's office or travel distances for a consultation. So, our team works with you to identify lifestyle factors, dietary triggers, and stressors that may contribute to your migraines. You're not just dealing with pain; you're facing a multifaceted monster that can knock you off your feet for hours or even days. We believe in empowering you with knowledge, so you'll understand not just the 'how' but the 'why' behind your migraines. They're also skilled in leveraging telehealth technology, ensuring you have access to their expertise regardless of your location in Experienced Migraine Neurologist California.

It's particularly beneficial for those living in rural or underserved areas, where specialist care is scarce. Instead, you can schedule appointments at times that suit you best, ensuring you're in a comfortable environment when discussing your condition with healthcare providers. By diving deep into the science of migraines, we're uncovering novel insights that could transform how migraines are approached and managed. Understanding your unique needs is the cornerstone of our approach to creating personalized care plans for managing your migraines.

With options for telehealth appointments, you can consult with their specialists from the comfort of your home. The specialists at Haven include neurologists, pain management experts, and nurse practitioners, all with a singular focus: to alleviate your headache and migraine symptoms. This evolution in healthcare delivery isn't just a minor adjustment; it's revolutionizing how you manage your health. We'll start with a comprehensive evaluation that includes discussing your migraine history, frequency, intensity, and any associated symptoms.

This level of care, all from the comfort of your home, underscores Haven's commitment to making headache and migraine management as accessible and effective as possible for Experienced Migraine Neurologist Californians. Telehealth also facilitates better management of your condition. Integrating lifestyle changes into your routine can significantly enhance the effectiveness of your migraine treatment plan. You've probably heard that personalized care is the key to managing migraines effectively, but how true is this theory in practice?

Chronic Migraine Care

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  3. Neurology Specialists
  4. Headache Disorder Treatment
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  6. Headache Triggers
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  8. Migraine Support
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  10. Migraine Prevention Therapy
  11. Chronic Headache Clinic
  12. Neurology Consultation
  13. Headache Disorder Specialists
  14. Headache Treatment
  15. Headache Relief Techniques
  16. Migraine Medication Management
  17. Migraine Research
  18. Headache Specialist
  19. Migraine Headache Diagnosis
  20. Tension Headache Therapy


Best Headache Neurologist California

Prior to European colonization, California was one of the most culturally and linguistically diverse areas in pre-Columbian North America. European exploration in the 16th and 17th centuries led to the colonization by the Spanish Empire. The area became a part of Mexico in 1821, following its successful war for independence, but was ceded to the United States in 1848 after the Mexican–American War. The California gold rush started in 1848 and led to social and demographic changes, including depopulation of Indigenous tribes. It organized itself and was admitted as the 31st state in 1850 as a free state, following the Compromise of 1850. It never had the status of territory.

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Experienced Migraine Neurologist California’s Top Migraine Doctor

They've embraced the power of virtual consultations and treatments. They're a neurological condition characterized by intense, debilitating pain often accompanied by nausea, vomiting, and sensitivity to light and sound.

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At the forefront of addressing migraine and headache disorders, Haven Headache & Migraine Center offers innovative treatments tailored to your specific needs. They can offer guidance, adjust your treatment plan as needed, and introduce you to new management strategies as they become available.

Migraine Support

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  2. Migraine Medication Management
  3. Migraine Research
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  6. Tension Headache Therapy
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Dehydration can trigger migraines, so make sure you're drinking plenty of water throughout the day.

Haven's approach combines the rise of telehealth with personalized care plans, promising an intriguing blend of convenience, customization, and ongoing support. Headache Clinic You've probably noticed certain foods can set off a headache. At Haven Headache & Migraine Center, we've developed a unique approach to migraine management that's tailored specifically to your needs. Your journey to relief starts with a comprehensive evaluation.

With just a few clicks, you can schedule a virtual appointment from the comfort of your home, office, or wherever you are. It's not just about managing symptoms; it's about restoring hope and enabling individuals to lead vibrant, fulfilling lives.

Headache Triggers

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Whether you're newly diagnosed or a long-term sufferer seeking new insights, our materials are accessible and relevant to your needs. Personalized care plans can include medication, lifestyle adjustments, and even stress management techniques to help you regain control over your migraines and improve your quality of life.

This holistic approach means you're not just dealing with symptoms as they come; you're taking control of your health, long-term. This pre-consultation form helps the specialists prepare for your session, ensuring they're armed with the necessary background to offer tailored advice. Haven Headache & Migraine Center's telehealth solutions don't just stop at initial treatment; they ensure you've got ongoing support every step of the way. They work together, combining their expertise to offer you a holistic approach to migraine management.

Migraine Prevention Therapy
Experienced Migraine Neurologist California’s Top Migraine Doctor
Experienced Migraine Neurologist California Headache And Neurology Expert

Experienced Migraine Neurologist California Headache And Neurology Expert

To get started, simply visit the Haven Headache & Migraine Center's website or give them a call. Frustrated and skeptical, he found solace in our approach. It's not just about accessibility; it's about receiving timely care without the burden of long-distance travel. This commitment to utilizing state-of-the-art diagnostic tools means you're in capable hands, ensuring that your journey to migraine relief is both effective and efficient. This not only saves you time but also allows you to rest immediately after your consultation.

Keeping a food diary can help you identify and steer clear of your specific triggers. Start by narrowing down specialists who've a strong focus on headache and migraine conditions. By integrating the latest scientific findings into our care plans, we ensure that you receive the most advanced, evidence-based treatments available. As you delve into understanding migraines, it's crucial to acknowledge the triggers and patterns unique to your experience.

These can range from dietary choices, stress levels, hormonal changes, to environmental factors like weather changes or bright lights. Welcome to a community where your well-being is our top priority. This platform supports video consultations that feel as close to an in-person visit as possible, with high-definition video and clear audio that make it easy for you to communicate with your healthcare provider. Headache Relief Center Instead, expert advice will be just a video call away, saving you time and hassle.

Privacy and comfort play significant roles in healthcare, and telemedicine respects both. It's easier than you might think. Most insurance policies have evolved to include telemedicine services, especially those related to chronic conditions like migraines. First, you'll visit the center's website, where you'll find the 'Book a Consultation' section.

Migraine Pain Management Experienced Migraine Neurologist California

This modern method of care ensures that you're supported every step of the way, with ongoing monitoring and adjustments to your treatment plan as needed. Virtual consultations also allow for quicker check-ins, meaning you can receive timely adjustments to your treatment plan. This includes securing a private space for your appointments and ensuring your own device's security. This accessibility means that you can schedule appointments without the added stress of long travel times, making it easier to fit crucial migraine management into your busy life.

By exploring how to access Haven's care, you'll uncover the benefits of telemedicine for headache management, including patient success stories that highlight the transformative power of this service. Haven Headache & Migraine Center understands the importance of convenience in healthcare, especially when you're struggling with the debilitating effects of migraines. You've got high-quality video calls that make virtual consultations almost as effective as in-person visits.

Migraine Prevention Therapy

  • Headache Pain Management
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  • Neurology Clinic
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  • Migraine Treatment Protocol
  • Migraine Specialist
  • Headache Treatment Center
  • Headache Relief Techniques
  • Migraine Medication Management
  • Migraine Research
  • Headache Specialist
  • Migraine Headache Diagnosis
  • Tension Headache Therapy
  • Migraine Treatment Clinics


We understand that migraines aren't just about the pain; they're about how they fit into your life. Headache Disorder Specialists Moreover, we've seen how peer support can significantly impact one's outlook and coping strategies.

Neurology Consultation

  1. Migraine and Headache Clinic
  2. Neurology Clinic
  3. Headache Specialist Consultation
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  5. Migraine Treatment Protocol
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  11. Migraine Support
  12. Chronic Migraine Care
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  14. Chronic Headache Clinic
  15. Neurology Consultation
  16. Headache Disorder Specialists
  17. Headache Treatment
  18. Headache Relief Techniques
  19. Migraine Medication Management
Embracing the Haven Approach means taking a significant step towards reclaiming your life from the debilitating effects of headaches and migraines.

Neurology Consultation

  • Tension Headache Therapy
  • Migraine Treatment Clinics
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  • Headache Treatment Plan
  • Migraine Support Groups
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  • Migraine Patient Care
  • Migraine and Headache Clinic
  • Neurology Clinic
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  • Migraine Specialist
  • Headache Treatment Center
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You mightn't know it, but migraines are triggered by a variety of factors. It's a chance to create a personalized care plan that includes the lifestyle adjustments you've learned about. The center also facilitates a community aspect, where you can share experiences and tips with others navigating similar challenges.

Migraine Pain Management Experienced Migraine Neurologist California
Chronic Migraine Care Center Experienced Migraine Neurologist California
Chronic Migraine Care Center Experienced Migraine Neurologist California

Some folks experience migraines several times a month, while others might only have a few episodes a year. Stick around, and you'll discover the remarkable ways in which Haven Headache & Migraine Center is revolutionizing migraine care statewide. There's no need to re-expose yourself to the elements or stressors that might've contributed to your migraine in the first place. Recognizing and avoiding your triggers is a crucial step toward managing your migraines effectively.

Instead, you can access top-notch headache and migraine care right from your home. You have the freedom to choose experts who truly understand your condition and can offer the most effective treatment options available. If you've ever felt isolated by your condition or frustrated by the lack of local resources, you'll want to explore how this digital health revolution could be your bridge to better care.

By integrating these holistic practices into your treatment plan, we aim to reduce the frequency and severity of your attacks, helping you lead a more balanced, healthier life. You'll find that we tailor our approach to fit your individual situation, ensuring you receive the most effective treatment possible. Then there's Michael, who'd tried everything before coming to us. Neurology Consultation

In essence, they're not just about treating migraines; they're about making sure the care you need fits into your life seamlessly.

Headache Therapy

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  • Tension Headache Therapy
  • Migraine Treatment Clinics
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  • Headache Specialist Consultation
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You won't have to worry about the stress of commuting or the risks of exposure to other illnesses, which is particularly reassuring in times of public health concerns.

Migraine Research

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  2. Migraine Support
  3. Chronic Migraine Care
  4. Migraine Prevention Therapy
  5. Chronic Headache Clinic
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  7. Headache Disorder Specialists
  8. Headache Treatment
  9. Headache Relief Techniques
  10. Migraine Medication Management
  11. Migraine Research
  12. Headache Specialist
  13. Migraine Headache Diagnosis
  14. Tension Headache Therapy
  15. Migraine Treatment Clinics
It's about finding that sweet spot-too little exercise and you miss out on its benefits, but too much can actually trigger a migraine.

Experienced Migraine Neurologist California Center For Migraine Therapy

Is it stress? Whether you're living in a bustling city or a remote rural area, you've got the same opportunity to consult with specialists. This holistic view allows for the development of a comprehensive treatment plan that might include medication, lifestyle changes, and alternative therapies. It's tailored to fit your life, not the other way around, making it a pivotal step forward in headache and migraine management.
Whether it's through medication, lifestyle adjustments, or novel treatments, they're committed to improving your quality of life. You'll see AI-powered systems offering real-time, personalized treatment plans based on your health data, making the one-size-fits-all approach a thing of the past. Every individual's migraine experience is unique, which is why personalized care plans are at the heart of effective management strategies.
These stories are just a snapshot of how telehealth is revolutionizing headache and migraine care, making it accessible and efficient for Experienced Migraine Neurologist Californians in need.

Migraine Headache Clinic

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  12. Tension Headache Therapy
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  14. Migraine Pain Management
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Explore Experienced Migraine Neurologist California here Read more about Experienced Migraine Neurologist California here By understanding the genetic, environmental, and lifestyle factors that trigger your migraines, we're working towards preventative approaches that minimize your migraine episodes and their severity. We've made the process straightforward, so you won't have to jump through hoops just to get the help you need.
Moreover, telehealth platforms often feature tracking tools that enable you and your doctor to monitor your progress over time. Migraine Medication Management Headaches, the more common of the two, can range from mild to severe pain in any part of your head. By staying informed, you can make empowered decisions about your health and wellness.

Experienced Migraine Neurologist California Center For Migraine Therapy

 

Headache
Other names Cephalalgia
Person with a headache
Specialty Neurology
Types Tension headache, cluster headache, sinusitis, migraine headache, hangover headache, cold-stimulus headache (brain freeze)
Treatment Over-the-counter painkillers, sleep, drinking water, eating food, head or neck massage

A headache, also known as cephalalgia, is the symptom of pain in the face, head, or neck. It can occur as a migraine, tension-type headache, or cluster headache.[1][2] There is an increased risk of depression in those with severe headaches.[3]

Headaches can occur as a result of many conditions. There are a number of different classification systems for headaches. The most well-recognized is that of the International Headache Society, which classifies it into more than 150 types of primary and secondary headaches. Causes of headaches may include dehydration; fatigue; sleep deprivation; stress;[4] the effects of medications (overuse) and recreational drugs, including withdrawal; viral infections; loud noises; head injury; rapid ingestion of a very cold food or beverage; and dental or sinus issues (such as sinusitis).[5]

Treatment of a headache depends on the underlying cause, but commonly involves pain medication (especially in case of migraine or cluster headaches).[6] A headache is one of the most commonly experienced of all physical discomforts.[7]

About half of adults have a headache in a given year.[3] Tension headaches are the most common,[7] affecting about 1.6 billion people (21.8% of the population) followed by migraine headaches which affect about 848 million (11.7%).[8]

Causes

[edit]

There are more than 200 types of headaches. Some are harmless and some are life-threatening. The description of the headache and findings on neurological examination, determine whether additional tests are needed and what treatment is best.[9]

Headaches are broadly classified as "primary" or "secondary".[10] Primary headaches are benign, recurrent headaches not caused by underlying disease or structural problems. For example, migraine is a type of primary headache. While primary headaches may cause significant daily pain and disability, they are not dangerous from a physiological point of view. Secondary headaches are caused by an underlying disease, like an infection, head injury, vascular disorders, brain bleed, stomach irritation, or tumors. Secondary headaches can be dangerous. Certain "red flags" or warning signs indicate a secondary headache may be dangerous.[11]

Primary

[edit]

Ninety percent of all headaches are primary headaches.[12] Primary headaches usually first start when people are between 20 and 40 years old.[13][14] The most common types of primary headaches are migraines and tension-type headaches.[14] They have different characteristics. Migraines typically present with pulsing head pain, nausea, photophobia (sensitivity to light) and phonophobia (sensitivity to sound).[15] Tension-type headaches usually present with non-pulsing "bandlike" pressure on both sides of the head, not accompanied by other symptoms.[16][17] Such kind of headaches may be further classified into-episodic and chronic tension type headaches[18] Other very rare types of primary headaches include:[11]

  • cluster headaches: short episodes (15–180 minutes) of severe pain, usually around one eye, with autonomic symptoms (tearing, red eye, nasal congestion) which occur at the same time every day. Cluster headaches can be treated with triptans and prevented with prednisone, ergotamine or lithium.
  • trigeminal neuralgia or occipital neuralgia: shooting face pain
  • hemicrania continua: continuous unilateral pain with episodes of severe pain. Hemicrania continua can be relieved by the medication indomethacin.
  • primary stabbing headache: recurrent episodes of stabbing "ice pick pain" or "jabs and jolts" for 1 second to several minutes without autonomic symptoms (tearing, red eye, nasal congestion). These headaches can be treated with indomethacin.
  • primary cough headache: starts suddenly and lasts for several minutes after coughing, sneezing or straining (anything that may increase pressure in the head). Serious causes (see secondary headaches red flag section) must be ruled out before a diagnosis of "benign" primary cough headache can be made.
  • primary exertional headache: throbbing, pulsatile pain which starts during or after exercising, lasting for 5 minutes to 24 hours. The mechanism behind these headaches is unclear, possibly due to straining causing veins in the head to dilate, causing pain. These headaches can be prevented by not exercising too strenuously and can be treated with medications such as indomethacin.
  • primary sex headache: dull, bilateral headache that starts during sexual activity and becomes much worse during orgasm. These headaches are thought to be due to lower pressure in the head during sex. It is important to realize that headaches that begin during orgasm may be due to a subarachnoid hemorrhage, so serious causes must be ruled out first. These headaches are treated by advising the person to stop sex if they develop a headache. Medications such as propranolol and diltiazem can also be helpful.
  • hypnic headache: a moderate-severe headache that starts a few hours after falling asleep and lasts 15–30 minutes. The headache may recur several times during the night. Hypnic headaches are usually in older women. They may be treated with lithium.

Secondary

[edit]

Headaches may be caused by problems elsewhere in the head or neck. Some of these are not harmful, such as cervicogenic headache (pain arising from the neck muscles). The excessive use of painkillers can paradoxically cause worsening painkiller headaches.[9][19]

More serious causes of secondary headaches include the following:[11]

Gastrointestinal disorders may cause headaches, including Helicobacter pylori infection, celiac disease, non-celiac gluten sensitivity, irritable bowel syndrome, inflammatory bowel disease, gastroparesis, and hepatobiliary disorders.[20][21][22] The treatment of the gastrointestinal disorders may lead to a remission or improvement of headaches.[22]

Migraine headaches are also associated with Cyclic Vomiting Syndrome (CVS). CVS is characterized by episodes of severe vomiting, and often occur alongside symptoms similar to those of migraine headaches (photophobia, abdominal pain, etc.).[23]

Pathophysiology

[edit]

The brain itself is not sensitive to pain, because it lacks pain receptors. However, several areas of the head and neck do have pain receptors and can thus sense pain. These include the extracranial arteries, middle meningeal artery, large veins, venous sinuses, cranial and spinal nerves, head and neck muscles, the meninges, falx cerebri, parts of the brainstem, eyes, ears, teeth, and lining of the mouth.[24][25] Pial arteries, rather than pial veins are responsible for pain production.[11]

Headaches often result from traction or irritation of the meninges and blood vessels.[26] The pain receptors may be stimulated by head trauma or tumours and cause headaches. Blood vessel spasms, dilated blood vessels, inflammation or infection of meninges and muscular tension can also stimulate pain receptors.[25] Once stimulated, a nociceptor sends a message up the length of the nerve fibre to the nerve cells in the brain, signalling that a part of the body hurts.[27]

Primary headaches are more difficult to understand than secondary headaches. The exact mechanisms which cause migraines, tension headaches and cluster headaches are not known.[28] There have been different hypotheses over time that attempt to explain what happens in the brain to cause these headaches.[29]

Migraines are currently thought to be caused by dysfunction of the nerves in the brain.[30] Previously, migraines were thought to be caused by a primary problem with the blood vessels in the brain.[31] This vascular theory, which was developed in the 20th century by Wolff, suggested that the aura in migraines is caused by constriction of intracranial vessels (vessels inside the brain), and the headache itself is caused by rebound dilation of extracranial vessels (vessels just outside the brain). Dilation of these extracranial blood vessels activates the pain receptors in the surrounding nerves, causing a headache. The vascular theory is no longer accepted.[30][32] Studies have shown migraine head pain is not accompanied by extracranial vasodilation, but rather only has some mild intracranial vasodilation.[33]

Currently, most specialists think migraines are due to a primary problem with the nerves in the brain.[30] Auras are thought to be caused by a wave of increased activity of neurons in the cerebral cortex (a part of the brain) known as cortical spreading depression[34] followed by a period of depressed activity.[35] Some people think headaches are caused by the activation of sensory nerves which release peptides or serotonin, causing inflammation in arteries, dura and meninges and also cause some vasodilation. Triptans, medications that treat migraines, block serotonin receptors and constrict blood vessels.[36]

People who are more susceptible to experiencing migraines without headaches are those who have a family history of migraines, women, and women who are experiencing hormonal changes or are taking birth control pills or are prescribed hormone replacement therapy.[37]

Tension headaches are thought to be caused by the activation of peripheral nerves in the head and neck muscles.[38]

Cluster headaches involve overactivation of the trigeminal nerve and hypothalamus in the brain, but the exact cause is unknown.[28][39]

Diagnosis

[edit]
Differential diagnosis of headaches
Tension headache New daily persistent headache Cluster headache Migraine
mild to moderate dull or aching pain   severe pain moderate to severe pain
duration of 30 minutes to several hours duration of at least four hours daily duration of 30 minutes to 3 hours duration of 4 hours to 3 days
  Occur in periods of 15 days a month for three months may happen multiple times in a day for months periodic occurrence; several per month to several per year
located as tightness or pressure across head located on one or both sides of the head located one side of head focused at eye or temple located on one or both sides of head
  consistent pain pain describable as sharp or stabbing pulsating or throbbing pain
no nausea or vomiting     nausea, perhaps with vomiting
no aura no aura   auras
uncommonly, light sensitivity or noise sensitivity   may be accompanied by running nose, tears, and drooping eyelid, often only on one side sensitivity to movement, light, and noise
  exacerbated by regular use of acetaminophen or NSAIDS   may exist with tension headache[40]

Most headaches can be diagnosed by the clinical history alone.[11] If the symptoms described by the person sound dangerous, further testing with neuroimaging or lumbar puncture may be necessary. Electroencephalography (EEG) is not useful for headache diagnosis.[41]

The first step to diagnosing a headache is to determine if the headache is old or new.[42] A "new headache" can be a headache that has started recently, or a chronic headache that has changed character.[42] For example, if a person has chronic weekly headaches with pressure on both sides of his head, and then develops a sudden severe throbbing headache on one side of his head, they have a new headache.[citation needed]

Red flags

[edit]

It can be challenging to differentiate between low-risk, benign headaches and high-risk, dangerous headaches since symptoms are often similar.[43] Headaches that are possibly dangerous require further lab tests and imaging to diagnose.[14]

The American College for Emergency Physicians published criteria for low-risk headaches. They are as follows:[44]

  • age younger than 30 years
  • features typical of primary headache
  • history of similar headache
  • no abnormal findings on neurologic exam
  • no concerning change in normal headache pattern
  • no high-risk comorbid conditions (for example, HIV)
  • no new concerning history or physical examination findings

A number of characteristics make it more likely that the headache is due to potentially dangerous secondary causes which may be life-threatening or cause long-term damage. These "red flag" symptoms mean that a headache warrants further investigation with neuroimaging and lab tests.[14]

In general, people complaining of their "first" or "worst" headache warrant imaging and further workup.[14] People with progressively worsening headache also warrant imaging, as they may have a mass or a bleed that is gradually growing, pressing on surrounding structures and causing worsening pain.[43] People with neurological findings on exam, such as weakness, also need further workup.[43]

The American Headache Society recommends using "SSNOOP", a mnemonic to remember the red flags for identifying a secondary headache:[42]

  • Systemic symptoms (fever or weight loss)
  • Systemic disease (HIV infection, malignancy)
  • Neurologic symptoms or signs
  • Onset sudden (thunderclap headache)
  • Onset after age 40 years
  • Previous headache history (first, worst, or different headache)

Other red flag symptoms include:[14][42][43][45]

Red Flag Possible causes The reason why a red flag indicates possible causes Diagnostic tests
New headache after age 50 Temporal arteritis, mass in brain Temporal arteritis is an inflammation of vessels close to the temples in older people, which decreases blood flow to the brain and causes pain. May also have tenderness in temples or jaw claudication. Some brain cancers are more common in older people. Erythrocyte sedimentation rate (diagnostic test for temporal arteritis), neuroimaging
Very sudden onset headache (thunderclap headache) Brain bleed (subarachnoid hemorrhage, hemorrhage into mass lesion, vascular malformation), pituitary apoplexy, mass (especially in posterior fossa) A bleed in the brain irritates the meninges which causes pain. Pituitary apoplexy (bleeding or impaired blood supply to the pituitary gland at the base of the brain) is often accompanied by double vision or visual field defects, since the pituitary gland is right next to the optic chiasm (eye nerves). Neuroimaging, lumbar puncture if computed tomography is negative
Headaches increasing in frequency and severity Mass, subdural hematoma, medication overuse As a brain mass gets larger, or a subdural hematoma (blood outside the vessels underneath the dura) it pushes more on surrounding structures causing pain. Medication overuse headaches worsen with more medication taken over time. Neuroimaging, drug screen
New onset headache in a person with possible HIV or cancer Meningitis (chronic or carcinomatous), brain abscess including toxoplasmosis, metastasis People with HIV or cancer are immunosuppressed so are likely to get infections of the meninges or infections in the brain causing abscesses. Cancer can metastasize, or travel through the blood or lymph to other sites in the body. Neuroimaging, lumbar puncture if neuroimaging is negative
Headache with signs of total body illness (fever, stiff neck, rash) Meningitis, encephalitis (inflammation of the brain tissue), Lyme disease, collagen vascular disease A stiff neck, or inability to flex the neck due to pain, indicates inflammation of the meninges. Other signs of systemic illness indicates infection. Neuroimaging, lumbar puncture, serology (diagnostic blood tests for infections)
Papilledema Brain mass, benign intracranial hypertension (pseudotumor cerebri), meningitis Increased intracranial pressure pushes on the eyes (from inside the brain) and causes papilledema. Neuroimaging, lumbar puncture
Severe headache following head trauma Brain bleeds (intracranial hemorrhage, subdural hematoma, epidural hematoma), post-traumatic headache Trauma can cause bleeding in the brain or shake the nerves, causing a post-traumatic headache Neuroimaging of brain, skull, and possibly cervical spine
Inability to move a limb Arteriovenous malformation, collagen vascular disease, intracranial mass lesion Focal neurological signs indicate something is pushing against nerves in the brain responsible for one part of the body Neuroimaging, blood tests for collagen vascular diseases
Change in personality, consciousness, or mental status Central nervous system infection, intracranial bleed, mass Change in mental status indicates a global infection or inflammation of the brain, or a large bleed compressing the brainstem where the consciousness centers lie Blood tests, lumbar puncture, neuroimaging
Headache triggered by cough, exertion or while engaged in sexual intercourse Mass lesion, subarachnoid hemorrhage Coughing and exertion increases the intra cranial pressure, which may cause a vessel to burst, causing a subarachnoid hemorrhage. A mass lesion already increases intracranial pressure, so an additional increase in intracranial pressure from coughing etc. will cause pain. Neuroimaging, lumbar puncture

Old headaches

[edit]

Old headaches are usually primary headaches and are not dangerous. They are most often caused by migraines or tension headaches. Migraines are often unilateral, pulsing headaches accompanied by nausea or vomiting. There may be an aura (visual symptoms, numbness or tingling) 30–60 minutes before the headache, warning the person of a headache. Migraines may also not have auras.[45] Tension-type headaches usually have bilateral "bandlike" pressure on both sides of the head usually without nausea or vomiting. However, some symptoms from both headache groups may overlap. It is important to distinguish between the two because the treatments are different.[45]

The mnemonic 'POUND' helps distinguish between migraines and tension-type headaches. POUND stands for:

  • Pulsatile quality of headache
  • One-day duration (four to 72 hours)
  • Unilateral location
  • Nausea or vomiting
  • Disabling intensity[46]

One review article found that if 4–5 of the POUND characteristics are present, a migraine is 24 times as likely a diagnosis than a tension-type headache (likelihood ratio 24). If 3 characteristics of POUND are present, migraine is 3 times more likely a diagnosis than tension type headache (likelihood ratio 3).[17] If only 2 POUND characteristics are present, tension-type headaches are 60% more likely (likelihood ratio 0.41). Another study found the following factors independently each increase the chance of migraine over tension-type headache: nausea, photophobia, phonophobia, exacerbation by physical activity, unilateral, throbbing quality, chocolate as a headache trigger, and cheese as a headache trigger.[47]

Cluster headaches are relatively rare (1 in 1000 people) and are more common in men than women.[48] They present with sudden onset explosive pain around one eye and are accompanied by autonomic symptoms (tearing, runny nose and red eye).[11]

Temporomandibular jaw pain (chronic pain in the jaw joint), and cervicogenic headache (headache caused by pain in muscles of the neck) are also possible diagnoses.[42]

For chronic, unexplained headaches, keeping a headache diary can be useful for tracking symptoms and identifying triggers, such as association with menstrual cycle, exercise and food. While mobile electronic diaries for smartphones are becoming increasingly common, a recent review found most are developed with a lack of evidence base and scientific expertise.[49]

Cephalalgiaphobia is fear of headaches or getting a headache.

New headaches

[edit]

New headaches are more likely to be dangerous secondary headaches. They can, however, simply be the first presentation of a chronic headache syndrome, like migraine or a tension headache.

One recommended diagnostic approach is as follows.[50] If any urgent red flags are present such as visual impairment, new seizures, new weakness, or new confusion, further workup with imaging and possibly a lumbar puncture should be done (see red flags section for more details). If the headache is sudden onset (thunderclap headache), a computed tomography scan (CT scan) to look for a brain bleed (subarachnoid hemorrhage) should be done. If the CT scan does not show a bleed, a lumbar puncture should be done to look for blood in the cerebrospinal fluid (CSF), as the CT scan can be falsely negative and subarachnoid hemorrhages can be fatal. If there are signs of infection such as fever, rash, or stiff neck, a lumbar puncture to look for meningitis should be considered. In an older person, if there is jaw claudication and scalp tenderness, a temporal artery biopsy should be performed to look for temporal arteritis, immediate treatment should be started, if results of the biopsy are positive.[citation needed]

Neuroimaging

[edit]

Old headaches

[edit]

The US Headache Consortium has guidelines for neuroimaging of non-acute headaches.[51] Most old, chronic headaches do not require neuroimaging. If a person has the characteristic symptoms of a migraine, neuroimaging is not needed as it is very unlikely the person has an intracranial abnormality.[52] If the person has neurological findings, such as weakness, on exam, neuroimaging may be considered.[citation needed]

New headaches

[edit]

All people who present with red flags indicating a dangerous secondary headache should receive neuroimaging.[45] The best form of neuroimaging for these headaches is controversial.[14] Non-contrast computerized tomography (CT) scan is usually the first step in head imaging as it is readily available in Emergency Departments and hospitals and is cheaper than MRI. Non-contrast CT is best for identifying an acute head bleed. Magnetic Resonance Imaging (MRI) is best for brain tumors and problems in the posterior fossa, or back of the brain.[14] MRI is more sensitive for identifying intracranial problems, however it can pick up brain abnormalities that are not relevant to the person's headaches.[14]

The American College of Radiology recommends the following imaging tests for different specific situations:[53]

Clinical Features Recommended neuroimaging test
Headache in immunocompromised people (cancer, HIV) MRI of head with or without contrast
Headache in people older than 60 with suspected temporal arteritis MRI of head with or without contrast
Headache with suspected meningitis CT or MRI without contrast
Severe headache in pregnancy CT or MRI without contrast
Severe unilateral headache caused by possible dissection of carotid or arterial arteries MRI of head with or without contrast, magnetic resonance angiography or Computed Tomography Angiography of head and neck.
Sudden onset headache or worst headache of life CT of head without contrast, Computed Tomography Angiography of head and neck with contrast, magnetic resonance angiography of head and neck with and without contrast, MRI of head without contrast

Lumbar puncture

[edit]

A lumbar puncture is a procedure in which cerebral spinal fluid is removed from the spine with a needle. A lumbar puncture is necessary to look for infection or blood in the spinal fluid. A lumbar puncture can also evaluate the pressure in the spinal column, which can be useful for people with idiopathic intracranial hypertension (usually young, obese women who have increased intracranial pressure), or other causes of increased intracranial pressure. In most cases, a CT scan should be done first.[11]

Classification

[edit]

Headaches are most thoroughly classified by the International Headache Society's International Classification of Headache Disorders (ICHD), which published the second edition in 2004.[54] The third edition of the International Headache Classification was published in 2013 in a beta version ahead of the final version.[55] This classification is accepted by the WHO.[56]

Other classification systems exist. One of the first published attempts was in 1951.[57] The US National Institutes of Health developed a classification system in 1962.[58]

ICHD-2

[edit]

The International Classification of Headache Disorders (ICHD) is an in-depth hierarchical classification of headaches published by the International Headache Society. It contains explicit (operational) diagnostic criteria for headache disorders. The first version of the classification, ICHD-1, was published in 1988. The current revision, ICHD-2, was published in 2004.[59] The classification uses numeric codes. The top, one-digit diagnostic level includes 14 headache groups. The first four of these are classified as primary headaches, groups 5-12 as secondary headaches, cranial neuralgia, central and primary facial pain and other headaches for the last two groups.[60]

The ICHD-2 classification defines migraines, tension-types headaches, cluster headache and other trigeminal autonomic headache as the main types of primary headaches.[54] Also, according to the same classification, stabbing headaches and headaches due to cough, exertion and sexual activity (sexual headache) are classified as primary headaches. The daily-persistent headaches along with the hypnic headache and thunderclap headaches are considered primary headaches as well.[61][62]

Secondary headaches are classified based on their cause and not on their symptoms.[54] According to the ICHD-2 classification, the main types of secondary headaches include those that are due to head or neck trauma such as whiplash injury, intracranial hematoma, post craniotomy or other head or neck injury. Headaches caused by cranial or cervical vascular disorders such as ischemic stroke and transient ischemic attack, non-traumatic intracranial hemorrhage, vascular malformations or arteritis are also defined as secondary headaches. This type of headache may also be caused by cerebral venous thrombosis or different intracranial vascular disorders. Other secondary headaches are those due to intracranial disorders that are not vascular such as low or high pressure of the cerebrospinal fluid pressure, non-infectious inflammatory disease, intracranial neoplasm, epileptic seizure or other types of disorders or diseases that are intracranial but that are not associated with the vasculature of the central nervous system.[citation needed]

ICHD-2 classifies headaches that are caused by the ingestion of a certain substance or by its withdrawal as secondary headaches as well. This type of headache may result from the overuse of some medications or exposure to some substances. HIV/AIDS, intracranial infections and systemic infections may also cause secondary headaches. The ICHD-2 system of classification includes the headaches associated with homeostasis disorders in the category of secondary headaches. This means that headaches caused by dialysis, high blood pressure, hypothyroidism, cephalalgia and even fasting are considered secondary headaches. Secondary headaches, according to the same classification system, can also be due to the injury of any of the facial structures including teeth, jaws, or temporomandibular joint. Headaches caused by psychiatric disorders such as somatization or psychotic disorders are also classified as secondary headaches.[citation needed]

The ICHD-2 classification puts cranial neuralgias and other types of neuralgia in a different category. According to this system, there are 19 types of neuralgias and headaches due to different central causes of facial pain. Moreover, the ICHD-2 includes a category that contains all the headaches that cannot be classified.[citation needed]

Although the ICHD-2 is the most complete headache classification there is and it includes frequency in the diagnostic criteria of some types of headaches (primarily primary headaches), it does not specifically code frequency or severity which are left at the discretion of the examiner.[54]

NIH

[edit]

The NIH classification consists of brief definitions of a limited number of headaches.[63]

The NIH system of classification is more succinct and only describes five categories of headaches. In this case, primary headaches are those that do not show organic or structural causes. According to this classification, primary headaches can only be vascular, myogenic, cervicogenic, traction, and inflammatory.[64]

Management

[edit]
An old advertisement for a headache medicine

Primary headache syndromes have many different possible treatments. In those with chronic headaches the long term use of opioids appears to result in greater harm than benefit.[65]

Secondary headaches (caused by another disease)

[edit]

Treatment of secondary headaches involves treating their underlying cause. For example, a person with meningitis will require antibiotics, and a person with a brain tumor may require surgery, chemotherapy or brain radiation. The possible origins of a headache have been studied and classified.

Migraines

[edit]

Migraine can be somewhat improved by lifestyle changes, but most people require medicines to control their symptoms.[11] Medications are either to prevent getting migraines, or to reduce symptoms once a migraine starts.[citation needed]

Preventive medications are generally recommended when people have more than four attacks of migraine per month, headaches last longer than 12 hours or the headaches are very disabling.[11][66] Possible therapies include beta blockers, antidepressants, anticonvulsants and NSAIDs.[66] The type of preventive medicine is usually chosen based on the other symptoms the person has. For example, if the person also has depression, an antidepressant is a good choice.[citation needed]

Abortive therapies for migraines may be oral, if the migraine is mild to moderate, or may require stronger medicine given intravenously or intramuscularly. Mild to moderate headaches should first be treated with acetaminophen (paracetamol) or NSAIDs, like ibuprofen. If accompanied by nausea or vomiting, an antiemetic such as metoclopramide (Reglan) can be given orally or rectally. Moderate to severe attacks should be treated first with an oral triptan, a medication that mimics serotonin (an agonist) and causes mild vasoconstriction. If accompanied by nausea and vomiting, parenteral (through a needle in the skin) triptans and antiemetics can be given.[67]

Sphenopalatine ganglion block (SPG block, also known nasal ganglion block or pterygopalatine ganglion blocks) can abort and prevent migraines, tension headaches and cluster headaches. It was originally described by American ENT surgeon Greenfield Sluder in 1908. Both blocks and neurostimulation have been studied as treatment for headaches.[68]

Several complementary and alternative strategies can help with migraines. The American Academy of Neurology guidelines for migraine treatment in 2000 stated relaxation training, electromyographic feedback and cognitive behavioral therapy may be considered for migraine treatment, along with medications.[69]

Tension-type headaches

[edit]

Tension-type headaches can usually be managed with NSAIDs (ibuprofen, naproxen, aspirin), or acetaminophen.[11] Triptans are not helpful in tension-type headaches unless the person also has migraines. For chronic tension type headaches, amitriptyline is the only medication proven to help.[11][70][71] Amitriptyline is a medication which treats depression and also independently treats pain. It works by blocking the reuptake of serotonin and norepinephrine, and also reduces muscle tenderness by a separate mechanism.[70] Studies evaluating acupuncture for tension-type headaches have been mixed.[72][73][74][75][76] Overall, they show that acupuncture is probably not helpful for tension-type headaches.

Cluster headaches

[edit]

Abortive therapy for cluster headaches includes subcutaneous sumatriptan (injected under the skin) and triptan nasal sprays. High flow oxygen therapy also helps with relief.[11]

For people with extended periods of cluster headaches, preventive therapy can be necessary. Verapamil is recommended as first line treatment. Lithium can also be useful. For people with shorter bouts, a short course of prednisone (10 days) can be helpful. Ergotamine is useful if given 1–2 hours before an attack.[11]

Neuromodulation

[edit]

Peripheral neuromodulation has tentative benefits in primary headaches including cluster headaches and chronic migraine.[77] How it may work is still being looked into.[77]

Epidemiology

[edit]

Literature reviews find that approximately 64–77% of adults have had a headache at some point in their lives.[78][79] During each year, on average, 46–53% of people have headaches.[78][79] However, the prevalence of headache varies widely depending on how the survey was conducted, with studies finding lifetime prevalence of as low as 8% to as high as 96%.[78][79][80] Most of these headaches are not dangerous. Only approximately 1–5% of people who seek emergency treatment for headaches have a serious underlying cause.[81]

More than 90% of headaches are primary headaches.[82] Most of these primary headaches are tension headaches.[79] Most people with tension headaches have "episodic" tension headaches that come and go. Only 3.3% of adults have chronic tension headaches, with headaches for more than 15 days in a month.[79]

Approximately 12–18% of people in the world have migraines.[79] More women than men experience migraines. In Europe and North America, 5–9% of men experience migraines, while 12–25% of women experience migraines.[78]

Cluster headaches are relatively uncommon. They affect only 1–3 per thousand people in the world. Cluster headaches affect approximately three times as many men as women.[79]

History

[edit]
An 1819 caricature by George Cruikshank depicting a headache

The first recorded classification system was published by Aretaeus of Cappadocia, a medical scholar of Greco-Roman antiquity. He made a distinction between three different types of headache: i) cephalalgia, by which he indicates a sudden onset, temporary headache; ii) cephalea, referring to a chronic type of headache; and iii) heterocrania, a paroxysmal headache on one side of the head. Another classification system that resembles the modern ones was published by Thomas Willis, in De Cephalalgia in 1672. In 1787 Christian Baur generally divided headaches into idiopathic (primary headaches) and symptomatic (secondary ones), and defined 84 categories.[63]

Children

[edit]

In general, children experience the same types of headaches as adults do, but their symptoms may be slightly different. The diagnostic approach to headaches in children is similar to that of adults. However, young children may not be able to verbalize pain well.[83] If a young child is fussy, they may have a headache.[84]

Approximately 1% of emergency department visits for children are for headache.[85][86] Most of these headaches are not dangerous. The most common type of headache seen in pediatric emergency rooms is headache caused by a cold (28.5%). Other headaches diagnosed in the emergency department include post-traumatic headache (20%), headache related to a problem with a ventriculoperitoneal shunt (a device put into the brain to remove excess CSF and reduce pressure in the brain) (11.5%) and migraine (8.5%).[86][87] The most common serious headaches found in children include brain bleeds (subdural hematoma, epidural hematoma), brain abscesses, meningitis and ventriculoperitoneal shunt malfunction. Only 4–6.9% of kids with a headache have a serious cause.[84]

Just as in adults, most headaches are benign, but when head pain is accompanied with other symptoms such as speech problems, muscle weakness, and loss of vision, a more serious underlying cause may exist: hydrocephalus, meningitis, encephalitis, abscess, hemorrhage, tumor, blood clots, or head trauma. In these cases, the headache evaluation may include CT scan or MRI in order to look for possible structural disorders of the central nervous system.[88] If a child with a recurrent headache has a normal physical exam, neuroimaging is not recommended. Guidelines state children with abnormal neurologic exams, confusion, seizures and recent onset of worst headache of life, change in headache type or anything suggesting neurologic problems should receive neuroimaging.[84]

When children complain of headaches, many parents are concerned about a brain tumor. Generally, headaches caused by brain masses are incapacitating and accompanied by vomiting.[84] One study found characteristics associated with brain tumor in children are: headache for greater than 6 months, headache related to sleep, vomiting, confusion, no visual symptoms, no family history of migraine and abnormal neurologic exam.[89]

Some measures can help prevent headaches in children. Drinking plenty of water throughout the day, avoiding caffeine, getting enough and regular sleep, eating balanced meals at the proper times, and reducing stress and excess of activities may prevent headaches.[90] Treatments for children are similar to those for adults, however certain medications such as narcotics should not be given to children.[84]

Children who have headaches will not necessarily have headaches as adults. In one study of 100 children with headache, eight years later 44% of those with tension headache and 28% of those with migraines were headache free.[91] In another study of people with chronic daily headache, 75% did not have chronic daily headaches two years later, and 88% did not have chronic daily headaches eight years later.[92]

Cardiac Cephalgia in Heart Attack

[edit]

Cardiac cephalgia[93] is a rare type of headache occurring during myocardial infarction, characterized by sudden, severe head pain that typically develops during or immediately following a heart attack. The pain is usually located in the occipital or frontal regions and can be accompanied by other cardiac symptoms like chest pain, shortness of breath, or radiating arm pain. This specific headache type is considered a potential warning sign of cardiac distress and requires immediate medical attention to prevent potentially life-threatening complications.[94]

See also

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[edit]

 

 

Headache
Other names Cephalalgia
Person with a headache
Specialty Neurology
Types Tension headache, cluster headache, sinusitis, migraine headache, hangover headache, cold-stimulus headache (brain freeze)
Treatment Over-the-counter painkillers, sleep, drinking water, eating food, head or neck massage

A headache, also known as cephalalgia, is the symptom of pain in the face, head, or neck. It can occur as a migraine, tension-type headache, or cluster headache.[1][2] There is an increased risk of depression in those with severe headaches.[3]

Headaches can occur as a result of many conditions. There are a number of different classification systems for headaches. The most well-recognized is that of the International Headache Society, which classifies it into more than 150 types of primary and secondary headaches. Causes of headaches may include dehydration; fatigue; sleep deprivation; stress;[4] the effects of medications (overuse) and recreational drugs, including withdrawal; viral infections; loud noises; head injury; rapid ingestion of a very cold food or beverage; and dental or sinus issues (such as sinusitis).[5]

Treatment of a headache depends on the underlying cause, but commonly involves pain medication (especially in case of migraine or cluster headaches).[6] A headache is one of the most commonly experienced of all physical discomforts.[7]

About half of adults have a headache in a given year.[3] Tension headaches are the most common,[7] affecting about 1.6 billion people (21.8% of the population) followed by migraine headaches which affect about 848 million (11.7%).[8]

Causes

[edit]

There are more than 200 types of headaches. Some are harmless and some are life-threatening. The description of the headache and findings on neurological examination, determine whether additional tests are needed and what treatment is best.[9]

Headaches are broadly classified as "primary" or "secondary".[10] Primary headaches are benign, recurrent headaches not caused by underlying disease or structural problems. For example, migraine is a type of primary headache. While primary headaches may cause significant daily pain and disability, they are not dangerous from a physiological point of view. Secondary headaches are caused by an underlying disease, like an infection, head injury, vascular disorders, brain bleed, stomach irritation, or tumors. Secondary headaches can be dangerous. Certain "red flags" or warning signs indicate a secondary headache may be dangerous.[11]

Primary

[edit]

Ninety percent of all headaches are primary headaches.[12] Primary headaches usually first start when people are between 20 and 40 years old.[13][14] The most common types of primary headaches are migraines and tension-type headaches.[14] They have different characteristics. Migraines typically present with pulsing head pain, nausea, photophobia (sensitivity to light) and phonophobia (sensitivity to sound).[15] Tension-type headaches usually present with non-pulsing "bandlike" pressure on both sides of the head, not accompanied by other symptoms.[16][17] Such kind of headaches may be further classified into-episodic and chronic tension type headaches[18] Other very rare types of primary headaches include:[11]

  • cluster headaches: short episodes (15–180 minutes) of severe pain, usually around one eye, with autonomic symptoms (tearing, red eye, nasal congestion) which occur at the same time every day. Cluster headaches can be treated with triptans and prevented with prednisone, ergotamine or lithium.
  • trigeminal neuralgia or occipital neuralgia: shooting face pain
  • hemicrania continua: continuous unilateral pain with episodes of severe pain. Hemicrania continua can be relieved by the medication indomethacin.
  • primary stabbing headache: recurrent episodes of stabbing "ice pick pain" or "jabs and jolts" for 1 second to several minutes without autonomic symptoms (tearing, red eye, nasal congestion). These headaches can be treated with indomethacin.
  • primary cough headache: starts suddenly and lasts for several minutes after coughing, sneezing or straining (anything that may increase pressure in the head). Serious causes (see secondary headaches red flag section) must be ruled out before a diagnosis of "benign" primary cough headache can be made.
  • primary exertional headache: throbbing, pulsatile pain which starts during or after exercising, lasting for 5 minutes to 24 hours. The mechanism behind these headaches is unclear, possibly due to straining causing veins in the head to dilate, causing pain. These headaches can be prevented by not exercising too strenuously and can be treated with medications such as indomethacin.
  • primary sex headache: dull, bilateral headache that starts during sexual activity and becomes much worse during orgasm. These headaches are thought to be due to lower pressure in the head during sex. It is important to realize that headaches that begin during orgasm may be due to a subarachnoid hemorrhage, so serious causes must be ruled out first. These headaches are treated by advising the person to stop sex if they develop a headache. Medications such as propranolol and diltiazem can also be helpful.
  • hypnic headache: a moderate-severe headache that starts a few hours after falling asleep and lasts 15–30 minutes. The headache may recur several times during the night. Hypnic headaches are usually in older women. They may be treated with lithium.

Secondary

[edit]

Headaches may be caused by problems elsewhere in the head or neck. Some of these are not harmful, such as cervicogenic headache (pain arising from the neck muscles). The excessive use of painkillers can paradoxically cause worsening painkiller headaches.[9][19]

More serious causes of secondary headaches include the following:[11]

Gastrointestinal disorders may cause headaches, including Helicobacter pylori infection, celiac disease, non-celiac gluten sensitivity, irritable bowel syndrome, inflammatory bowel disease, gastroparesis, and hepatobiliary disorders.[20][21][22] The treatment of the gastrointestinal disorders may lead to a remission or improvement of headaches.[22]

Migraine headaches are also associated with Cyclic Vomiting Syndrome (CVS). CVS is characterized by episodes of severe vomiting, and often occur alongside symptoms similar to those of migraine headaches (photophobia, abdominal pain, etc.).[23]

Pathophysiology

[edit]

The brain itself is not sensitive to pain, because it lacks pain receptors. However, several areas of the head and neck do have pain receptors and can thus sense pain. These include the extracranial arteries, middle meningeal artery, large veins, venous sinuses, cranial and spinal nerves, head and neck muscles, the meninges, falx cerebri, parts of the brainstem, eyes, ears, teeth, and lining of the mouth.[24][25] Pial arteries, rather than pial veins are responsible for pain production.[11]

Headaches often result from traction or irritation of the meninges and blood vessels.[26] The pain receptors may be stimulated by head trauma or tumours and cause headaches. Blood vessel spasms, dilated blood vessels, inflammation or infection of meninges and muscular tension can also stimulate pain receptors.[25] Once stimulated, a nociceptor sends a message up the length of the nerve fibre to the nerve cells in the brain, signalling that a part of the body hurts.[27]

Primary headaches are more difficult to understand than secondary headaches. The exact mechanisms which cause migraines, tension headaches and cluster headaches are not known.[28] There have been different hypotheses over time that attempt to explain what happens in the brain to cause these headaches.[29]

Migraines are currently thought to be caused by dysfunction of the nerves in the brain.[30] Previously, migraines were thought to be caused by a primary problem with the blood vessels in the brain.[31] This vascular theory, which was developed in the 20th century by Wolff, suggested that the aura in migraines is caused by constriction of intracranial vessels (vessels inside the brain), and the headache itself is caused by rebound dilation of extracranial vessels (vessels just outside the brain). Dilation of these extracranial blood vessels activates the pain receptors in the surrounding nerves, causing a headache. The vascular theory is no longer accepted.[30][32] Studies have shown migraine head pain is not accompanied by extracranial vasodilation, but rather only has some mild intracranial vasodilation.[33]

Currently, most specialists think migraines are due to a primary problem with the nerves in the brain.[30] Auras are thought to be caused by a wave of increased activity of neurons in the cerebral cortex (a part of the brain) known as cortical spreading depression[34] followed by a period of depressed activity.[35] Some people think headaches are caused by the activation of sensory nerves which release peptides or serotonin, causing inflammation in arteries, dura and meninges and also cause some vasodilation. Triptans, medications that treat migraines, block serotonin receptors and constrict blood vessels.[36]

People who are more susceptible to experiencing migraines without headaches are those who have a family history of migraines, women, and women who are experiencing hormonal changes or are taking birth control pills or are prescribed hormone replacement therapy.[37]

Tension headaches are thought to be caused by the activation of peripheral nerves in the head and neck muscles.[38]

Cluster headaches involve overactivation of the trigeminal nerve and hypothalamus in the brain, but the exact cause is unknown.[28][39]

Diagnosis

[edit]
Differential diagnosis of headaches
Tension headache New daily persistent headache Cluster headache Migraine
mild to moderate dull or aching pain   severe pain moderate to severe pain
duration of 30 minutes to several hours duration of at least four hours daily duration of 30 minutes to 3 hours duration of 4 hours to 3 days
  Occur in periods of 15 days a month for three months may happen multiple times in a day for months periodic occurrence; several per month to several per year
located as tightness or pressure across head located on one or both sides of the head located one side of head focused at eye or temple located on one or both sides of head
  consistent pain pain describable as sharp or stabbing pulsating or throbbing pain
no nausea or vomiting     nausea, perhaps with vomiting
no aura no aura   auras
uncommonly, light sensitivity or noise sensitivity   may be accompanied by running nose, tears, and drooping eyelid, often only on one side sensitivity to movement, light, and noise
  exacerbated by regular use of acetaminophen or NSAIDS   may exist with tension headache[40]

Most headaches can be diagnosed by the clinical history alone.[11] If the symptoms described by the person sound dangerous, further testing with neuroimaging or lumbar puncture may be necessary. Electroencephalography (EEG) is not useful for headache diagnosis.[41]

The first step to diagnosing a headache is to determine if the headache is old or new.[42] A "new headache" can be a headache that has started recently, or a chronic headache that has changed character.[42] For example, if a person has chronic weekly headaches with pressure on both sides of his head, and then develops a sudden severe throbbing headache on one side of his head, they have a new headache.[citation needed]

Red flags

[edit]

It can be challenging to differentiate between low-risk, benign headaches and high-risk, dangerous headaches since symptoms are often similar.[43] Headaches that are possibly dangerous require further lab tests and imaging to diagnose.[14]

The American College for Emergency Physicians published criteria for low-risk headaches. They are as follows:[44]

  • age younger than 30 years
  • features typical of primary headache
  • history of similar headache
  • no abnormal findings on neurologic exam
  • no concerning change in normal headache pattern
  • no high-risk comorbid conditions (for example, HIV)
  • no new concerning history or physical examination findings

A number of characteristics make it more likely that the headache is due to potentially dangerous secondary causes which may be life-threatening or cause long-term damage. These "red flag" symptoms mean that a headache warrants further investigation with neuroimaging and lab tests.[14]

In general, people complaining of their "first" or "worst" headache warrant imaging and further workup.[14] People with progressively worsening headache also warrant imaging, as they may have a mass or a bleed that is gradually growing, pressing on surrounding structures and causing worsening pain.[43] People with neurological findings on exam, such as weakness, also need further workup.[43]

The American Headache Society recommends using "SSNOOP", a mnemonic to remember the red flags for identifying a secondary headache:[42]

  • Systemic symptoms (fever or weight loss)
  • Systemic disease (HIV infection, malignancy)
  • Neurologic symptoms or signs
  • Onset sudden (thunderclap headache)
  • Onset after age 40 years
  • Previous headache history (first, worst, or different headache)

Other red flag symptoms include:[14][42][43][45]

Red Flag Possible causes The reason why a red flag indicates possible causes Diagnostic tests
New headache after age 50 Temporal arteritis, mass in brain Temporal arteritis is an inflammation of vessels close to the temples in older people, which decreases blood flow to the brain and causes pain. May also have tenderness in temples or jaw claudication. Some brain cancers are more common in older people. Erythrocyte sedimentation rate (diagnostic test for temporal arteritis), neuroimaging
Very sudden onset headache (thunderclap headache) Brain bleed (subarachnoid hemorrhage, hemorrhage into mass lesion, vascular malformation), pituitary apoplexy, mass (especially in posterior fossa) A bleed in the brain irritates the meninges which causes pain. Pituitary apoplexy (bleeding or impaired blood supply to the pituitary gland at the base of the brain) is often accompanied by double vision or visual field defects, since the pituitary gland is right next to the optic chiasm (eye nerves). Neuroimaging, lumbar puncture if computed tomography is negative
Headaches increasing in frequency and severity Mass, subdural hematoma, medication overuse As a brain mass gets larger, or a subdural hematoma (blood outside the vessels underneath the dura) it pushes more on surrounding structures causing pain. Medication overuse headaches worsen with more medication taken over time. Neuroimaging, drug screen
New onset headache in a person with possible HIV or cancer Meningitis (chronic or carcinomatous), brain abscess including toxoplasmosis, metastasis People with HIV or cancer are immunosuppressed so are likely to get infections of the meninges or infections in the brain causing abscesses. Cancer can metastasize, or travel through the blood or lymph to other sites in the body. Neuroimaging, lumbar puncture if neuroimaging is negative
Headache with signs of total body illness (fever, stiff neck, rash) Meningitis, encephalitis (inflammation of the brain tissue), Lyme disease, collagen vascular disease A stiff neck, or inability to flex the neck due to pain, indicates inflammation of the meninges. Other signs of systemic illness indicates infection. Neuroimaging, lumbar puncture, serology (diagnostic blood tests for infections)
Papilledema Brain mass, benign intracranial hypertension (pseudotumor cerebri), meningitis Increased intracranial pressure pushes on the eyes (from inside the brain) and causes papilledema. Neuroimaging, lumbar puncture
Severe headache following head trauma Brain bleeds (intracranial hemorrhage, subdural hematoma, epidural hematoma), post-traumatic headache Trauma can cause bleeding in the brain or shake the nerves, causing a post-traumatic headache Neuroimaging of brain, skull, and possibly cervical spine
Inability to move a limb Arteriovenous malformation, collagen vascular disease, intracranial mass lesion Focal neurological signs indicate something is pushing against nerves in the brain responsible for one part of the body Neuroimaging, blood tests for collagen vascular diseases
Change in personality, consciousness, or mental status Central nervous system infection, intracranial bleed, mass Change in mental status indicates a global infection or inflammation of the brain, or a large bleed compressing the brainstem where the consciousness centers lie Blood tests, lumbar puncture, neuroimaging
Headache triggered by cough, exertion or while engaged in sexual intercourse Mass lesion, subarachnoid hemorrhage Coughing and exertion increases the intra cranial pressure, which may cause a vessel to burst, causing a subarachnoid hemorrhage. A mass lesion already increases intracranial pressure, so an additional increase in intracranial pressure from coughing etc. will cause pain. Neuroimaging, lumbar puncture

Old headaches

[edit]

Old headaches are usually primary headaches and are not dangerous. They are most often caused by migraines or tension headaches. Migraines are often unilateral, pulsing headaches accompanied by nausea or vomiting. There may be an aura (visual symptoms, numbness or tingling) 30–60 minutes before the headache, warning the person of a headache. Migraines may also not have auras.[45] Tension-type headaches usually have bilateral "bandlike" pressure on both sides of the head usually without nausea or vomiting. However, some symptoms from both headache groups may overlap. It is important to distinguish between the two because the treatments are different.[45]

The mnemonic 'POUND' helps distinguish between migraines and tension-type headaches. POUND stands for:

  • Pulsatile quality of headache
  • One-day duration (four to 72 hours)
  • Unilateral location
  • Nausea or vomiting
  • Disabling intensity[46]

One review article found that if 4–5 of the POUND characteristics are present, a migraine is 24 times as likely a diagnosis than a tension-type headache (likelihood ratio 24). If 3 characteristics of POUND are present, migraine is 3 times more likely a diagnosis than tension type headache (likelihood ratio 3).[17] If only 2 POUND characteristics are present, tension-type headaches are 60% more likely (likelihood ratio 0.41). Another study found the following factors independently each increase the chance of migraine over tension-type headache: nausea, photophobia, phonophobia, exacerbation by physical activity, unilateral, throbbing quality, chocolate as a headache trigger, and cheese as a headache trigger.[47]

Cluster headaches are relatively rare (1 in 1000 people) and are more common in men than women.[48] They present with sudden onset explosive pain around one eye and are accompanied by autonomic symptoms (tearing, runny nose and red eye).[11]

Temporomandibular jaw pain (chronic pain in the jaw joint), and cervicogenic headache (headache caused by pain in muscles of the neck) are also possible diagnoses.[42]

For chronic, unexplained headaches, keeping a headache diary can be useful for tracking symptoms and identifying triggers, such as association with menstrual cycle, exercise and food. While mobile electronic diaries for smartphones are becoming increasingly common, a recent review found most are developed with a lack of evidence base and scientific expertise.[49]

Cephalalgiaphobia is fear of headaches or getting a headache.

New headaches

[edit]

New headaches are more likely to be dangerous secondary headaches. They can, however, simply be the first presentation of a chronic headache syndrome, like migraine or a tension headache.

One recommended diagnostic approach is as follows.[50] If any urgent red flags are present such as visual impairment, new seizures, new weakness, or new confusion, further workup with imaging and possibly a lumbar puncture should be done (see red flags section for more details). If the headache is sudden onset (thunderclap headache), a computed tomography scan (CT scan) to look for a brain bleed (subarachnoid hemorrhage) should be done. If the CT scan does not show a bleed, a lumbar puncture should be done to look for blood in the cerebrospinal fluid (CSF), as the CT scan can be falsely negative and subarachnoid hemorrhages can be fatal. If there are signs of infection such as fever, rash, or stiff neck, a lumbar puncture to look for meningitis should be considered. In an older person, if there is jaw claudication and scalp tenderness, a temporal artery biopsy should be performed to look for temporal arteritis, immediate treatment should be started, if results of the biopsy are positive.[citation needed]

Neuroimaging

[edit]

Old headaches

[edit]

The US Headache Consortium has guidelines for neuroimaging of non-acute headaches.[51] Most old, chronic headaches do not require neuroimaging. If a person has the characteristic symptoms of a migraine, neuroimaging is not needed as it is very unlikely the person has an intracranial abnormality.[52] If the person has neurological findings, such as weakness, on exam, neuroimaging may be considered.[citation needed]

New headaches

[edit]

All people who present with red flags indicating a dangerous secondary headache should receive neuroimaging.[45] The best form of neuroimaging for these headaches is controversial.[14] Non-contrast computerized tomography (CT) scan is usually the first step in head imaging as it is readily available in Emergency Departments and hospitals and is cheaper than MRI. Non-contrast CT is best for identifying an acute head bleed. Magnetic Resonance Imaging (MRI) is best for brain tumors and problems in the posterior fossa, or back of the brain.[14] MRI is more sensitive for identifying intracranial problems, however it can pick up brain abnormalities that are not relevant to the person's headaches.[14]

The American College of Radiology recommends the following imaging tests for different specific situations:[53]

Clinical Features Recommended neuroimaging test
Headache in immunocompromised people (cancer, HIV) MRI of head with or without contrast
Headache in people older than 60 with suspected temporal arteritis MRI of head with or without contrast
Headache with suspected meningitis CT or MRI without contrast
Severe headache in pregnancy CT or MRI without contrast
Severe unilateral headache caused by possible dissection of carotid or arterial arteries MRI of head with or without contrast, magnetic resonance angiography or Computed Tomography Angiography of head and neck.
Sudden onset headache or worst headache of life CT of head without contrast, Computed Tomography Angiography of head and neck with contrast, magnetic resonance angiography of head and neck with and without contrast, MRI of head without contrast

Lumbar puncture

[edit]

A lumbar puncture is a procedure in which cerebral spinal fluid is removed from the spine with a needle. A lumbar puncture is necessary to look for infection or blood in the spinal fluid. A lumbar puncture can also evaluate the pressure in the spinal column, which can be useful for people with idiopathic intracranial hypertension (usually young, obese women who have increased intracranial pressure), or other causes of increased intracranial pressure. In most cases, a CT scan should be done first.[11]

Classification

[edit]

Headaches are most thoroughly classified by the International Headache Society's International Classification of Headache Disorders (ICHD), which published the second edition in 2004.[54] The third edition of the International Headache Classification was published in 2013 in a beta version ahead of the final version.[55] This classification is accepted by the WHO.[56]

Other classification systems exist. One of the first published attempts was in 1951.[57] The US National Institutes of Health developed a classification system in 1962.[58]

ICHD-2

[edit]

The International Classification of Headache Disorders (ICHD) is an in-depth hierarchical classification of headaches published by the International Headache Society. It contains explicit (operational) diagnostic criteria for headache disorders. The first version of the classification, ICHD-1, was published in 1988. The current revision, ICHD-2, was published in 2004.[59] The classification uses numeric codes. The top, one-digit diagnostic level includes 14 headache groups. The first four of these are classified as primary headaches, groups 5-12 as secondary headaches, cranial neuralgia, central and primary facial pain and other headaches for the last two groups.[60]

The ICHD-2 classification defines migraines, tension-types headaches, cluster headache and other trigeminal autonomic headache as the main types of primary headaches.[54] Also, according to the same classification, stabbing headaches and headaches due to cough, exertion and sexual activity (sexual headache) are classified as primary headaches. The daily-persistent headaches along with the hypnic headache and thunderclap headaches are considered primary headaches as well.[61][62]

Secondary headaches are classified based on their cause and not on their symptoms.[54] According to the ICHD-2 classification, the main types of secondary headaches include those that are due to head or neck trauma such as whiplash injury, intracranial hematoma, post craniotomy or other head or neck injury. Headaches caused by cranial or cervical vascular disorders such as ischemic stroke and transient ischemic attack, non-traumatic intracranial hemorrhage, vascular malformations or arteritis are also defined as secondary headaches. This type of headache may also be caused by cerebral venous thrombosis or different intracranial vascular disorders. Other secondary headaches are those due to intracranial disorders that are not vascular such as low or high pressure of the cerebrospinal fluid pressure, non-infectious inflammatory disease, intracranial neoplasm, epileptic seizure or other types of disorders or diseases that are intracranial but that are not associated with the vasculature of the central nervous system.[citation needed]

ICHD-2 classifies headaches that are caused by the ingestion of a certain substance or by its withdrawal as secondary headaches as well. This type of headache may result from the overuse of some medications or exposure to some substances. HIV/AIDS, intracranial infections and systemic infections may also cause secondary headaches. The ICHD-2 system of classification includes the headaches associated with homeostasis disorders in the category of secondary headaches. This means that headaches caused by dialysis, high blood pressure, hypothyroidism, cephalalgia and even fasting are considered secondary headaches. Secondary headaches, according to the same classification system, can also be due to the injury of any of the facial structures including teeth, jaws, or temporomandibular joint. Headaches caused by psychiatric disorders such as somatization or psychotic disorders are also classified as secondary headaches.[citation needed]

The ICHD-2 classification puts cranial neuralgias and other types of neuralgia in a different category. According to this system, there are 19 types of neuralgias and headaches due to different central causes of facial pain. Moreover, the ICHD-2 includes a category that contains all the headaches that cannot be classified.[citation needed]

Although the ICHD-2 is the most complete headache classification there is and it includes frequency in the diagnostic criteria of some types of headaches (primarily primary headaches), it does not specifically code frequency or severity which are left at the discretion of the examiner.[54]

NIH

[edit]

The NIH classification consists of brief definitions of a limited number of headaches.[63]

The NIH system of classification is more succinct and only describes five categories of headaches. In this case, primary headaches are those that do not show organic or structural causes. According to this classification, primary headaches can only be vascular, myogenic, cervicogenic, traction, and inflammatory.[64]

Management

[edit]
An old advertisement for a headache medicine

Primary headache syndromes have many different possible treatments. In those with chronic headaches the long term use of opioids appears to result in greater harm than benefit.[65]

Secondary headaches (caused by another disease)

[edit]

Treatment of secondary headaches involves treating their underlying cause. For example, a person with meningitis will require antibiotics, and a person with a brain tumor may require surgery, chemotherapy or brain radiation. The possible origins of a headache have been studied and classified.

Migraines

[edit]

Migraine can be somewhat improved by lifestyle changes, but most people require medicines to control their symptoms.[11] Medications are either to prevent getting migraines, or to reduce symptoms once a migraine starts.[citation needed]

Preventive medications are generally recommended when people have more than four attacks of migraine per month, headaches last longer than 12 hours or the headaches are very disabling.[11][66] Possible therapies include beta blockers, antidepressants, anticonvulsants and NSAIDs.[66] The type of preventive medicine is usually chosen based on the other symptoms the person has. For example, if the person also has depression, an antidepressant is a good choice.[citation needed]

Abortive therapies for migraines may be oral, if the migraine is mild to moderate, or may require stronger medicine given intravenously or intramuscularly. Mild to moderate headaches should first be treated with acetaminophen (paracetamol) or NSAIDs, like ibuprofen. If accompanied by nausea or vomiting, an antiemetic such as metoclopramide (Reglan) can be given orally or rectally. Moderate to severe attacks should be treated first with an oral triptan, a medication that mimics serotonin (an agonist) and causes mild vasoconstriction. If accompanied by nausea and vomiting, parenteral (through a needle in the skin) triptans and antiemetics can be given.[67]

Sphenopalatine ganglion block (SPG block, also known nasal ganglion block or pterygopalatine ganglion blocks) can abort and prevent migraines, tension headaches and cluster headaches. It was originally described by American ENT surgeon Greenfield Sluder in 1908. Both blocks and neurostimulation have been studied as treatment for headaches.[68]

Several complementary and alternative strategies can help with migraines. The American Academy of Neurology guidelines for migraine treatment in 2000 stated relaxation training, electromyographic feedback and cognitive behavioral therapy may be considered for migraine treatment, along with medications.[69]

Tension-type headaches

[edit]

Tension-type headaches can usually be managed with NSAIDs (ibuprofen, naproxen, aspirin), or acetaminophen.[11] Triptans are not helpful in tension-type headaches unless the person also has migraines. For chronic tension type headaches, amitriptyline is the only medication proven to help.[11][70][71] Amitriptyline is a medication which treats depression and also independently treats pain. It works by blocking the reuptake of serotonin and norepinephrine, and also reduces muscle tenderness by a separate mechanism.[70] Studies evaluating acupuncture for tension-type headaches have been mixed.[72][73][74][75][76] Overall, they show that acupuncture is probably not helpful for tension-type headaches.

Cluster headaches

[edit]

Abortive therapy for cluster headaches includes subcutaneous sumatriptan (injected under the skin) and triptan nasal sprays. High flow oxygen therapy also helps with relief.[11]

For people with extended periods of cluster headaches, preventive therapy can be necessary. Verapamil is recommended as first line treatment. Lithium can also be useful. For people with shorter bouts, a short course of prednisone (10 days) can be helpful. Ergotamine is useful if given 1–2 hours before an attack.[11]

Neuromodulation

[edit]

Peripheral neuromodulation has tentative benefits in primary headaches including cluster headaches and chronic migraine.[77] How it may work is still being looked into.[77]

Epidemiology

[edit]

Literature reviews find that approximately 64–77% of adults have had a headache at some point in their lives.[78][79] During each year, on average, 46–53% of people have headaches.[78][79] However, the prevalence of headache varies widely depending on how the survey was conducted, with studies finding lifetime prevalence of as low as 8% to as high as 96%.[78][79][80] Most of these headaches are not dangerous. Only approximately 1–5% of people who seek emergency treatment for headaches have a serious underlying cause.[81]

More than 90% of headaches are primary headaches.[82] Most of these primary headaches are tension headaches.[79] Most people with tension headaches have "episodic" tension headaches that come and go. Only 3.3% of adults have chronic tension headaches, with headaches for more than 15 days in a month.[79]

Approximately 12–18% of people in the world have migraines.[79] More women than men experience migraines. In Europe and North America, 5–9% of men experience migraines, while 12–25% of women experience migraines.[78]

Cluster headaches are relatively uncommon. They affect only 1–3 per thousand people in the world. Cluster headaches affect approximately three times as many men as women.[79]

History

[edit]
An 1819 caricature by George Cruikshank depicting a headache

The first recorded classification system was published by Aretaeus of Cappadocia, a medical scholar of Greco-Roman antiquity. He made a distinction between three different types of headache: i) cephalalgia, by which he indicates a sudden onset, temporary headache; ii) cephalea, referring to a chronic type of headache; and iii) heterocrania, a paroxysmal headache on one side of the head. Another classification system that resembles the modern ones was published by Thomas Willis, in De Cephalalgia in 1672. In 1787 Christian Baur generally divided headaches into idiopathic (primary headaches) and symptomatic (secondary ones), and defined 84 categories.[63]

Children

[edit]

In general, children experience the same types of headaches as adults do, but their symptoms may be slightly different. The diagnostic approach to headaches in children is similar to that of adults. However, young children may not be able to verbalize pain well.[83] If a young child is fussy, they may have a headache.[84]

Approximately 1% of emergency department visits for children are for headache.[85][86] Most of these headaches are not dangerous. The most common type of headache seen in pediatric emergency rooms is headache caused by a cold (28.5%). Other headaches diagnosed in the emergency department include post-traumatic headache (20%), headache related to a problem with a ventriculoperitoneal shunt (a device put into the brain to remove excess CSF and reduce pressure in the brain) (11.5%) and migraine (8.5%).[86][87] The most common serious headaches found in children include brain bleeds (subdural hematoma, epidural hematoma), brain abscesses, meningitis and ventriculoperitoneal shunt malfunction. Only 4–6.9% of kids with a headache have a serious cause.[84]

Just as in adults, most headaches are benign, but when head pain is accompanied with other symptoms such as speech problems, muscle weakness, and loss of vision, a more serious underlying cause may exist: hydrocephalus, meningitis, encephalitis, abscess, hemorrhage, tumor, blood clots, or head trauma. In these cases, the headache evaluation may include CT scan or MRI in order to look for possible structural disorders of the central nervous system.[88] If a child with a recurrent headache has a normal physical exam, neuroimaging is not recommended. Guidelines state children with abnormal neurologic exams, confusion, seizures and recent onset of worst headache of life, change in headache type or anything suggesting neurologic problems should receive neuroimaging.[84]

When children complain of headaches, many parents are concerned about a brain tumor. Generally, headaches caused by brain masses are incapacitating and accompanied by vomiting.[84] One study found characteristics associated with brain tumor in children are: headache for greater than 6 months, headache related to sleep, vomiting, confusion, no visual symptoms, no family history of migraine and abnormal neurologic exam.[89]

Some measures can help prevent headaches in children. Drinking plenty of water throughout the day, avoiding caffeine, getting enough and regular sleep, eating balanced meals at the proper times, and reducing stress and excess of activities may prevent headaches.[90] Treatments for children are similar to those for adults, however certain medications such as narcotics should not be given to children.[84]

Children who have headaches will not necessarily have headaches as adults. In one study of 100 children with headache, eight years later 44% of those with tension headache and 28% of those with migraines were headache free.[91] In another study of people with chronic daily headache, 75% did not have chronic daily headaches two years later, and 88% did not have chronic daily headaches eight years later.[92]

Cardiac Cephalgia in Heart Attack

[edit]

Cardiac cephalgia[93] is a rare type of headache occurring during myocardial infarction, characterized by sudden, severe head pain that typically develops during or immediately following a heart attack. The pain is usually located in the occipital or frontal regions and can be accompanied by other cardiac symptoms like chest pain, shortness of breath, or radiating arm pain. This specific headache type is considered a potential warning sign of cardiac distress and requires immediate medical attention to prevent potentially life-threatening complications.[94]

See also

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