Headache facts
What is a headache?
Headache is defined as a pain arising from the head or upper neck of the body. The pain originates from the tissues and structures that surround the brain because the brain itself has no nerves that give rise to the sensation of pain (pain fibers). The periosteum that surrounds bones; muscles that encase the skull, sinuses, eyes, and ears; and meninges that cover the surface of the brain and spinal cord, arteries, veins, and nerves, all can become inflamed or irritated to cause the pain of a headache. This pain may be a dull ache, sharp, throbbing, constant, mild, or intense.
How are headaches classified?
In 2005, the International Headache Society released its latest classification system for headache. Because so many people suffer from headaches and because treatment sometimes is difficult, it was hoped that the new classification system would help health care professionals make a specific diagnosis as to the type of headache and allow better and more effective options for treatment.
There are three major categories of headache based upon the source of the pain:
What are primary headaches?
Primary headaches include migraine, tension, and cluster headaches, as well as a variety of other less common types of headache.
Primary headaches can affect the quality of life. Some people have occasional headaches that resolve quickly while others are debilitated. While these headaches are not life-threatening, they may be associated with symptoms that can mimic strokes.
Many patients equate severe headache with migraine, but the amount of pain does not determine the diagnosis of migraine. A full discussion of migraine headaches can be found in this article.
What are secondary headaches?
Secondary headaches are those that are due to an underlying structural problem in the head or neck. This is a very broad group of medical conditions ranging from dental pain from infected teeth to pain from an infected sinus, to life-threatening conditions like bleeding in the brain or infections like encephalitis or meningitis.
Traumatic headaches fall into this category including post-concussion headaches.
This group of headaches also includes those headaches associated with substance abuse and excess use of medications used to treat headaches (rebound headaches).
What are cranial neuralgias, facial pain, and other headaches?
Neuralgia means nerve pain (neur= nerve + algia=pain). Cranial neuralgia describes inflammation of one of the 12 nerves that supply the motor and sensation function of the head and neck. Perhaps the most commonly recognized example is trigeminal neuralgia, which affects cranial nerve V (the trigeminal nerve) and can cause intense facial pain.
What causes tension headaches?
While tension headaches are the most frequently occurring type of headache, their cause is not known. The most likely cause is contraction of the muscles that cover the skull. When the muscles covering the skull are stressed, they may become inflamed, go into spasm, and cause pain. Common sites include the base of the skull where the trapezius muscles of the neck insert, the temples where muscles that move the jaw are located, and the forehead.
There is little research to confirm the exact cause of tension headaches. Tension headaches occur because of physical or emotional stress placed on the body. For example, these stressors can cause the muscles surrounding the skull to clench the teeth and go into spasm. Physical stressors include difficult and prolonged manual labor, or sitting at a desk or computer for long periods of time concentrating. Emotional stress also may cause tension headaches by causing the muscles surrounding the skull to contract.
What are the symptoms of tension headaches?
Common presentation of tension headaches includes the following:
How are tension headaches diagnosed?
The key to making the diagnosis of any headache is the history given by the patient. The health care professional will ask questions about the headache to try to help make the diagnosis. Those questions may include learning about the quality, quantity, and duration of the pain, and asking about any associated symptoms. The person with a tension headache will usually complain of pain that is mild-to-moderate, located on both sides of the head, described as a tightness that is not throbbing, and not made worse with activity. There will be no associated symptoms like nausea, vomiting, or light sensitivity.
The physical examination, particularly the neurologic portion of the examination, is important in tension headaches because to make the diagnosis, it should be normal. However, there may be some tenderness of the scalp or neck muscles. If the health care professional finds an abnormality on neurologic exam, then the diagnosis of tension headache should be put on hold while the potential for other causes of headaches has been investigated.
How are tension headaches treated?
Tension headaches are painful, and patients may be upset that the diagnosis is "only" a tension headache. Even though it is not life-threatening, a tension headache can make daily activities more difficult to accomplish. Most people successfully treat themselves with over-the–counter (OTC) pain medications to control tension headaches. The following work well for most people:
If these fail, other supportive treatments are available. Recurrent headaches should be a signal to seek medical help. Massage, biofeedback, and stress management can all be used as adjuncts to help with control of tension headaches.
It is important to remember that OTC medications, while safe, are medications and may have side effects and potential interactions with prescription medications. It always is wise to ask a health care professional or pharmacist if one has questions about OTC medications and their use. This is especially important with OTC pain medications, because they are used so frequently.
It is important to read the listing of ingredients in OTC pain medications. Often an OTC medication is a combination of ingredients, and the second or third listed ingredient may have the potential for drug interaction or contraindication based upon a patient's other medical issues For example:
Other examples where caution should be used include the following:
What causes cluster headaches?
Cluster headaches are so named because they tend to occur daily for periods of a week or more with long periods of time, months to years, with no headache symptoms. They occur at the same time of day, often waking the patient in the middle of the night.
The cause of cluster headaches is uncertain but may be due to a sudden release of the chemicals histamine and serotonin in the brain. The hypothalamus, an area located at the base of the brain, is responsible for the body's biologic clock and may be the location that is the source for this type of headache. When brain scans are performed on patients who are in the midst of a cluster headache, abnormal activity has been found in the hypothalamus.
Cluster headaches also:
If an individual is in a susceptible period for cluster headache, cigarette smoking, alcohol, and some foods (for example, chocolate and foods high in nitrites like smoked meats) also can be potential causes for headache.
What are the symptoms of cluster headaches?
Cluster headaches are headaches that come in groups (clusters) separated by pain-free periods of months or years. A patient may experience a headache on a daily basis for weeks or months and then be pain free for years. This type of headache affects males more frequently and often begins in adolescence but can extend to those in middle age.
Unlike patients with migraine headaches, patients with cluster headaches tend to be restless. They often pace the floor, bang their heads against a wall, and patients can be driven to desperate measures including contemplating suicide.
How are cluster headaches diagnosed?
The diagnosis of cluster headache is made by taking the patient's history. The description of the pain and its clock-like recurrence is usually enough to make the diagnosis.
If examined in the midst of an attack, the patient usually is in a painful crisis and may have the eye and nose watering as described previously. If the patient is seen when the pain is not present, the physical examination is normal and the diagnosis will depends upon the history.
How are cluster headaches treated?
Cluster headaches may be very difficult to treat, and it may take trial and error to find the specific treatment regimen that will work for each patient. Since the headache recurs daily, there are two treatment needs. The pain of the first episode needs to be controlled, and the following headaches need to be prevented.
Initial treatment options may include one or more of the following:
Prevention of the next cluster headache may include the following:
Can cluster headaches be prevented?
Since cluster headache episodes may be spaced years apart, and since the first headache of a new cluster episode can't be predicted, daily medication may not be warranted.
Lifestyle changes may help minimize the risk of a cluster headache flare. Stopping smoking and minimizing alcohol may prevent future episodes of cluster headache.
What diseases cause secondary headaches?
Headache is a symptom associated with many illnesses. While head pain itself is the issue with primary headaches, secondary headaches are due to an underlying disease or injury that needs to be diagnosed and treated. Controlling the headache symptom will need to occur at the same time that diagnostic tests are being considered to diagnose the underlying disease. Some of the causes of secondary headache may be potentially life-threatening and deadly. Early diagnosis and treatment is essential if damage is to be limited.
The International Headache Society lists eight categories of secondary headache. A few examples in each category are noted (This is not a complete list.).
Head and neck traumaHow are secondary headaches diagnosed?
If there is time, the diagnosis of secondary headache begins with a complete patient history followed by a physical examination and laboratory and radiology tests as appropriate.
However, some patients present in crisis with a decreased level of consciousness or unstable vital signs. In these situations, the health care professional may decide to treat a specific cause without waiting for tests to confirm the diagnosis.
For example, a patient with headache, fever, stiff neck, and confusion may have symptoms that suggest meningitis. Since meningitis can be rapidly fatal, antibiotic therapy may be started before blood tests and a lumbar puncture are performed to confirm the diagnosis. It may be that the diagnosis is found to be a brain tumor or subarachnoid hemorrhage, but the benefit of early antibiotics outweighs the risk of not giving them promptly.
What are the exams and tests for secondary headaches?
The patient history and physical examination provide the initial direction for determining the cause of secondary headaches. Therefore, it is extremely important that a patient with new, severe headache seeks medical care and gives their health care professional an opportunity to assess their condition. Tests that may be useful in making the diagnosis of the underlying disease causing the headaches will depend upon the doctor's evaluation and what specific disease, illness, or injury is being considered as the cause of the headaches (the differential diagnosis). Common tests that are considered include the following:
Specific tests will depend upon what potential issues the health care professional and patient want to address.
Blood tests
Blood tests provide helpful information in association with the history and physical examination in pursuing a diagnosis. For example, an infection or inflammation in the body may cause a rise in the white blood cell count, the erythrocyte sedimentation rate (ESR), or C-reactive protein (CRP). These two tests are very nonspecific; that is, they may be abnormal with any infection or inflammation, and abnormalities do not point to a specific diagnosis of the cause of the infection or inflammation. The ESR is often used to make the tentative diagnosis of temporal arteritis, a condition that affects an older patient, usually over the age of 65, who presents with a sharp, stabbing temporal headache.
Blood tests may be used to assess electrolyte disturbances, and a variety of organ dysfunctions including liver, kidney, and thyroid.
Toxicology tests may be helpful if the patient is suspected of abusing alcohol, prescription, or other drugs of abuse.
Computerized tomography of the head
Computerized tomography (CT scan) is able to detect bleeding, swelling, and some tumors within the skull and brain. It can also show evidence of previous stroke. With intravenous contrast injection, it may also be used to look at the arteries of the brain.
Magnetic resonance imaging (MRI) of the head
MRI is able to better look at the anatomy of the brain and meninges (the layers that cover the brain and the spinal cord). While it is more precise, the time to perform the scan is significantly longer than for computerized tomography. This type of scan is not available at all hospitals. Moreover, it takes much longer to perform, requires the patient to cooperate by holding still, and requires that the patient have no metal in their body (for example, a heart pacemaker or metal foreign objects in the eye).
Lumbar puncture
Cerebrospinal fluid, the fluid that surrounds the brain and spinal cord, can be obtained with a needle that is inserted into the spine in the lower back. Examination of the fluid looks for infection (such as meningitis due to bacteria, virus, fungus, or tuberculosis) or blood from hemorrhage. In almost all cases, computerized tomography is done prior to lumbar puncture to make certain there is no bleeding, swelling, or tumor within the brain. Pressure within the space can be measured when the lumbar puncture needle is inserted. Elevated pressures may make the diagnosis of idiopathic intracranial hypertension in combination with the appropriate history and physical examination.
What are primary headaches?
Primary headaches include migraine, tension, and cluster headaches, as well as a variety of other less common types of headache.
Primary headaches can affect the quality of life. Some people have occasional headaches that resolve quickly while others are debilitated. While these headaches are not life-threatening, they may be associated with symptoms that can mimic strokes.
Many patients equate severe headache with migraine, but the amount of pain does not determine the diagnosis of migraine. A full discussion of migraine headaches can be found in this article.
What are secondary headaches?
Secondary headaches are those that are due to an underlying structural problem in the head or neck. This is a very broad group of medical conditions ranging from dental pain from infected teeth to pain from an infected sinus, to life-threatening conditions like bleeding in the brain or infections like encephalitis or meningitis.
Traumatic headaches fall into this category including post-concussion headaches.
This group of headaches also includes those headaches associated with substance abuse and excess use of medications used to treat headaches (rebound headaches).
What are cranial neuralgias, facial pain, and other headaches?
Neuralgia means nerve pain (neur= nerve + algia=pain). Cranial neuralgia describes inflammation of one of the 12 nerves that supply the motor and sensation function of the head and neck. Perhaps the most commonly recognized example is trigeminal neuralgia, which affects cranial nerve V (the trigeminal nerve) and can cause intense facial pain.
What causes tension headaches?
While tension headaches are the most frequently occurring type of headache, their cause is not known. The most likely cause is contraction of the muscles that cover the skull. When the muscles covering the skull are stressed, they may become inflamed, go into spasm, and cause pain. Common sites include the base of the skull where the trapezius muscles of the neck insert, the temples where muscles that move the jaw are located, and the forehead.
There is little research to confirm the exact cause of tension headaches. Tension headaches occur because of physical or emotional stress placed on the body. For example, these stressors can cause the muscles surrounding the skull to clench the teeth and go into spasm. Physical stressors include difficult and prolonged manual labor, or sitting at a desk or computer for long periods of time concentrating. Emotional stress also may cause tension headaches by causing the muscles surrounding the skull to contract.
What are the symptoms of tension headaches?
Common presentation of tension headaches includes the following:
How are tension headaches diagnosed?
The key to making the diagnosis of any headache is the history given by the patient. The health care professional will ask questions about the headache to try to help make the diagnosis. Those questions may include learning about the quality, quantity, and duration of the pain, and asking about any associated symptoms. The person with a tension headache will usually complain of pain that is mild-to-moderate, located on both sides of the head, described as a tightness that is not throbbing, and not made worse with activity. There will be no associated symptoms like nausea, vomiting, or light sensitivity.
The physical examination, particularly the neurologic portion of the examination, is important in tension headaches because to make the diagnosis, it should be normal. However, there may be some tenderness of the scalp or neck muscles. If the health care professional finds an abnormality on neurologic exam, then the diagnosis of tension headache should be put on hold while the potential for other causes of headaches has been investigated.
How are tension headaches treated?
Tension headaches are painful, and patients may be upset that the diagnosis is "only" a tension headache. Even though it is not life-threatening, a tension headache can make daily activities more difficult to accomplish. Most people successfully treat themselves with over-the–counter (OTC) pain medications to control tension headaches. The following work well for most people:
If these fail, other supportive treatments are available. Recurrent headaches should be a signal to seek medical help. Massage, biofeedback, and stress management can all be used as adjuncts to help with control of tension headaches.
It is important to remember that OTC medications, while safe, are medications and may have side effects and potential interactions with prescription medications. It always is wise to ask a health care professional or pharmacist if one has questions about OTC medications and their use. This is especially important with OTC pain medications, because they are used so frequently.
It is important to read the listing of ingredients in OTC pain medications. Often an OTC medication is a combination of ingredients, and the second or third listed ingredient may have the potential for drug interaction or contraindication based upon a patient's other medical issues For example:
Other examples where caution should be used include the following:
What causes cluster headaches?
Cluster headaches are so named because they tend to occur daily for periods of a week or more with long periods of time, months to years, with no headache symptoms. They occur at the same time of day, often waking the patient in the middle of the night.
The cause of cluster headaches is uncertain but may be due to a sudden release of the chemicals histamine and serotonin in the brain. The hypothalamus, an area located at the base of the brain, is responsible for the body's biologic clock and may be the location that is the source for this type of headache. When brain scans are performed on patients who are in the midst of a cluster headache, abnormal activity has been found in the hypothalamus.
Cluster headaches also:
If an individual is in a susceptible period for cluster headache, cigarette smoking, alcohol, and some foods (for example, chocolate and foods high in nitrites like smoked meats) also can be potential causes for headache.
What are the symptoms of cluster headaches?
Cluster headaches are headaches that come in groups (clusters) separated by pain-free periods of months or years. A patient may experience a headache on a daily basis for weeks or months and then be pain free for years. This type of headache affects males more frequently and often begins in adolescence but can extend to those in middle age.
Unlike patients with migraine headaches, patients with cluster headaches tend to be restless. They often pace the floor, bang their heads against a wall, and patients can be driven to desperate measures including contemplating suicide.
How are cluster headaches diagnosed?
The diagnosis of cluster headache is made by taking the patient's history. The description of the pain and its clock-like recurrence is usually enough to make the diagnosis.
If examined in the midst of an attack, the patient usually is in a painful crisis and may have the eye and nose watering as described previously. If the patient is seen when the pain is not present, the physical examination is normal and the diagnosis will depends upon the history.
How are cluster headaches treated?
Cluster headaches may be very difficult to treat, and it may take trial and error to find the specific treatment regimen that will work for each patient. Since the headache recurs daily, there are two treatment needs. The pain of the first episode needs to be controlled, and the following headaches need to be prevented.
Initial treatment options may include one or more of the following:
Prevention of the next cluster headache may include the following:
Can cluster headaches be prevented?
Since cluster headache episodes may be spaced years apart, and since the first headache of a new cluster episode can't be predicted, daily medication may not be warranted.
Lifestyle changes may help minimize the risk of a cluster headache flare. Stopping smoking and minimizing alcohol may prevent future episodes of cluster headache.
What diseases cause secondary headaches?
Headache is a symptom associated with many illnesses. While head pain itself is the issue with primary headaches, secondary headaches are due to an underlying disease or injury that needs to be diagnosed and treated. Controlling the headache symptom will need to occur at the same time that diagnostic tests are being considered to diagnose the underlying disease. Some of the causes of secondary headache may be potentially life-threatening and deadly. Early diagnosis and treatment is essential if damage is to be limited.
The International Headache Society lists eight categories of secondary headache. A few examples in each category are noted (This is not a complete list.).
Head and neck traumaHow are secondary headaches diagnosed?
If there is time, the diagnosis of secondary headache begins with a complete patient history followed by a physical examination and laboratory and radiology tests as appropriate.
However, some patients present in crisis with a decreased level of consciousness or unstable vital signs. In these situations, the health care professional may decide to treat a specific cause without waiting for tests to confirm the diagnosis.
For example, a patient with headache, fever, stiff neck, and confusion may have symptoms that suggest meningitis. Since meningitis can be rapidly fatal, antibiotic therapy may be started before blood tests and a lumbar puncture are performed to confirm the diagnosis. It may be that the diagnosis is found to be a brain tumor or subarachnoid hemorrhage, but the benefit of early antibiotics outweighs the risk of not giving them promptly.
What are the exams and tests for secondary headaches?
The patient history and physical examination provide the initial direction for determining the cause of secondary headaches. Therefore, it is extremely important that a patient with new, severe headache seeks medical care and gives their health care professional an opportunity to assess their condition. Tests that may be useful in making the diagnosis of the underlying disease causing the headaches will depend upon the doctor's evaluation and what specific disease, illness, or injury is being considered as the cause of the headaches (the differential diagnosis). Common tests that are considered include the following:
Specific tests will depend upon what potential issues the health care professional and patient want to address.
Blood tests
Blood tests provide helpful information in association with the history and physical examination in pursuing a diagnosis. For example, an infection or inflammation in the body may cause a rise in the white blood cell count, the erythrocyte sedimentation rate (ESR), or C-reactive protein (CRP). These two tests are very nonspecific; that is, they may be abnormal with any infection or inflammation, and abnormalities do not point to a specific diagnosis of the cause of the infection or inflammation. The ESR is often used to make the tentative diagnosis of temporal arteritis, a condition that affects an older patient, usually over the age of 65, who presents with a sharp, stabbing temporal headache.
Blood tests may be used to assess electrolyte disturbances, and a variety of organ dysfunctions including liver, kidney, and thyroid.
Toxicology tests may be helpful if the patient is suspected of abusing alcohol, prescription, or other drugs of abuse.
Computerized tomography of the head
Computerized tomography (CT scan) is able to detect bleeding, swelling, and some tumors within the skull and brain. It can also show evidence of previous stroke. With intravenous contrast injection, it may also be used to look at the arteries of the brain.
Magnetic resonance imaging (MRI) of the head
MRI is able to better look at the anatomy of the brain and meninges (the layers that cover the brain and the spinal cord). While it is more precise, the time to perform the scan is significantly longer than for computerized tomography. This type of scan is not available at all hospitals. Moreover, it takes much longer to perform, requires the patient to cooperate by holding still, and requires that the patient have no metal in their body (for example, a heart pacemaker or metal foreign objects in the eye).
Lumbar puncture
Cerebrospinal fluid, the fluid that surrounds the brain and spinal cord, can be obtained with a needle that is inserted into the spine in the lower back. Examination of the fluid looks for infection (such as meningitis due to bacteria, virus, fungus, or tuberculosis) or blood from hemorrhage. In almost all cases, computerized tomography is done prior to lumbar puncture to make certain there is no bleeding, swelling, or tumor within the brain. Pressure within the space can be measured when the lumbar puncture needle is inserted. Elevated pressures may make the diagnosis of idiopathic intracranial hypertension in combination with the appropriate history and physical examination.
Source: http://www.rxlist.com
Primary headaches can affect the quality of life. Some people have occasional headaches that resolve quickly while others are debilitated. While these headaches are not life-threatening, they may be associated with symptoms that can mimic strokes.
Many patients equate severe headache with migraine, but the amount of pain does not determine the diagnosis of migraine. A full discussion of migraine headaches can be found in this article.
Source: http://www.rxlist.com
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