
For more information on headache, visit Britannica.com.
Pain within the head. It is probably the most common complaint for which people seek a physician's help. Headaches can be grouped into three primary categories: vascular, muscle-contraction, and organic.
Vascular headaches include classic and common migraine as well as cluster, toxic, and hypertensive headaches. All are caused by dilation of cerebral blood vessels. Constriction of the blood vessels may also occur in any part of the cerebral vascu-lature and cause the neurologic symptoms associated with some forms of vascular headache. Migraine affects one side of the head but may be bilateral. Nerologic symptoms, especially visual disturbances, are common. Cluster headache is the occurrence of migraines in groups or series. The cluster headache is characterized by its one-sided, excruciating attack that is usually localized around one eye. Other forms ofvascular headache may be caused by systemic infection or fever, which causes dilation of the blood vessels. The ingestion of alcohol, poisons, or some medications used to treat hypertension or cardiac disease may produce adverse effects, including vascular headaches. See also Hypertension.
The most common form of headache is the muscle-contraction or tension headache. It is characterized by dull, constricting pain that can either occur intermittently or continue for days, months, or years. Muscle-contraction headaches usually affect both sides of the head and may be described as having a hat-band distribution of pain.
Very few headaches have an organic cause, such as brain tumor or aneurysm. Headache is not a prominent symptom of brain tumor: if present, headache will become progressively worse and constant, and it may not appear until late in the course of the tumor development. The headache associated with an aneurysm is usually mild until the aneurysm is at the point of rupture. If a patient complains of an exceptionally severe headache, organic disease, such as aneurysm, must be ruled out. See also Aneurysm.
Acute sinus headache is characterized by nasal congestion and fever. The headache is minimalin the morning and increases in severity through the day. Temporomandibular joint (TMJ) diseaseinvolves a faulty bite or misalignment of the teeth and can cause a headache. Eye conditions may also cause headache. The increased intraocular pressure of glaucoma, for example, may cause a headache, and so complaints of a recent onset of headache, particularly in the elderly, shouldprompt a screening for glaucoma. See also Glaucoma; Pain.
Headaches have a variety of causes. Most are relatively trivial including those associated with alcoholic hangovers, exertion, fatigue, emotional stress, and poor posture. Some headaches have more sinister implications and may be associated with food poisoning, very high blood pressure, or brain damage after a blow to the head.
Headaches encountered during or after vigorous physical activity are sometimes called exercise-induced headaches. Typically the headache is benign, occurs suddenly, and produces a throbbing pain. Other headaches, more severe in intensity, may develop after prolonged exertion in heat, high humidity, or at altitude. These effort headaches usually last about one hour and are probably due to acute dehydration. Not surprisingly, footballers sometimes develop headaches and other unpleasant symptoms after heading a ball. These ‘footballers' migraines’ are more likely if the ball is not headed properly. Another common exercise-induced headache is called weight-lifter's headache. This occurs when a person lifts a heavy weight while breathing in or holding breath (see Valsalva's manoeuvre); pressure in the brain increases, precipitating an intense, incapacitating pain.
Headaches may also be diet related: food allergies, low blood sugar levels, and very salty foods can provoke headaches and migraines.
Migraines are severe, throbbing, disabling headaches that usually affect only one side of the head. The pain often starts behind one eye and is accompanied by nausea, vomiting, and visual disturbances (variously described as ‘auras’, ‘shimmering lights’, or temporary ‘blind spots’). Doctors reassure us that migraine is a medically harmless condition, but this is little comfort to those whose lives are periodically disrupted by excruciatingly painful attacks. These usually last from 4 to 72 hours. About 10 per cent of the population in Britain suffer from a migraine attack some time during their life. Women are about three times more likely to suffer from these debilitating headaches than men. A woman's migraine often coincides with the sudden drop in oestrogen levels that occurs just before menstruation. Although there are many theories, the exact cause of migraine is unknown. Migraineurs (migraine sufferers) often attribute their attack to dietary triggers such as coffee, cheese, chocolate, citrus fruits, and red wine. They may be reacting to chemicals in these foods (such as tyramine and phenylethylamine in chocolate, octopamine in citrus fruits, and 5-hydroxytryptamine in tomatoes, bananas and pineapples). An elimination diet is sometimes successful in identifying triggers which can then be avoided. However, for many migraineurs, no obvious trigger can be found. During an attack, most sufferers lie down in a dark room, drink plenty of watery fluids, and keep themselves warm with blankets and hot water bottles. Treatment includes antimigraine drugs, self-hypnosis, and acupuncture.
Those suffering from persistent headaches or severe chronic headaches should seek medical advice. It is especially important to see a doctor if a child has a headache which starts suddenly and is accompanied by a rash, vomiting, high temperature, or a stiff neck.
Headache is arguably the commonest of the human ills, and perhaps, in proportion to its impact, one of the least well understood.
There are many different types of headache, whether considered as to how they behave or as to how they are caused. Headache may broadly be classified as primary or secondary: there are situations in which headache itself is the problem (primary headache), and others in which headache is a symptom of some other condition (secondary headache). Headache has been classified in detail by the International Headache Society, and whole textbooks have been written about it.
The main types of primary and secondary headache are listed in the table, which is based on a population survey. The main primary headaches are migraine (which is considered separately under that heading) and ‘tension-type headache — which is the commonest of all. It is often dull, both-sided, mild but otherwise featureless. It is surprisingly poorly understood. One of the most severe forms of headache, and one of the most difficult to treat, is ‘chronic daily headache’, which involves having headache most days of the week for most of the day. This may be either a form of chronic migraine or of tension-type headache; it is probably experienced in some form by up to 4% of the population, and is often associated with analgesic (painkiller) overuse. The daily headache syndrome is often due in part to the constant cycle of taking painkillers and then having their effects wear off: so-called rebound headache. Regular use of painkillers, particularly those containing more than one ingredient, such as mixtures with codeine, caffeine, or barbiturates, is a potent cause of difficulty in the treatment of headache. Also any regular intake of anti-migraine drugs, including ergotamine and triptans (sumatriptan and related compounds), may potentially cause or aggravate this problem.
Headache does not have any single cause. Just as there are many types of headache, there are many causes of the problem. With respect to the cause of the pain the mechanisms are much less well understood for the primary than for the secondary headaches. Whereas the pain due to injury to the skin, for example, is well understood as being due to stimulation of specific nerve endings in conjunction with local inflammatory events, it is not clear in primary head pain whether the nerves are firing normally or abnormally in response to various stimuli. Much work is to be to done, especially in regard to understanding tension-type headache.
Headache due to serious disease is rare, but a sufferer should be concerned about a headache when it has certain features. These include: sudden onset or sudden worsening, such as a severe headache never previously experienced; headache associated with fever, together with neck stiffness or altered consciousness, such as drowsiness; headache that is gradually worsening over a short period — say one to two months; or headache associated with pain in the temples, and pain on chewing, particularly if there is any visual disturbance. These latter symptoms are very important and a sufferer should seek immediate medical attention.
Most countries have established flourishing patient groups, which can be contacted by reference to telephone directories, such as the Migraine Trust in the UK and the American Council for Headache Education in the US.
| Primary headache | Secondary headache | ||
|---|---|---|---|
| Type | Prevalence (% of all | Cause | Prevalence (% of all |
| primary headaches) | secondary headaches) | ||
| tension-type | 69 | systemic infection | 63 |
| migraine | 16 | head injury | 4 |
| idiopathic stabbing | 2 | vascular disorders | 1 |
| exertional | 1 | sub-arachnoid haemorrhage | <1 |
| cluster | 0.6 | brain tumour | 0.1 |
| Types of headache. After Rassmussen, B. K. (1995) Epidemology of headache. Cephalalgia;15: 45-68. |
— Peter J. Goadsby
See also migraine.
Bibliography
noun
Definition
A headache involves pain in the head that can arise from many disorders or may be a disorder in and of itself.
Description
Headaches can be categorized as primary or secondary. Primary headaches occur independently and are not the result of another medical problem. Secondary headaches are caused by illness, infection, or injury and account for less than 10 percent of all headaches.
There are many classifications of headaches, including more than 150 diagnostic headache categories identified by the International Headache Society. In general, there are three types of primary headaches, including:
Some chronic tension headaches may start as migraines but become daily headaches. These are called transformed migraines. Drug rebound headaches are those that occur from over-using medications for headache pain; they result from exceeding labeling instructions or a physician's directions.
Headaches that occur along with other neurological symptoms, such as balance problems and vision changes, may be a sign of a disease process in the brain. These organic causes of headache may include hydrocephalus (abnormal build-up of fluid in the brain), infection of the brain, tumor, or other conditions.
Demographics
Headaches are very common in children and adolescents. One study reported that 56 percent of boys and 74 percent of girls between ages 12 and 17 have at least one headache within a 30-day period. Tension headaches are the most common type of headache, affecting 15–20 percent of adolescents. The American Council for Headache Education (ACHE) estimates 4–10 percent of children have migraine headaches. Many adults with headaches report that they first began in childhood, and 20 percent report headache onset before age 10. Before puberty, migraines occur equally in girls and boys. After puberty, girls are three times more likely to have migraines than boys because of associated hormonal changes and menstruation. Headaches are a major cause of missed school days.
Causes and Symptoms
Causes
Most headaches in children and adolescents are benign and not the result of an underlying disease or disorder. Rather, most headaches in children are the result of stress and muscle tension, lack of sleep, orthe common cold, flu, or sinus or ear infection.
Traditional theories about headaches link tension-type headaches to muscle contraction, and migraine and cluster headaches to blood vessel dilation (swelling). Pain-sensitive structures in the head include blood vessel walls, membranous coverings of the brain, and scalp and neck muscles. Brain tissue itself has no sensitivity to pain. Therefore, headaches may result from contraction of the muscles of the scalp, face or neck; dilation of the blood vessels in the head; or brain swelling that stretches the brain's coverings. Involvement of specific nerves of the face and head may also cause characteristic headaches. Sinus inflammation is a common cause of headache.
Tension-type headaches are often brought on by emotional or mental stress, overexertion, poor posture, loud noise, and other external factors.
In post-puberty girls, a hormonal connection is likely, since headaches occur at specific points in the menstrual cycle.
Secondary headaches are caused by a wide range of conditions, including some rare diseases and other more treatable conditions. Secondary headaches may be the result of infection, meningitis, tumors, or localized head injury.
Some headaches have a genetic link; sensitivities to certain environmental triggers and migraines also have been identified in one or both parents.
HEADACHE TRIGGERS. Migraines are often triggered by food and environmental factors. Known food triggers include chocolate; aged cheeses; pizza; monosodium glutamate (MSG); bananas; nuts; peanut butter; ice cream; yogurt; fatty or fried foods; processed meats containing nitrates, such as hot dogs and pepperoni; certain food dyes; artificial sweeteners such as aspartame; and caffeine. Environmental triggers include weather changes; smoking; strong odors; and bright lights. Other triggers include sudden changes in sleep patterns and changes in hormone levels. By keeping a headache diary, the child and parents can identify and then avoid the specific substances that seem to cause headache symptoms.
When to Call the Doctor
The parent or caregiver should call the child's pediatrician or neurologist when the child has these symptoms or conditions:
The parent or caregiver should seek prompt medical attention when the child has these symptoms or conditions:
Diagnosis
All children who experience headaches on a relatively regular basis should be evaluated. Since headaches arise from many causes, a physical exam assesses general health and a neurological exam evaluates the possibility of neurological disease that is causing the headache. The doctor will look for signs of illness, including fever, high blood pressure, muscle weakness, difficulties with balance, or visual problems.
If the headache is the primary illness, the doctor elicits a thorough history of the headache to help classify the headache, including:
The child's medical and family history help the physician determine if the child has any conditions or disorders that might contribute to or cause the headache. A family history of migraines or neurological disease might suggest a genetic predisposition to the condition.
The diagnostic evaluation for headache may include blood tests and urinalysis to rule out other medical conditions that may be causing the headaches. Neurological imaging tests such as computed tomography (CT) scan or magnetic resonance imaging (MRI) may be performed to rule out the presence of neurological diseases or disorders. Other tests may include a sinus x ray and ophthalmology examination. If a condition affecting the brain and spinal cord is suspected, a lumbar puncture or spinal tap may be performed.
A psychological assessment is not part of a routine headache evaluation but may be performed to identify stress triggers.
Treatment
The specific treatment prescribed will depend upon the type and frequency of the headache, its cause, and the child's age.
Headache Diary
A headache diary can be used to record the characteristics of headaches, including possible triggers, such as foods, weather changes, odors, mood, stressful situations, emotions, or menstrual phases. It also can help the doctor identify the appropriate treatment.
Lifestyle Changes
Making certain dietary and lifestyle changes can significantly improve the child's headache symptoms. Exercise is an important part of a healthy lifestyle. It aids in stress reduction and improves circulation, which may help reduce headache symptoms. Relaxation and stress management techniques may help the child cope with headache symptoms. Getting enough sleep is equally important; most children and adolescents need at least eight to 10 hours of sleep per night. Counseling can help the child identify stressful situations or events that cause the headaches. It also can teach the child various coping strategies.
Medications
Some children may find enough relief with over-the-counter pain relievers in the right dose. Other children need more aggressive treatment that includes preventive (prophylactic) medication.
Headache medications are classified as abortive, prophylactic, or symptom relief. Abortive medications treat a headache in progress, prophylactic medications prevent a headache, and symptom relief medications relieve associated headache symptoms.
Abortive medications are taken with the onset of the first sign of a migraine. Some prescribed abortive medications include the triptan drugs such as sumatriptan (Imitrex), zolmitriptan (Zomig), naratriptan (Amerge), and ergotamine tartrate and caffeine (Caffergot).
Prophylactic medications are prescribed to treat frequent tension headaches or migraines, or the combination of both headaches. These medications must be taken daily to reduce the frequency and severity of headaches, and they may take a few weeks to be fully effective. Some prophylactic treatments include antidepressants, antihistamines, nonsteroidal anti-inflammatories (NSAIDs), prednisone, beta-blockers, and calcium channel blockers.
Symptom relief medications are used to relieve symptoms associated with headaches, including headache pain or nausea. These drugs may include over-thecounter pain-relieving medications such as acetaminophen, ibuprofen, naproxen, or anti-nausea medications (called antiemitics). Prescribed symptom relief medications may include sedatives (to induce sleep) and muscle relaxants. If symptom relief medications are needed more than twice a week, the child should see his or her doctor, who can make adjustments to the treatment plan. When taken more than three times per week, symptom relief medications can actually cause a type of headache called a rebound headache. To treat rebound headaches, all pain-relieving medications are usually discontinued for a few weeks (as advised by the physician), then used no more than two to three times per week to relieve symptoms.
Alternative Treatment
Alternative headache treatments include:
Biofeedback, which teaches patients how to direct mental thoughts to influence physical functions, may be helpful for some patients. For example, patients can use certain relaxation techniques to help them learn how their personal response to muscle tension is related to their headache symptoms. By practicing biofeedback, a patient may be able to stop a migraine attack before it occurs or prevent headache symptoms from becoming worse.
Follow-Up Care
It is important for the child to keep a regular followup appointment schedule so the doctor can monitor the effects of treatment and make any necessary medication adjustments.
Prognosis
Most headaches are benign (not the result of a severe disease). Headaches are typically resolved through the use of analgesics and other treatments. As a child grows, the headaches may disappear.
Prevention
Some headaches may be prevented if the child avoids triggering substances and situations, or practices alternative therapies, such as yoga or biofeedback. Regular exercise and good sleep habits also can help prevent headaches.
Nutritional Concerns
Since food allergies are often linked with headaches, especially cluster headaches and migraines, identifying and eliminating the allergy-causing food(s) from the diet can be an important preventive measure. To help control migraines, the child should eat three balanced meals at regular intervals, take a multi-vitamin supplement to maintain adequate nutrient needs, and drink four to eight glasses of non-caffeinated fluids per day. Sports drinks during exercise and during a headache can help balance sugar and sodium levels. To prevent headache symptoms associated with certain foods, parents should work with a registered dietitian to facilitate specific dietary changes. They also should carefully read food labels to identify and avoid dietary triggers.
Parental Concerns
It is important for parents to reassure their child that most headaches are not caused by a serious illness. Parents can help their child create and maintain a headache diary to record headache symptoms, triggers, as well as the duration and frequency of the headaches. Parents should make sure their child drinks enough fluids, eats three well-balanced meals each day, gets plenty of sleep, and balances activities to avoid an over-crowded schedule that may cause stress and lead to a headache. When headaches occur, parents should allow the child to take a nap; a dark, quiet room is usually preferred by the child. In addition, parents can help the child learn relaxation techniques to help relieve or prevent headache symptoms. If the headaches are linked to anxiety or depression, the parents should ask the child's doctor for a referral to a counselor who can provide additional assistance.
Resources
Books
Diamond, Seymour, M.D. Headache and Your Child: The Complete Guide to Understanding and Treating Migraine and Other Headaches in Children and Adolescents. New York: Fireside, 2001.
Silberstein, Stephen D., M.D., FACP, et al. Headache in Clinical Practice. 2nd ed. London, England: Martin Dunitz, Ltd., 2002.
Wolff, Harold G., et al. Wolff's Headache and Other Head Pain. New York: Oxford University Press, Inc., 2001.
Organizations
American Council for Headache Education (ACHE). 19 Mantua Road, Mt. Royal, NJ 08061. (856) 423-0258. Web site: www.achenet.org.
American Headache Society. 19 Mantua Rd., Mt Royal, NJ 08061.(856) 423-0043. Web site: www.ahsnet.org.
MAGNUM (Migraine Awareness Group: A National Understanding for Migraineurs). 113 South St. Asaph St., Suite 300, Alexandria, VA 22314. (703) 739-9384. Web site: www.migraines.org.
National Headache Foundation. 820 N. Orleans, Suite 217, Chicago, IL 60610. (888) NHF-5552. Web site: www.headaches.org.
National Institutes of Health (NIH). National Institute of Neurological Disorders and Stroke. NIH Neurological Institute. P.O. Box 5801, Bethesda, MD 20824. (800) 352-9424. Web site: www.ninds.nih.gov.
Web Sites
Excedrin Headache Resource Center. Sponsored by Bristol-Myers Squibb Company. Available online at: www.Excedrin.com.
Headache Impact Test. A tool to measure the impact headaches are having on patients' lives, to track headaches over time, and to share this information with the physician. Available online at: www.headachetest.com.
Migraine Information Center. Sponsored by GlaxoSmithKline. Available online at: www.migrainehelp.com.
"When Kids Get Headaches." The Nemours Foundation. [cited October 12, 2004]. Available online at: www.kidshealth.org/parent/general/aches/headache.html.
[Article by: Julia Barrett Angela M. Costello]
A pain felt deep within the skull. Headaches have a variety of causes, most are relatively trivial, including those associated with fatigue, emotional stress, and poor posture. Some headaches, however, have more sinister implications and may be due to poisoning, high blood pressure, or brain damage after a blow to the head. Anyone suffering from a persistent headache, or headaches following physical trauma, should seek medical advice. Exercise-related headaches include benign exertional headache, effort headache, footballer's migraine, and weight-lifter's headache.
|
|
|
| Aching Head |
| House Un-American Activities Committee | |
| How do a pig, a duck, a monkey and an owl say "Happy Birthday?" |
From our Archives: Today's Highlights, June 6, 2010
If a man sits down to think, he is immediately asked if has a headache.
— Ralph Waldo Emerson (1803-1882)
LearnThatWord.com is a free vocabulary and spelling program where you only pay for results!
Pain in the cranial vault resulting from intracranial, extracranial, or psychogenic causes: intra-cranial vascular dilation; space-occupying lesions; diseases of the eyes, ears, and sinuses; extracranial vascular dilation; sustained muscular contraction; hysteria; certain habit patterns (clenching); and reaction to stress.

|
A person with a headache. |
|
| ICD-10 | G43-G44, R51 |
|---|---|
| ICD-9 | 339, 784.0 |
| DiseasesDB | 19825 |
| MedlinePlus | 003024 |
| eMedicine | neuro/517 neuro/70 |
| MeSH | D006261 |
A headache or cephalalgia is pain anywhere in the region of the head or neck. It can be a symptom of a number of different conditions of the head and neck.[1] The brain tissue itself is not sensitive to pain because it lacks pain receptors. Rather, the pain is caused by disturbance of the pain-sensitive structures around the brain. Nine areas of the head and neck have these pain-sensitive structures, which are the cranium (the periosteum of the skull), muscles, nerves, arteries and veins, subcutaneous tissues, eyes, ears, sinuses and mucous membranes.
There are a number of different classification systems for headaches. The most well-recognized is that of the International Headache Society. Headache is a non-specific symptom, which means that it has many possible causes. Treatment of a headache depends on the underlying etiology or cause, but commonly involves analgesics.
|
Contents
|
Headaches are most thoroughly classified by the International Headache Society's International Classification of Headache Disorders (ICHD), which published the second edition in 2004.[2] This classification is accepted by the WHO.[3]
Other classification systems exist. One of the first published attempts was in 1951.[4] The National Institutes of Health developed a classification system in 1962.[5]
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.[6]
The classification uses numeric codes. The top, one-digit diagnostic level includes 13 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.[7]
The ICHD-2 classification defines migraines, tension-types headaches, cluster headache and other trigeminal autonomic cephalalgias as the main types of primary headaches.[8] Also, according to the same classification, stabbing headaches and headaches due to cough, exertion and sexual activity (coital cephalalgia) are classified as primary headaches. The daily-persistent headaches along with the hypnic headache and thunderclap headaches are considered primary headaches as well.
Secondary headaches are classified based on their etiology and not on their symptoms.[8] 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 headaches 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. 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 by 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, and 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.
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.
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.[8]
The NIH classification consists of brief definitions of a limited number of headaches.[9]
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 etiology. According to this classification, headaches can only be vascular, myogenic, cervicogenic, traction and inflammatory.
There are over 200 types of headache, and the causes range from harmless to life-threatening. The description of the headache, together with findings on neurological examination, determines the need for any further investigations and the most appropriate treatment.[10]
The most common types of headache are the "primary headache disorders", such as tension-type headache and migraine. They have typical features; migraine, for example, tends to be pulsating in character, affecting one side of the head, associated with nausea, disabling in severity, and usually lasts between 3 hours and 3 days. Rarer primary headache disorders are trigeminal neuralgia (a shooting face pain), cluster headache (severe pains that occur together in bouts), and hemicrania continua (a continuous headache on one side of the head).[10]
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). Medication overuse headache may occur in those using excessive painkillers for headaches, paradoxically causing worsening headaches.[10]
A number of characteristics make it more likely that the headache is due to potentially dangerous secondary causes; some of these may be life-threatening or cause long-term damage. A number of "red flag" symptoms therefore means that a headache warrants further investigations, usually by a specialist. The red flag symptoms are a new or different headache in someone over 50 years old, headache that develops within minutes (thunderclap headache), inability to move a limb or abnormalities on neurological examination, mental confusion, being woken by headache, headache that worsens with changing posture, headache worsened by exertion or Valsalva manoeuvre (coughing, straining), visual loss or visual abnormalities, jaw claudication (jaw pain on chewing that resolves afterwards), neck stiffness, fever, and headaches in people with HIV, cancer or risk factors for thrombosis.[10]
"Thunderclap headache" may be the only symptom of subarachnoid hemorrhage, a form of stroke in which blood accumulates around the brain, often from a ruptured brain aneurysm. Headache with fever may be caused by meningitis, particularly if there is meningism (inability to flex the neck forward due to stiffness), and confusion may be indicative of encephalitis (inflammation of the brain, usually due to particular viruses). Headache that is worsened by straining or a change in position may be caused by increased pressure in the skull; this is often worse in the morning and associated with vomiting. Raised intracranial pressure may be due to brain tumors, idiopathic intracranial hypertension (IIH, more common in younger overweight women) and occasionally cerebral venous sinus thrombosis. Headache together with weakness in part of the body may indicate a stroke (particularly intracranial hemorrhage or subdural hematoma) or brain tumor. Headache in older people, particularly when associated with visual symptoms or jaw claudication, may indicate giant cell arteritis (GCA), in which the blood vessel wall is inflamed and obstructs blood flow. Carbon monoxide poisoning may lead to headaches as well as nausea, vomiting, dizziness, muscle weakness and blurred vision. Angle closure glaucoma (acute raised pressure in the eyeball) may lead to headache, particularly around the eye, as well as visual abnormalities, nausea, vomiting and a red eye with a dilated pupil.[10]
The brain itself is not sensitive to pain, because it lacks pain receptors. However, several areas of the head and neck do have nociceptors, and can thus sense pain. These include the extracranial arteries, large veins, cranial and spinal nerves, head and neck muscles and the meninges.[11]
Headache often results from traction to or irritation of the meninges and blood vessels. The nociceptors may also be stimulated by other factors than head trauma or tumors and cause headaches. Some of these include stress, dilated blood vessels and muscular tension. Once stimulated, a nociceptor sends a message up the length of the nerve fiber to the nerve cells in the brain, signaling that a part of the body hurts.[12]
It has been suggested that the level of endorphins in one's body may have a great impact on how people feel headaches[citation needed]. Thus, it is believed that people who suffer from chronic headaches or severe headaches have lower levels of endorphins compared to people who do not complain of headaches.
Primary headaches are even more difficult to understand than secondary headaches. Although the pathophysiology of migraines, cluster headaches and tension headaches is still not well understood, there have been different theories over time which attempt to provide an explanation of what exactly happens within the brain when individuals suffer from headaches. One of the oldest such theories is referred to as the vascular theory which was developed in the middle of the 20th century[citation needed]. The vascular theory was proposed by Wolff and it described the intracranial vasoconstriction as being responsible for the aura of the migraine. The headache was believed to result from the subsequent rebound of the dilatation of the blood vessels which led to the activation of the perivascular nociceptive nerves. The developers of this theory took into consideration the changes that occur within the blood vessels outside the cranium when a migraine attack occurs and other data that was available at that time including the effect of vasodilators and vasoconstrictors on headaches.
The neurovascular approach towards primary headaches is currently accepted by most specialists. According to this newer theory, migraines are triggered by a complex series of neural and vascular events. Different studies concluded that individuals who suffer from migraines but not from headache have a state of neuronal hyperexcitability in the cerebral cortex, especially in the occipital cortex.[13] People who are more susceptible to experience migraines without headache 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.[14]
The American College of Emergency Physicians have guidelines on the evaluation and management of adult patients who have a nontraumatic headache of acute onset.[11]
While, statistically, headaches are most likely to be primary (non serious and self-limiting), some specific secondary headache syndromes may demand specific treatment or may be warning signals of more serious disorders.[citation needed] Differentiating between primary and secondary headaches can be difficult.
As it is often difficult for patients to recall the precise details regarding each headache, it is often useful for the sufferer to fill-out a "headache diary" detailing the characteristics of the headache.
When the headache does not clearly fit into one of the recognized primary headache syndromes or when atypical symptoms or signs are present then further investigations are justified.[15] Neuroimaging (noncontrast head CT) is recommended if there are new neurological problems such as decreased level of consciousness, one sided weakness, pupil size difference, etc. or if the pain is of sudden onset and severe, or if the person is known HIV positive.[11] People over the age of 50 years may also warrant a CT scan.[11]
In recurrent unexplained headaches keeping a "headache diary" with entries on type of headache, associated symptoms, precipitating and aggravating factors may be helpful. This may reveal specific patterns, such as an association with medication, menstruation or absenteeism or with certain foods. It was reported in March 2007 by two separate teams of researchers that stimulating the brain with implanted electrodes appears to help ease the pain of cluster headaches.[16]
Acupuncture has been found to be beneficial in chronic headaches[17] of both tension type[18] and migraine type.[19] Research comparing acupuncture to 'sham' acupuncture has shown that the results of acupuncture may be due to the placebo effect.[19]
One type of treatment, however, is usually not sufficient for chronic sufferers and they may have to find a variety of different ways of managing, living with, and seeking treatment of chronic daily headache pains.[20]
There are however two types of treatment for chronic headaches meaning acute abortive treatment and preventive treatment. Whereas the first is aimed to relieve the symptoms immediately, the latter is focused on controlling the headaches that are chronic. From this reason, the acute treatment is commonly and effectively used in treating migraines and the preventive treatment is the usual approach in managing chronic headaches. The primary goal of preventive treatment is to reduce the frequency, severity, and duration of headaches. This type of treatment involves taking medication on a daily basis for at least 3 months and in some cases, for over 6 months.[21] The medication used in preventive treatment is normally chosen based on the other conditions that the patient is suffering from. Generally, medication in preventive treatment starts at the minimum dosage which increases gradually until the pain is relieved and the goal achieved or until side effects appear.
To date, only amitriptyline, fluoxetine, gabapentin, tizanidine, topiramate, and botulinum toxin type A (BoNTA) have been evaluated as "prophylactic treatment of chronic daily headache in randomized, double-blind, placebo-controlled or active comparator-controlled trials. Antiepileptics can be used as preventative treatment of chronic daily headache and includes Valproate.[21]
Psychological treatments are usually considered in comorbid patients or in those who are unresponsive to the medication.
During a given year, 90% of people suffer from headaches. Of the ones seen in the ER, about 1% have a serious underlying problem.[22]
Primary headaches account for more than 90% of all headache complaints, and of these, episodic tension-type headache is the most common.[23]
It is estimated that women are three times more prone than men to suffer from migraines. Also, the prevalence of this particular type of headache seems to vary depending on the specific area of the world where one lives. However, migraines appear to be experienced by 12% to 18% of the population.[23]
Cluster headaches are thought to affect less than 0.5% of the population, though their prevalence is hard to estimate because they are often mistaken for a sinusal problem. However, according to the existent data, cluster headaches are more likely to occur in men than women, given that the condition tends to affect 5 to 8 times more men.
The first recorded 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.[9]
Children can suffer from the same types of headaches as adults do although their symptoms may vary. Some kinds of headaches include tension headaches, migraines, chronic daily headaches, cluster headache and sinuses headaches.[24] Dental braces and orthodontic headgear (due to the constant pressure placed on the jaw area) are also known for causing occasional to frequent headaches in adolescents. It is actually common for headaches to start in childhood or adolescence, for instance, 20% of adults who suffer headaches report that their headaches started before age 10 while 50% report they started before age 20. The incidence of headaches in children and adolescents is very common. One study reported that 56% of boys and 74% of girls between 12 and 17 indicated having experienced a form of headache within the past month.[25]
The causes of headaches in children include either one factor or a combination of factors. Some of the most common factors include genetic predisposition, especially in the case of migraine; head trauma, produced by accidental falls; illness and infection, for example in the presence of ear or sinus infection as well as colds and flu; environmental factors, which include weather changes; emotional factors, such as stress, anxiety, and depression; foods and beverages, caffeine or food additives; change in sleep or routine pattern; loud noises. Also, excess physical activity or sun may be a trigger specifically of migraine.[26]
Although most cases of headaches in children are considered to be benign, when they are accompanied with other symptoms such as speech problems, muscle weakness, and loss of vision, a more serious underlying cause may be suspected: 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.[27]
Some measures can help prevent headaches in children. Some of them are 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.[28]
This entry is from Wikipedia, the leading user-contributed encyclopedia. It may not have been reviewed by professional editors (see full disclaimer)
Nederlands (Dutch)
hoofdpijn, probleem
Français (French)
n. - mal de tête, migraine, (fig) ennuis, (fig) problème
Deutsch (German)
n. - Kopfschmerz, Problem
Ελληνική (Greek)
n. - κεφαλόπονος, πονοκέφαλος, (μτφ.) μπελάς, σκοτούρα
Italiano (Italian)
mal di testa
Português (Portuguese)
n. - dor (f) de cabeça
Русский (Russian)
головная боль
Español (Spanish)
n. - dolor de cabeza
Svenska (Swedish)
n. - huvudvärk, huvudbry
中文(简体)(Chinese (Simplified))
头痛, 令人头痛之事
中文(繁體)(Chinese (Traditional))
n. - 頭痛, 令人頭痛之事
한국어 (Korean)
n. - 두통, 골칫거리, 걱정거리
idioms:
العربيه (Arabic)
(الاسم) صداع, مشكله, ورطه, مأزق
If you are unable to view some languages clearly, click here.