Headache

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{{SignSymptom infobox | Name = Headache | ICD10 = {{ICD10|R|51||r|50--> | ICD9 = {{ICD9|784.0--> | -->A headache (cephalgia in medical terminology) is a condition of pain in the head; sometimes neck or upper back pain may also be interpreted as a headache. It ranks amongst the most common local pain complaints.

The vast majority of headaches are benign and self-limiting. Common causes are tension headache, migraine, eye strain, dehydration, low blood sugar, and sinusitis. Much rarer are headaches due to life-threatening conditions such as meningitis, encephalitis, cerebral aneurysms, hypertensive emergency, and brain tumors. When the headache occurs in conjunction with a head injury the cause is usually quite evident. A large percentage of headaches among females are caused by ever-fluctuating estrogen during menstruation years. This can occur prior to, during or even midcycle menstruation.

Treatment of uncomplicated headache is usually symptomatic with Over-the-counter drug analgesic such as aspirin, paracetamol (acetaminophen), or ibuprofen, although some specific forms of headaches (e.g., migraines) may demand other, more suitable treatment. It may be possible to relate the occurrence of a headache to other particular triggers (such as stress or particular foods), which can then be avoided.

Pathophysiology The brain in itself is not sensitive to Pain and nociception, because it lacks pain-sensitive nerve fibers. Several areas of the head can hurt, including a network of nerves which extend over the scalp and certain nerves in the face, mouth, and throat. The meninges and the blood vessels do have pain perception. Headaches often result from traction to or irritation of the meninges and blood vessels. The muscles of the head may similarly be sensitive to pain.

Types There are five types of headache: vascular, myogenic (muscle tension), cervicogenic, traction, and inflammatory.

Vascular The most common type of vascular headache is migraine. Migraine headaches are usually characterized by severe pain on one or both sides of the head, an upset stomach, and, for some people, disturbed vision. It is more common in women. While vascular changes are evident during a migraine, the cause of the headache is neurologic, not vascular. After migraine, the most common type of vascular headache is the Toxic headache produced by fever.

Other kinds of vascular headaches include cluster headaches, which cause repeated episodes of intense pain, and headaches resulting from hypertension (rare).

Muscular/myogenic Muscular (or myogenic) headaches appear to involve the tightening or tensing of facial and neck muscles; they may radiate to the forehead. Tension headache is the most common form of myogenic headache.

Cervicogenic Cervicogenic headaches originate from disorders of the neck, including the anatomical structures innervated by the cervical roots C1–C3. Cervical headache is often precipitated by neck movement and/or sustained awkward head positioning. It is often accompanied by restricted cervical range of motion, ipsilateral neck, shoulder, or arm pain of a rather vague non-radicular nature or, occasionally, arm pain of a radicular nature.

Traction/inflammatory Traction and inflammatory headaches are symptoms of other disorders, ranging from stroke to sinus infection.

Specific types of headaches include:

Tension headache
Migraine
Idiopathic intracranial hypertension (headache with visual symptoms due to raised intracranial pressure)
Ictal headache
"Brain freeze" (also known as: ice cream headache)
Thunderclap headache
Vascular headache
Toxic headache
Coital cephalalgia (also known as: sex headache)
Hemicrania continua
Rebound headache (also called medication overuse headache, abbreviated MOH)
Red wine headache
"Spinal headache" (or: post-dural puncture headaches) after lumbar puncture or related procedure that will lower the intracranial pressure
Hangover (caused by heavy alcohol consumption)

A headache may also be a symptom of sinusitis.

Like other types of pain, headaches can serve as warning signals of more serious disorders. This is particularly true for headaches caused by inflammation, including those related to meningitis as well as those resulting from diseases of the sinuses, spine, neck, ears, and teeth.

Diagnosis While, statistically, headaches are most likely to be harmless and self-limiting, some specific headache syndromes may demand specific treatment or may be warning signals of more serious disorders. Some headache subtypes are characterized by a specific pattern of symptoms, and no further testing may be necessary, while others may prompt further diagnostic tests.

Headache associated with specific symptoms may warrant urgent medical attention, particularly sudden, severe headache or sudden headache associated with a neck stiffness; headaches associated with fever, convulsions or accompanied by confusion or loss of consciousness; headaches following a blow to the head, or associated with pain in the eye or ear; persistent headache in a person with no previous history of headaches; and recurring headache in children.

The most important step in diagnosing a headache is for the physician to take a careful history and to examine the patient. In the majority of cases the diagnosis will be tension headache or migraine, both of which can be managed on the basis of a clear-cut clinical picture. Where doubt remains, or if there are abnormalities detected on examination, further investigations are justified.Detsky ME, McDonald DR, Baerlocher MO, Tomlinson GA, McCrory DC, Booth CM. Does this patient with headache have a migraine or need neuroimaging? JAMA 2006;296:1274-83 Computed tomography (CT/CAT) scans of the brain or sinuses are commonly performed, or magnetic resonance imaging (MRI) in specific settings. Blood tests may help narrow down the differential diagnosis, but are rarely confirmatory of specific headache forms.

Treatment Not all headaches require medical attention, and respond with simple analgesia (painkillers) such as paracetamol/acetaminophen or members of the Non-steroidal anti-inflammatory drug class (such as aspirin/acetylsalicylic acid or ibuprofen).

In recurrent unexplained headaches, healthcare professionals may recommend keeping a "headache diary" with entries on type of headache, associated symptoms, precipitating and aggravating factors. 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. Brain Stimulation May Ease Headaches. Reuters, March 9, 2007.

Prevention Some forms of headache, such as migraine, may be amenable to preventative treatment. On the whole, long-term use of painkillers is discouraged as this may lead to "rebound headaches" on withdrawal. Caffeine, a vasoconstrictor, is sometimes prescribed or recommended as a remedy or supplement to pain killers in the case of extreme migraine. This has led to the development of paracetamol/caffeine analgesic. One popular herbal preventive treatment for migraines is Feverfew. Magnesium, Vitamin B2, and Coenzyme Q10 are "natural" supplements that have shown some efficacy for migraine prevention(5).Mauskop A. Alternative therapies in headache: Is there a role? Med Clin North Am 2001;85(4):1077-1084. PMID 11480259.

Manipulative therapy A controversial approach to headache treatment is chiropractic care. Most research supporting the chiropractic adjustment (also known as spinal manipulation by the scientific community) has been self-funded by the chiropractic profession.

The most compelling study of chiropractic efficacy is Nelson's randomized trial, comparing chiropractic to medical care, "The Efficacy of Spinal Manipulation, Amitriptyline and the Combination of Both Therapies for the Prophylaxis of Migraine Headache." J Manipulative Physiol Ther 1998; 21 (8) Oct: 511–519. which included the drug amitriptyline, for the treatment of Migraine Headache. During the 4-week trial, both groups reduced in symptoms. After withdrawal of treatment, the medical group relapsed or got worse, whereas the group receiving chiropractic care maintained their improvements. The amitriptyline is more cost-effective as it is cheaper than the cost of visiting a doctor, but freedom from symptoms or a reduction in frequency only happened in the chiropractic group.

Independent (non-chiropractic) researchers reviewed research on many different types of behavioral and physical treatments for tension-type and cervicogenic headaches "Evidence Report: Behavioral and Physical Treatments for Tension-type and Cervicogenic Headache." Duke University Evidence-based Practice Center, Center for Clinical Health Policy Research. and found that cervical spinal manipulation was associated with improvement in cervicogenic headache outcomes (but not for tension-type headache), and was superior to soft-tissue therapies like massage.

References

External links

National Headache Foundation
IHS - The International Headache Classification (ICHD-2)

Headaches
Headaches involve mild to severe pain in one or more parts of the head as well as the back of the neck. There are many different types of headache patterns and a variety of causes.

Headache
We at the American Headache Society and Wiley-Blackwell Publishing are pleased to offer a website that should serve both to give you a taste of the Society's flagship journal, ...

Headache Introduction - Health encyclopaedia - NHS Direct
Tension-type and cluster headaches ... A tension-type headache is the most common type of primary headache. Many people have 1 or 2 headaches of this type every month.

Headache
Headache NHS Direct Online Health Encyclopaedia Headache Introduction There are two main types of headache: primary and secondary: Primary headaches include tension headaches ...

Brain & Spine Foundation - Headache
Headache is one of the commonest symptoms experienced by human beings - indeed it is unusual not to have at least occasional headaches. Find out more about the causes, prevention ...

Headache types-migraine sinusitis chronic tmj trigeminal neuralgia ...
Take the headaches test for all headache types. Ocular migraine, trigeminal neuralgia, tmj symptoms, sinusitis, chronic head pain, tension, cluster, sinus, icepick, post herpetic ...

Headaches - TheSite.org
Why do headaches occur, what are the different types of heaches, how can they be treated and when its time to consult your GP through information, advice and support on TheSite.org

Headache - Wikipedia, the free encyclopedia
A headache (cephalalgia in medical terminology) is a condition of pain in the head; sometimes neck or upper back pain may also be interpreted as a headache.

The National Headache Foundation
Information on headache causes and treatments, a support group list, a state list of NHF physician members (on request) and a quarterly newsletter.

Headache UK
an alliance working for people with headache ... To achieve recognition of chronic headaches as a major public health problem