Headache

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Editors-In-Chief: C. Michael Gibson, M.S., M.D., Robert G. Schwartz, M.D. [1], Piedmont Physical Medicine and Rehabilitation, P.A.; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Overview

Headache Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Headache from other Diseases
Epidemiology and Demographics
Risk Factors
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
CT
MRI
Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Headache On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Headache All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Headache
CDC on Headache
Headache in the news
Blogs on Headache
Directions to Hospitals Treating Headache
Risk calculators and risk factors for Headache

Editor-In-Chief: Robert G. Schwartz, M.D. [3], Piedmont Physical Medicine and Rehabilitation, P.A.; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [4]

Overview

A headache 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.

Historical Perspective

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.

Pathophysiology

The brain in itself is not sensitive to pain, 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.

Causes

The vast majority of headaches are benign and self-limiting. Common causes are tension, Neck pain, migraine, eye strain, dehydration, low blood sugar, and sinusitis. The vast majority of chronic headaches are multifactoral in nature. Much rarer are headaches due to life-threatening conditions such asmeningitis, encephalitis, cerebral aneurysms, extremely high blood pressure, 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 menstrual years. This can occur prior to, during or even midcycle menstruation.

Natural History, Complications and Prognosis

The prognosis of headache depends on the underlying cause.

Diagnosis

Laboratory Findings

Blood tests may help narrow down the differential diagnosis, but are rarely confirmatory of specific headache forms.

CT

Computed tomography (CT/CAT) scans of the brain or sinuses are commonly performed.

MRI

Magnetic resonance imaging (MRI) of the brain and sinuses are done in specific settings.

Treatment

Medical Therapy

Headaches may be successfully treated through medical therapies such as analgesisa and, in some cases, a tandem approach with implanted electrodes.

Primary Prevention

Some forms of headache, such as migraine, may be amenable to preventative treatment.

References

Causes

Headache Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Headache from other Diseases
Epidemiology and Demographics
Risk Factors
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
CT
MRI
Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Headache On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Headache All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Headache
CDC on Headache
Headache in the news
Blogs on Headache
Directions to Hospitals Treating Headache
Risk calculators and risk factors for Headache

Editor-In-Chief: Robert G. Schwartz, M.D. [5], Piedmont Physical Medicine and Rehabilitation, P.A.; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [6]

Overview

The vast majority of headaches are benign and self-limiting. Common causes are tension,Neck pain, migraine, eye strain, dehydration, low blood sugar, and sinusitis. Much rarer are headaches due to life-threatening conditions such as meningitis, encephalitis, cerebral aneurysms, extremely high blood pressure, 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 menstrual years. This can occur prior to, during or even midcycle menstruation.

Causes

Common Causes

• Tension headache
• Neck pain
• Migraine
• Eye strain
• Dehydration
• Low blood sugar
• Sinusitis.

Causes by Organ System

Cardiac	Hypotension, Hypertension, Malignant hypertension,
Chemical / Poisoning	Amnesic shellfish poisoning, Anadenanthera peregrina, Antimony, Arsenic poisoning, Artemisia afra, Carbon monoxide, Copper, Cyanide, Heavy metal ingestion, Hemlock, Hydrogen sulfide, Lead poisoning, Manganese, Marine toxins, Monocrotophos, Nicotine poisoning, Radiation poisoning, Soil contamination, Thallium, Toxic headache, Water intoxication,
Dermatologic	Linear immunoglobulin A dermatosis,
Drug Side Effect	Acamprosate, Acetaminophen, Acyclovir, Agalsidase beta, Alatrofloxacin Injection, Albendazole, Alogliptin, Alosetron, Amantadine, Ambrisentan, Aminophylline, Amiodarone, Amlodipine, Amobarbital sodium, Amoxicillin, Amphotericin B, Anagrelide, Apremilast, Aprepitant, Armodafinil, Articaine, Atorvastatin, Atropine, bedaquiline fumarate, Benazepril, Benzphetamine, Bepotastine Besilate, Bepridil, Besifloxacin, Bexarotene, Bisoprolol, Blinatumomab, Bosentan, Botulinum toxin, Bromocriptine, Busulfan, Butabarbital, Butorphanol, Cabergoline, Caffeine, Candesartan, Capecitabine, Carbamazepine, Carbidopa and Levodopa, Carbimazole, Carisoprodol, Carmustine, Carteolol, Carvedilol, Caspofungin, Cetrorelix, Cilansetron, Cilostazol, Cimetidine, Clomethiazole, Combined oral contraceptive pill, Cortisone, Cycloserine, Cyclosporin, Cefaclor, Cefamandole Nafate Injection, Cefotetan, Cefdinir, Cetirizine hydrochloride, Cefoperazone Sodium Injection, Ceftibuten, Calcitriol, Chelation therapy, Chlorothiazide, Chlorthalidone, Clomifene, Cilostazol, Cimetidine, Clopidogrel, Clozapine, Coagulation factor IX, Conjugated estrogens, Cycloserine, Cyclosporine Injection, Dalfampridine, Deferasirox, Denileukin diftitox, Desmopressin, Dexamethasone, Dexamfetamine, Digoxin, dabrafenib mesylate, Didanosine, Diltiazem, Dimercaprol, Dinoprostone, Dipivefrine, Dipyridamole, Disopyramide, Docosanol, Dolasetron, Dofetilide, Doripenem, Drospirenone and Ethinyl estradiol, Doxazosin, Ecallantide, Eculizumab, Eliglustat, Emtricitabine, Rilpivirine Hydrochloride,Tenofovir Disoproxil Fumarate, Efavirenz, Emedastine Difumarate, Enalapril, Epinephrine (aerosol), Eslicarbazepine acetate, Estradiol valerate and estradiol valerate/dienogest, Ethynodiol diacetate and ethinyl estradiol, Elosulfase alfa, Epinephrine, Eplerenone, Epoprostenol, Eribulin, Ergotamine, Etanercept Injection, Ethacrynic Acid, Ethanol, Ethosuximide, Etidronic acid, Etidronate, Etodolac, Etonogestrel, Exemestane, Ezetimibe, Felbamate, Felodipine, Fenofibrate, Fenoldopam, Fesoterodine, Flavoxate . Florbetapir F-18 . Flutemetamol F 18, Flu vaccine, Flunisolide, Flurbiprofen, Fluorouracil, Fluoxetine, Fluvastatin, Epinephrine, Ethosuximide, Flucytosine, Fosinopril, Fulvestrant, Furosemide, Gadoterate, Ganciclovir, Ganirelix, Gemeprost, Glimepiride, Glipizide, Glucarpidase, Glyburide and Metformin, Glyceryl trinitrate, Granisetron, Griseofulvin, Gyromitrin, Histrelin, Hydrocortisone, Hydroxocobalamin, Hydroxyzine, Ibuprofen, Idursulfase, Imiglucerase, Imiquimod, Indinavir, Indomethacin, Insulin lispro, Influenza vaccine, Imatinib mesylate, Interferon beta- 1b, Interferon gamma, Interleukin 2, Isoproterenol (aerosol), Isotretinoin, Isosorbide dinitrate, Isosorbide mononitrate, Ivacaftor, Ketorolac tromethamine, Lacosamide, lamivudine, Lansoprazole, Lerisetron, Lenvatinib, Levocabastine, Levofloxacin, Levonorgestrel, Levosimendan, Lisinopril and Hydrochlorothiazide, Lofepramine, Lomotil, Loratadine, Lorcaserin, Lidocaine (cream), Lisuride, Lomefloxacin hydrochloride, Mebendazole, Medroxyprogesterone, Mefloquine Memantine Meropenem, Metaxalone, Metipranolol, Metformin, Methimazole, Metronidazole, Methacholine, Methotrexate, Methylphenidate, Methyprylon, Micafungin sodium, Mifepristone, Milnacipran hydrochloride, Mirabegron, Misoprostol, Modafinil• Monosodium glutamate, Moricizine, Nafarelin, Naproxen sodium, Natalizumab, Niacin/simvastatin, Nicorandil, Nifedipine, Nitrendipine, Nitroglycerine, Nizatidine, Non-steroidal anti-inflammatory drugs, Norethindrone acetate and Ethinyl estradiol, Norgestimate and Ethinyl estradiol, Norgestrel and Ethinyl estradiol, Ofloxacin, Olaparib, Olsalazine, Oprelvekin, Oxtriphylline, Oxytocin injection, Omalizumab, Ondansetron, Oritavancin, Palonosetron, Pasireotide,, pazopanib hydrochloride, permethrin, Pantoprazole, Paroxetine, Pegylated interferon alfa-2a, Pemirolast, Pergolide, Pirfenidone, Pimecrolimus, Piribedil, Pirbuterol, Piroxicam, Plerixafor, Praziquantel, Progesterone , Prednisone, Propylthiouracil, Potassium iodide, Pyrantel pamoate, Quazepam* Quinidine, Quinine, Rabeprazole, Rasagiline, Rasburicase, Reproterol, Ribavirin, Rimexolone, Roflumilast, Ropinirole, roflumilast, Romiplostim, Ruxolitinib, Salbutamol, Saxagliptin, Saxagliptin hydrochloride and Metformin hydrochloride, Selective serotonin reuptake inhibitor, Sildenafil, Siltuximab, Sipuleucel-T, Sodium nitrite, Sulprostone, Sumatriptan, Spironolactone, Stavudine, Sunitinib, Tacrolimus, Tamsulosin, Tadalafil, tedizolid* Temozolomide, Teniposide, Tigecycline, Tocilizumab, Trabectedin, Tretinoin, Trimeprazine, Trimethobenzamide, Tribavirin, Trimethadione, Triptorelin pamoate, Tropisetron, Trospium, Trovafloxacin mesylate, Tolbutamide, Valacyclovir, Vardenafil, Varenicline, Venlafaxine, Vitamin A, Von Willebrand factor• Voriconazole, Vytorin, Zafirlukast, Zaleplon, Zidovudine, Zileuton, Zomepirac, Zopiclone, vandetanib
Ear Nose Throat	Angina tonsillaris, Nasal polyp, Otitis externa, Otitis media, Pharyngitis, Rhinolith , Peritonsillar abscess, Strep throat, Sinusitis, Trochleitis, Tonsillitis, Upper respiratory tract infection,
Endocrine	Acromegaly, Addison's disease, Conn syndrome, Diabetes mellitus, Hypoglycemia, Hyperaldosteronism, Hyperparathyroidism, Hyperpituitarism, Insulinoma, Menopause, Multiple endocrine neoplasia type 1, Pituitary tumour (growth hormone secreting), Polycystic Ovarian Syndrome,
Environmental Conditions	Airsickness, Altitude sickness, Brain freeze, Diesel particulate matter, Heat stroke, Ice cream headache, Multiple chemical sensitivity, Second-hand smoke,
Gastroenterologic	Crohn's disease, Inflammatory Bowel Disease,
Genetic	No underlying causes,
Hematologic	Anemia, Blood transfusion, Leukemia, Multiple myeloma,
Infectious Disease	Acute Disseminated Encephalomyelitis, Acute viral nasopharyngitis (common cold), Adenoiditis, AIDS, Alkhurma virus, Anaplasmosis, Aseptic meningitis, Aspergillus clavatus, Astrovirus, Blastomycosis, Bolivian hemorrhagic fever, Byssinosis, Brucellosis, Bruxism, Boutonneuse fever, Campylobacteriosis, California encephalitis virus, Chagas disease, Chikungunya, Cladosporium, Cotton fever, Coxsackie B, Cryptococcosis, Cysticercosis, Dengue fever, Dental infection, Ebola, Encephalitis, Fever, Feverfew, Freshers' Flu, Giardia lamblia, Glioblastoma multiforme, Gradenigo's syndrome, Group A streptococcal infection, Haemophilus influenzae serotype B infection, Hangover, Hantavirus, Hay fever, Harvest mite, Henipavirus, Herpes zoster, Hepatitis, Herpesviridae, HIV, Japanese encephalitis[, Hymenolepis infection, Influenza, Intracranial abscess / granuloma, Lábrea fever, Legionellosis, Lenvatinib , Leptospirosis, Listeriosis, Lyme disease, Malaria, Marburg virus, Mansonelliasis, Meningococcemia, Meningoencephalitis, Metabolic acidosis, Metal fume fever, Mononucleosis, Micropolyspora faeni, Monkeypox virus, Mucormycosis, Mumps, Mycoplasma pneumoniae, Naegleria fowleri, Naegleria infection, Neisseria meningitidis, Nipah virus encephalitis, Nocardiosis, Norovirus, Oropouche fever, Pityriasis rosea, Psittacosis, Q fever, Ramsay Hunt syndromes, Rat-bite fever, Relapsing fever, Rhinovirus, Rickettsial infections, Rift valley fever, Ross River Fever, Rocky Mountain spotted fever, Rubella, Saccharopolyspora rectivirgula, Snakebite, Scarlet fever, Scrumpox, Shingles, Siraitia grosvenorii, Sitophilus granarius, Sodoku, St. Louis encephalitis, Staphylococcal enteritis, Streptobacillus, Syphilis, Thermoactinomyces sacchari, Thermoactinomyces vulgaris, Trench fever, Trichinosis, Tuberculous meningitis, Tularemia, Typhoid fever, Viral Gastroenteritis, Viral Hepatitis C, West Nile Virus, Yellow fever, Yersinia Pestis Infection, Zika fever,
Musculoskeletal / Ortho	Cervical spondylosis, Temporomandibular joint disorder,
Neurologic	Acoustic neuroma, Apoplexy, Arachnoid cyst, Arcuate foramen, Acute disseminated encephalomyelitis, Arnold nerve cough syndrome, Epilepsy, Idiopathic intracranial hypertension, Multiple sclerosis, Pituitary apoplexy, Posterior cervical sympathetic syndrome, Posterior leucoencephalopathy syndrome, Raised intracranial pressure, Spinal autonomic dysreflexia, West syndrome,
Nutritional / Metabolic	Thiamine (Vitamin B1) deficiency,
Obstetrics & Gynecology	Eclampsia, Pre-eclampsia, Pregnancy, Premenstrual syndrome,
Oncologic	Acoustic neuroma, Adrenal carcinoma, Adrenal tumor, Astrocytoma, Atypical Teratoid Rhabdoid Tumor, Brain tumor, Brain Stem Gliomas, Carcinoid tumours and carcinoid syndrome, Craniopharyngioma, Ependymoma, Gliomatosis cerebri, Medulloblastoma, Meningioma, Oligoastrocytoma, Phaeochromocytoma, Polycythaemia rubra vera, Subdural hygroma, Tongue cancer,
Opthalmologic	Acute posterior multifocal placoid pigment epitheliopathy, Aneisokonia, Asthenopia, Computer vision syndrome, Ocular Neurosis, Oculogyric crisis, Progressive lenses,
Overdose / Toxicity	Acute alcohol intoxication, Alcohol withdrawal, Alcoholism, Medication overuse,
Psychiatric	Anxiety disorder, Functional disorders, Primary affective disorder, Chronic stress, Clinical depression, Workplace stress, Gulf War syndrome,
Pulmonary	Acute bronchitis, Bird breeder's lung, Bird fancier's lung, Cheese worker's lung, Chemical worker's lung, Cough, Community-acquired pneumonia, Grain handler's lung, Hot tub lung, Humidifier lung, Hypersensitivity pneumonitis, Lower respiratory tract infection, Malt worker's lung, Nylon worker's lung, Obesity hypoventilation syndrome, Paprika splitter's lung,
Renal / Electrolyte	Diabetic nephropathy, Hypercalcemia, Hyponatremia,
Rheum / Auto Immune / Allergy	Antiphospholipid syndrome, Polymyalgia rheumatica, Systemic lupus erythematosus, Takayasu arteritis, Temporal arteritis, Wegener's granulomatosis,
Trauma	Cervical spine trauma, Dental trauma,
Vascular Diseases & Malformations	Arteriovenous malformation, Berry aneurysm, Carotid artery dissection, Cavernous angioma, Cavernous Sinus Thrombosis, Cerebral venous sinus thrombosis, Cerebellar infarction, Cerebral aneurysm, Cerebral arteriovenous malformation, Cerebrovascular accident, Cerebrovascular disease, Epidural hematoma, Intracranial haemorrhage, Migraine, Posterior communicating artery aneurysm, Subarachnoid haemorrhage, Superior vena cava syndrome, Vascular headache, Vertebral artery dissection, Vertebro-basilar artery syndrome,
Miscellaneous	Agastache rugosa, Bearberry, Cluster headache, Colloid cyst of third ventricle, Hepatic failure, Intracranial space-occupying lesion, Paroxysmal hemicrania, chronic, Parry-Romberg syndrome, Reversible posterior leukoencephalopathy syndrome, Spontaneous intracranial hypotension, Standing (position), Thunderclap headache,

Causes by alphabetical order

• Amoxicillin
• Aprepitant
• Busulfan
• Carmustine
• Ceftibuten
• Cimetidine
• Cycloserine
• Desmopressin
• Didanosine
• Doripenem
• Eculizumab
• Efavirenz
• Eribulin
• Etonogestrel
• Exemestane
• Flunisolide
• Flurbiprofen
• Pegylated interferon alfa-2a
• Histrelin
• Hydroxyzine
• Hydroxocobalamin
• Interferon gamma
• Ivacaftor
• Levonorgestrel
• Lomefloxacin hydrochloride
• Loratadine
• Mebendazole
• Micafungin sodium
• Mifepristone
• Milnacipran hydrochloride
• Multiple endocrine neoplasia type 1
• Natalizumab
• Oprelvekin
• Oritavancin
• Papaverine
• Pirfenidone
• Plerixafor
• Pyrantel pamoate
• Ribavirin
• Siltuximab
• Sipuleucel-T
• Stavudine
• Sunitinib
• Temozolomide
• Teniposide
• Tigecycline
• triptorelin pamoate
• Trovafloxacin mesylate
• Von Willebrand factor
• Voriconazole

References

Diagnosis

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Treatment

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