Headache
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Editor-In-Chief: 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
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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
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Headache Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Headache On the Web |
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American Roentgen Ray Society Images of 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[1][2]
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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Headache Classifications
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Headache On the Web |
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American Roentgen Ray Society Images of Headache |
Editor-In-Chief: Robert G. Schwartz, M.D. [7], Piedmont Physical Medicine and Rehabilitation, P.A.; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [8]
Overview
Headache may be classified according to international headache society(IHS) into two groups: primary and secondary.Based on the duration of symptoms, headache may be classified as either acute or chronic.There are five types of headache: vascular, myogenic (muscle tension), cervicogenic, traction, and inflammatory.
Classification
There are five types of headache: vascular, myogenic (muscle tension), cervicogenic, traction, and inflammatory.
Classification Based on Pathophysiology
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. Barre-Lieou is an excellent example [9]. 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 high blood pressure (rare).[1][2]
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. Myofascial pain [10] is a common cause of muscular headache.
Cervicogenic
Cervicogenic headaches originate from disorders of the neck Neck pain 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.
Classification Based on Origin
There are two kinds of headache: primary headaches and second headaches.[2][1]
Primary Headaches
Primary headaches refer to headaches not associating with any stuctural problem in the head or neck, including migraine, tension, and cluster headaches, and a variety of other less common types of headache.[2]
Secondary Headaches
Secondary headaches are those that are due to an underlying stuctural problem in the head or neck, such as brain tumor, stroke, or brain infection.[2]
Specific Types of Headaches
- Tension headache
- Migraine,[11]
- 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.
References
- ↑ 1.0 1.1 May A (2018). "Hints on Diagnosing and Treating Headache". Dtsch Arztebl Int. 115 (17): 299–308. doi:10.3238/arztebl.2018.0299. PMC 5974268. PMID 29789115.
- ↑ 2.0 2.1 2.2 2.3 Hainer BL, Matheson EM (2013). "Approach to acute headache in adults". Am Fam Physician. 87 (10): 682–7. PMID 23939446.
Headache Pathophysiology
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Headache Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Headache On the Web |
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American Roentgen Ray Society Images of Headache |
Editor-In-Chief: Robert G. Schwartz, M.D. [12], Piedmont Physical Medicine and Rehabilitation, P.A.; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [13]
Overview
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.
Pathophysiology
Physiology
- The normal pathophysiology of cluster can be understood as follows:
- vascular dilation,trigeminal nerve stimulation and histamine release.[1]
Pathogenesis
- The exact pathophysiology of cluster headache is not completely understood.
- It is understood that cluster headache is caused by either vascular dilation,trigeminal nerve stimulation and histamine release.[1]
- Previously thought cluster headache was a type of vascular headache, but current proof implies that pathophysiology of cluster headache includes the brain, trigeminovascular and cranial parasympathetic system.[2]
- One of the theories of migraine pain in patients without aura is extracranial arterial dilatation.[3]
Genetics
Genes involved in the pathogenesis of migraine include:
- MTDH
- LRP1
- TRPM8
The development of familial hemiplegic migraine is the result of multiple genetic mutations such as:
- CACNA1A
- ATP1A2
- SCN1A[4]
References
- ↑ 1.0 1.1 Weaver-Agostoni J (2013). "Cluster headache". Am Fam Physician. 88 (2): 122–8. PMID 23939643.
- ↑ May A, Schwedt TJ, Magis D, Pozo-Rosich P, Evers S, Wang SJ (2018). "Cluster headache". Nat Rev Dis Primers. 4: 18006. doi:10.1038/nrdp.2018.6. PMID 29493566.
- ↑ Amin FM, Asghar MS, Hougaard A, Hansen AE, Larsen VA, de Koning PJ; et al. (2013). "Magnetic resonance angiography of intracranial and extracranial arteries in patients with spontaneous migraine without aura: a cross-sectional study". Lancet Neurol. 12 (5): 454–61. doi:10.1016/S1474-4422(13)70067-X. PMID 23578775.
- ↑ Andreou AP, Edvinsson L (2019). "Mechanisms of migraine as a chronic evolutive condition". J Headache Pain. 20 (1): 117. doi:10.1186/s10194-019-1066-0. PMC 6929435 Check
|pmc=value (help). PMID 31870279.