7/27/2019 HEADACHE.docx

1/5

HEADACHE

A headache or cephalalgia ispain anywhere in the region of thehead orneck.It can be

asymptom of a number of different conditions of the head and neck.[1]

Thebrain tissueitself is

not sensitive to pain because it lackspain 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 (theperiosteum of the

skull),muscles,nerves,arteries andveins,subcutaneous tissues,eyes,ears,sinusesandmucous

membranes.

There are a number of different classification systems for headaches. The most well-recognized

is that of theInternational Headache Society.Headache is anon-specific symptom,which means

that it has many possible causes. Treatment of a headache depends on the underlyingetiology or

cause, but commonly involvesanalgesics

Headaches are most thoroughly classified by theInternational Headache Society's InternationalClassification of Headache Disorders (ICHD), which published the second edition in

2004.[2]

This classification is accepted by theWHO.[3]

Other classification systems exist. One of the first published attempts was in

1951.[4]

TheNational Institutes of Health developed a classification system in 1962.[5]

ICHD-2[edit]

Main article:International Classification of Headache Disorders

TheInternational Classification of Headache Disorders (ICHD) is an in-

depthhierarchical classification of headaches published by theInternational Headache Society.It

contains explicit (operational)diagnostic criteria for headache disorders. The first version of theclassification, 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,cranialneuralgia,central and primary facial pain and other headaches for the last two

groups.[7]

The ICHD-2 classification definesmigraines,tension-types headaches, cluster headache and

othertrigeminal autonomic cephalalgias as the main types of primary headaches.[8]

Also,

according to the same classification, stabbing headaches and headaches due tocough,exertion

and sexual activity (coital cephalalgia)are classified as primary headaches. The daily-persistentheadaches 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

theirsymptoms.[8]

According to the ICHD-2 classification, the main types of secondary

headaches include those that are due to head or neck trauma such aswhiplash injury,intracranial

hematoma,post craniotomy or other head or neck injury. Headaches caused by cranial or

http://en.wikipedia.org/wiki/Painhttp://en.wikipedia.org/wiki/Headhttp://en.wikipedia.org/wiki/Neckhttp://en.wikipedia.org/wiki/Symptomhttp://en.wikipedia.org/wiki/Headache#cite_note-1http://en.wikipedia.org/wiki/Headache#cite_note-1http://en.wikipedia.org/wiki/Headache#cite_note-1http://en.wikipedia.org/wiki/Brain_tissuehttp://en.wikipedia.org/wiki/Nociceptorshttp://en.wikipedia.org/wiki/Pericraniumhttp://en.wikipedia.org/wiki/Pericraniumhttp://en.wikipedia.org/wiki/Muscleshttp://en.wikipedia.org/wiki/Nerveshttp://en.wikipedia.org/wiki/Arterieshttp://en.wikipedia.org/wiki/Veinshttp://en.wikipedia.org/wiki/Subcutaneous_tissuehttp://en.wikipedia.org/wiki/Human_eyeshttp://en.wikipedia.org/wiki/Earshttp://en.wikipedia.org/wiki/Sinuseshttp://en.wikipedia.org/wiki/Mucous_membraneshttp://en.wikipedia.org/wiki/Mucous_membraneshttp://en.wikipedia.org/wiki/International_Headache_Societyhttp://en.wikipedia.org/wiki/Non-specific_symptomhttp://en.wikipedia.org/wiki/Etiologyhttp://en.wikipedia.org/wiki/Analgesicshttp://en.wikipedia.org/wiki/International_Headache_Societyhttp://en.wikipedia.org/wiki/Headache#cite_note-ICHD2-2http://en.wikipedia.org/wiki/Headache#cite_note-ICHD2-2http://en.wikipedia.org/wiki/Headache#cite_note-ICHD2-2http://en.wikipedia.org/wiki/WHOhttp://en.wikipedia.org/wiki/Headache#cite_note-3http://en.wikipedia.org/wiki/Headache#cite_note-3http://en.wikipedia.org/wiki/Headache#cite_note-3http://en.wikipedia.org/wiki/Headache#cite_note-4http://en.wikipedia.org/wiki/Headache#cite_note-4http://en.wikipedia.org/wiki/Headache#cite_note-4http://en.wikipedia.org/wiki/National_Institutes_of_Healthhttp://en.wikipedia.org/wiki/Headache#cite_note-5http://en.wikipedia.org/wiki/Headache#cite_note-5http://en.wikipedia.org/wiki/Headache#cite_note-5http://en.wikipedia.org/w/index.php?title=Headache&action=edit&section=2http://en.wikipedia.org/wiki/International_Classification_of_Headache_Disordershttp://en.wikipedia.org/wiki/International_Classification_of_Headache_Disordershttp://en.wikipedia.org/wiki/Hierarchicalhttp://en.wikipedia.org/wiki/International_Headache_Societyhttp://en.wikipedia.org/wiki/Diagnostic_criteriahttp://en.wikipedia.org/wiki/Headache#cite_note-6http://en.wikipedia.org/wiki/Headache#cite_note-6http://en.wikipedia.org/wiki/Headache#cite_note-6http://en.wikipedia.org/wiki/Human_craniumhttp://en.wikipedia.org/wiki/Neuralgiahttp://en.wikipedia.org/wiki/Headache#cite_note-7http://en.wikipedia.org/wiki/Headache#cite_note-7http://en.wikipedia.org/wiki/Headache#cite_note-7http://en.wikipedia.org/wiki/Migrainehttp://en.wikipedia.org/wiki/Trigeminalhttp://en.wikipedia.org/wiki/Headache#cite_note-A-8http://en.wikipedia.org/wiki/Headache#cite_note-A-8http://en.wikipedia.org/wiki/Headache#cite_note-A-8http://en.wikipedia.org/wiki/Coughhttp://en.wikipedia.org/wiki/Coital_cephalalgiahttp://en.wikipedia.org/wiki/Symptomshttp://en.wikipedia.org/wiki/Headache#cite_note-A-8http://en.wikipedia.org/wiki/Headache#cite_note-A-8http://en.wikipedia.org/wiki/Headache#cite_note-A-8http://en.wikipedia.org/wiki/Whiplash_(medicine)http://en.wikipedia.org/wiki/Intracranial_hematomahttp://en.wikipedia.org/wiki/Intracranial_hematomahttp://en.wikipedia.org/wiki/Intracranial_hematomahttp://en.wikipedia.org/wiki/Intracranial_hematomahttp://en.wikipedia.org/wiki/Whiplash_(medicine)http://en.wikipedia.org/wiki/Headache#cite_note-A-8http://en.wikipedia.org/wiki/Symptomshttp://en.wikipedia.org/wiki/Coital_cephalalgiahttp://en.wikipedia.org/wiki/Coughhttp://en.wikipedia.org/wiki/Headache#cite_note-A-8http://en.wikipedia.org/wiki/Trigeminalhttp://en.wikipedia.org/wiki/Migrainehttp://en.wikipedia.org/wiki/Headache#cite_note-7http://en.wikipedia.org/wiki/Neuralgiahttp://en.wikipedia.org/wiki/Human_craniumhttp://en.wikipedia.org/wiki/Headache#cite_note-6http://en.wikipedia.org/wiki/Diagnostic_criteriahttp://en.wikipedia.org/wiki/International_Headache_Societyhttp://en.wikipedia.org/wiki/Hierarchicalhttp://en.wikipedia.org/wiki/International_Classification_of_Headache_Disordershttp://en.wikipedia.org/wiki/International_Classification_of_Headache_Disordershttp://en.wikipedia.org/w/index.php?title=Headache&action=edit&section=2http://en.wikipedia.org/wiki/Headache#cite_note-5http://en.wikipedia.org/wiki/National_Institutes_of_Healthhttp://en.wikipedia.org/wiki/Headache#cite_note-4http://en.wikipedia.org/wiki/Headache#cite_note-3http://en.wikipedia.org/wiki/WHOhttp://en.wikipedia.org/wiki/Headache#cite_note-ICHD2-2http://en.wikipedia.org/wiki/International_Headache_Societyhttp://en.wikipedia.org/wiki/Analgesicshttp://en.wikipedia.org/wiki/Etiologyhttp://en.wikipedia.org/wiki/Non-specific_symptomhttp://en.wikipedia.org/wiki/International_Headache_Societyhttp://en.wikipedia.org/wiki/Mucous_membraneshttp://en.wikipedia.org/wiki/Mucous_membraneshttp://en.wikipedia.org/wiki/Sinuseshttp://en.wikipedia.org/wiki/Earshttp://en.wikipedia.org/wiki/Human_eyeshttp://en.wikipedia.org/wiki/Subcutaneous_tissuehttp://en.wikipedia.org/wiki/Veinshttp://en.wikipedia.org/wiki/Arterieshttp://en.wikipedia.org/wiki/Nerveshttp://en.wikipedia.org/wiki/Muscleshttp://en.wikipedia.org/wiki/Pericraniumhttp://en.wikipedia.org/wiki/Pericraniumhttp://en.wikipedia.org/wiki/Nociceptorshttp://en.wikipedia.org/wiki/Brain_tissuehttp://en.wikipedia.org/wiki/Headache#cite_note-1http://en.wikipedia.org/wiki/Symptomhttp://en.wikipedia.org/wiki/Neckhttp://en.wikipedia.org/wiki/Headhttp://en.wikipedia.org/wiki/Pain

7/27/2019 HEADACHE.docx

2/5

cervical vascular disorders such asischemic stroke andtransient ischemic attack,non-traumatic

intracranial hemorrhage,vascular malformations orarteritis are also defined as secondary

headaches. This type of headaches may also be caused bycerebral 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 ofdisorders or diseases that are intracranial but that are not associated with the vasculature of

thecentral 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,

intracranialinfections 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 bydialysis,high blood

pressure,hypothyroidism,and cephalalgia and evenfasting 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 includingteeth,jaws, ortemporomandibular joint.Headaches

caused by psychiatric disorders such assomatization orpsychotic disorders are also classified as

secondary headaches.

The ICHD-2 classification puts cranial neuralgias and other types ofneuralgia 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]

NIH[edit]

Main article:NIH classification of headaches

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 headaches, and the causes range from harmless to life-threatening.

The description of the headache, together with findings onneurological examination,determines

the need for any further investigations and the most appropriate treatment.[10]

Primary headaches[edit]

The most common types of headache are the "primary headache disorders", such astension-type

headache andmigraine.They have typical features; migraine, for example, tends to be pulsating

http://en.wikipedia.org/wiki/Stroke#Ischemic_strokehttp://en.wikipedia.org/wiki/Transient_ischemic_attackhttp://en.wikipedia.org/wiki/Cerebral_arteriovenous_malformationhttp://en.wikipedia.org/wiki/Arteritishttp://en.wikipedia.org/wiki/Cerebral_venous_thrombosishttp://en.wikipedia.org/wiki/Epileptic_seizurehttp://en.wikipedia.org/wiki/Central_nervous_systemhttp://en.wikipedia.org/wiki/HIVhttp://en.wikipedia.org/wiki/AIDShttp://en.wikipedia.org/wiki/Infectionshttp://en.wikipedia.org/wiki/Dialysishttp://en.wikipedia.org/wiki/High_blood_pressurehttp://en.wikipedia.org/wiki/High_blood_pressurehttp://en.wikipedia.org/wiki/Hypothyroidismhttp://en.wikipedia.org/wiki/Fastinghttp://en.wikipedia.org/wiki/Teethhttp://en.wikipedia.org/wiki/Temporomandibular_jointhttp://en.wikipedia.org/wiki/Somatizationhttp://en.wikipedia.org/wiki/Psychotic_disordershttp://en.wikipedia.org/wiki/Neuralgiahttp://en.wikipedia.org/wiki/Headache#cite_note-A-8http://en.wikipedia.org/wiki/Headache#cite_note-A-8http://en.wikipedia.org/wiki/Headache#cite_note-A-8http://en.wikipedia.org/w/index.php?title=Headache&action=edit&section=3http://en.wikipedia.org/wiki/NIH_classification_of_headacheshttp://en.wikipedia.org/wiki/Headache#cite_note-Levine_et_al..2C_p_60-9http://en.wikipedia.org/wiki/Headache#cite_note-Levine_et_al..2C_p_60-9http://en.wikipedia.org/wiki/Headache#cite_note-Levine_et_al..2C_p_60-9http://en.wikipedia.org/wiki/Myogenichttp://en.wikipedia.org/wiki/Neurological_examinationhttp://en.wikipedia.org/wiki/Headache#cite_note-SIGN-10http://en.wikipedia.org/wiki/Headache#cite_note-SIGN-10http://en.wikipedia.org/wiki/Headache#cite_note-SIGN-10http://en.wikipedia.org/w/index.php?title=Headache&action=edit&section=5http://en.wikipedia.org/wiki/Tension_headachehttp://en.wikipedia.org/wiki/Tension_headachehttp://en.wikipedia.org/wiki/Migrainehttp://en.wikipedia.org/wiki/Migrainehttp://en.wikipedia.org/wiki/Tension_headachehttp://en.wikipedia.org/wiki/Tension_headachehttp://en.wikipedia.org/w/index.php?title=Headache&action=edit&section=5http://en.wikipedia.org/wiki/Headache#cite_note-SIGN-10http://en.wikipedia.org/wiki/Neurological_examinationhttp://en.wikipedia.org/wiki/Myogenichttp://en.wikipedia.org/wiki/Headache#cite_note-Levine_et_al..2C_p_60-9http://en.wikipedia.org/wiki/NIH_classification_of_headacheshttp://en.wikipedia.org/w/index.php?title=Headache&action=edit&section=3http://en.wikipedia.org/wiki/Headache#cite_note-A-8http://en.wikipedia.org/wiki/Neuralgiahttp://en.wikipedia.org/wiki/Psychotic_disordershttp://en.wikipedia.org/wiki/Somatizationhttp://en.wikipedia.org/wiki/Temporomandibular_jointhttp://en.wikipedia.org/wiki/Teethhttp://en.wikipedia.org/wiki/Fastinghttp://en.wikipedia.org/wiki/Hypothyroidismhttp://en.wikipedia.org/wiki/High_blood_pressurehttp://en.wikipedia.org/wiki/High_blood_pressurehttp://en.wikipedia.org/wiki/Dialysishttp://en.wikipedia.org/wiki/Infectionshttp://en.wikipedia.org/wiki/AIDShttp://en.wikipedia.org/wiki/HIVhttp://en.wikipedia.org/wiki/Central_nervous_systemhttp://en.wikipedia.org/wiki/Epileptic_seizurehttp://en.wikipedia.org/wiki/Cerebral_venous_thrombosishttp://en.wikipedia.org/wiki/Arteritishttp://en.wikipedia.org/wiki/Cerebral_arteriovenous_malformationhttp://en.wikipedia.org/wiki/Transient_ischemic_attackhttp://en.wikipedia.org/wiki/Stroke#Ischemic_stroke

7/27/2019 HEADACHE.docx

3/5

in character, affecting one side of the head, associated withnausea,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),

andhemicrania continua (a continuous headache on one side of the head).[10]

Secondary headaches[edit]

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 onneurological examination,mental confusion,being woken by headache,

headache that worsens with changing posture, headache worsened by exertion orValsalva

manoeuvre (coughing, straining),visual loss or visual abnormalities,jaw claudication (jaw pain

on chewing that resolves afterwards),neck stiffness,fever,and headaches in people

withHIV,cancer or risk factors forthrombosis.[10]

"Thunderclap headache" may be the only symptom ofsubarachnoid hemorrhage,a form

ofstroke in which blood accumulates around the brain, often from a rupturedbrain aneurysm.

Headache with fever may be caused bymeningitis,particularly if there is meningism (inability to

flex the neck forward due to stiffness), and confusion may be indicative

ofencephalitis (inflammation of the brain, usually due to particularviruses). Headache that is

worsened by straining or a change in position may be caused by increasedpressure in the skull;

this is often worse in the morning and associated with vomiting. Raised intracranial pressure may

be due tobrain tumors,idiopathic intracranial hypertension (IIH, more common in younger

overweight women) and occasionallycerebral venous sinus thrombosis.Headache together with

weakness in part of the body may indicate astroke (particularlyintracranial

hemorrhage orsubdural hematoma)or brain tumor. Headache in older people, particularly when

associated with visual symptoms or jaw claudication, may indicategiant cell arteritis (GCA), in

which theblood vessel wall is inflamed and obstructs blood flow.Carbon monoxide

poisoningmay lead to headaches as well as nausea, vomiting, dizziness, muscle weakness and

blurred vision.Angle closure glaucoma (acute raisedpressure 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]

Pathophysiology[edit]

Thebrain itself is not sensitive topain,because it lackspain receptors.However, several areas of

thehead andneck do have nociceptors, and can thus sense pain. These include the extracranial

arteries, large veins, cranial and spinal nerves, head and neck muscles and themeninges.[11]

http://en.wikipedia.org/wiki/Nauseahttp://en.wikipedia.org/wiki/Trigeminal_neuralgiahttp://en.wikipedia.org/wiki/Trigeminal_neuralgiahttp://en.wikipedia.org/wiki/Cluster_headachehttp://en.wikipedia.org/wiki/Hemicrania_continuahttp://en.wikipedia.org/wiki/Headache#cite_note-SIGN-10http://en.wikipedia.org/wiki/Headache#cite_note-SIGN-10http://en.wikipedia.org/wiki/Headache#cite_note-SIGN-10http://en.wikipedia.org/w/index.php?title=Headache&action=edit&section=6http://en.wikipedia.org/wiki/Medication_overuse_headachehttp://en.wikipedia.org/wiki/Medication_overuse_headachehttp://en.wikipedia.org/wiki/Headache#cite_note-SIGN-10http://en.wikipedia.org/wiki/Headache#cite_note-SIGN-10http://en.wikipedia.org/wiki/Headache#cite_note-SIGN-10http://en.wikipedia.org/wiki/Thunderclap_headachehttp://en.wikipedia.org/wiki/Paresishttp://en.wikipedia.org/wiki/Neurological_examinationhttp://en.wikipedia.org/wiki/Mental_confusionhttp://en.wikipedia.org/wiki/Valsalva_manoeuvrehttp://en.wikipedia.org/wiki/Valsalva_manoeuvrehttp://en.wikipedia.org/wiki/Visual_losshttp://en.wikipedia.org/wiki/Claudication#Jawhttp://en.wikipedia.org/wiki/Meningismhttp://en.wikipedia.org/wiki/Feverhttp://en.wikipedia.org/wiki/HIVhttp://en.wikipedia.org/wiki/Cancerhttp://en.wikipedia.org/wiki/Thrombosishttp://en.wikipedia.org/wiki/Headache#cite_note-SIGN-10http://en.wikipedia.org/wiki/Headache#cite_note-SIGN-10http://en.wikipedia.org/wiki/Headache#cite_note-SIGN-10http://en.wikipedia.org/wiki/Subarachnoid_hemorrhagehttp://en.wikipedia.org/wiki/Strokehttp://en.wikipedia.org/wiki/Intracranial_berry_aneurysmhttp://en.wikipedia.org/wiki/Meningitishttp://en.wikipedia.org/wiki/Encephalitishttp://en.wikipedia.org/wiki/Virushttp://en.wikipedia.org/wiki/Intracranial_pressurehttp://en.wikipedia.org/wiki/Brain_tumorhttp://en.wikipedia.org/wiki/Idiopathic_intracranial_hypertensionhttp://en.wikipedia.org/wiki/Cerebral_venous_sinus_thrombosishttp://en.wikipedia.org/wiki/Strokehttp://en.wikipedia.org/wiki/Intracranial_hemorrhagehttp://en.wikipedia.org/wiki/Intracranial_hemorrhagehttp://en.wikipedia.org/wiki/Subdural_hematomahttp://en.wikipedia.org/wiki/Giant_cell_arteritishttp://en.wikipedia.org/wiki/Vasculitishttp://en.wikipedia.org/wiki/Carbon_monoxide_poisoninghttp://en.wikipedia.org/wiki/Carbon_monoxide_poisoninghttp://en.wikipedia.org/wiki/Glaucomahttp://en.wikipedia.org/wiki/Intraocular_pressurehttp://en.wikipedia.org/wiki/Headache#cite_note-SIGN-10http://en.wikipedia.org/wiki/Headache#cite_note-SIGN-10http://en.wikipedia.org/wiki/Headache#cite_note-SIGN-10http://en.wikipedia.org/w/index.php?title=Headache&action=edit&section=7http://en.wikipedia.org/wiki/Human_brainhttp://en.wikipedia.org/wiki/Painhttp://en.wikipedia.org/wiki/Nociceptorhttp://en.wikipedia.org/wiki/Headhttp://en.wikipedia.org/wiki/Neckhttp://en.wikipedia.org/wiki/Meningeshttp://en.wikipedia.org/wiki/Headache#cite_note-ACEP2008-11http://en.wikipedia.org/wiki/Headache#cite_note-ACEP2008-11http://en.wikipedia.org/wiki/Headache#cite_note-ACEP2008-11http://en.wikipedia.org/wiki/Headache#cite_note-ACEP2008-11http://en.wikipedia.org/wiki/Meningeshttp://en.wikipedia.org/wiki/Neckhttp://en.wikipedia.org/wiki/Headhttp://en.wikipedia.org/wiki/Nociceptorhttp://en.wikipedia.org/wiki/Painhttp://en.wikipedia.org/wiki/Human_brainhttp://en.wikipedia.org/w/index.php?title=Headache&action=edit&section=7http://en.wikipedia.org/wiki/Headache#cite_note-SIGN-10http://en.wikipedia.org/wiki/Intraocular_pressurehttp://en.wikipedia.org/wiki/Glaucomahttp://en.wikipedia.org/wiki/Carbon_monoxide_poisoninghttp://en.wikipedia.org/wiki/Carbon_monoxide_poisoninghttp://en.wikipedia.org/wiki/Vasculitishttp://en.wikipedia.org/wiki/Giant_cell_arteritishttp://en.wikipedia.org/wiki/Subdural_hematomahttp://en.wikipedia.org/wiki/Intracranial_hemorrhagehttp://en.wikipedia.org/wiki/Intracranial_hemorrhagehttp://en.wikipedia.org/wiki/Strokehttp://en.wikipedia.org/wiki/Cerebral_venous_sinus_thrombosishttp://en.wikipedia.org/wiki/Idiopathic_intracranial_hypertensionhttp://en.wikipedia.org/wiki/Brain_tumorhttp://en.wikipedia.org/wiki/Intracranial_pressurehttp://en.wikipedia.org/wiki/Virushttp://en.wikipedia.org/wiki/Encephalitishttp://en.wikipedia.org/wiki/Meningitishttp://en.wikipedia.org/wiki/Intracranial_berry_aneurysmhttp://en.wikipedia.org/wiki/Strokehttp://en.wikipedia.org/wiki/Subarachnoid_hemorrhagehttp://en.wikipedia.org/wiki/Headache#cite_note-SIGN-10http://en.wikipedia.org/wiki/Thrombosishttp://en.wikipedia.org/wiki/Cancerhttp://en.wikipedia.org/wiki/HIVhttp://en.wikipedia.org/wiki/Feverhttp://en.wikipedia.org/wiki/Meningismhttp://en.wikipedia.org/wiki/Claudication#Jawhttp://en.wikipedia.org/wiki/Visual_losshttp://en.wikipedia.org/wiki/Valsalva_manoeuvrehttp://en.wikipedia.org/wiki/Valsalva_manoeuvrehttp://en.wikipedia.org/wiki/Mental_confusionhttp://en.wikipedia.org/wiki/Neurological_examinationhttp://en.wikipedia.org/wiki/Paresishttp://en.wikipedia.org/wiki/Thunderclap_headachehttp://en.wikipedia.org/wiki/Headache#cite_note-SIGN-10http://en.wikipedia.org/wiki/Medication_overuse_headachehttp://en.wikipedia.org/wiki/Medication_overuse_headachehttp://en.wikipedia.org/w/index.php?title=Headache&action=edit&section=6http://en.wikipedia.org/wiki/Headache#cite_note-SIGN-10http://en.wikipedia.org/wiki/Hemicrania_continuahttp://en.wikipedia.org/wiki/Cluster_headachehttp://en.wikipedia.org/wiki/Trigeminal_neuralgiahttp://en.wikipedia.org/wiki/Trigeminal_neuralgiahttp://en.wikipedia.org/wiki/Nausea

7/27/2019 HEADACHE.docx

4/5

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 includestress,dilatedblood 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 ofendorphins 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.[13]

The vascular theory was proposed by Wolff and it described the intracranial

vasoconstriction as being responsible for theaura of the migraine. The headache was believed toresult 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 thecerebral cortex,especially in

theoccipital cortex.[14]

People who are more susceptible to experience migraines withoutheadache are those who have a family history of migraines, women, and women who are

experiencing hormonal changes or are takingbirth control pills or are prescribedhormone

replacement therapy

TheAmerican 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. Differentiating between primary and secondary headaches canbe 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.Electroencephalograms have not been found to be useful in working up this

symptom.[17]

Imaging[edit]

http://en.wikipedia.org/wiki/Stress_(biology)http://en.wikipedia.org/wiki/Blood_vesselshttp://en.wikipedia.org/wiki/Headache#cite_note-12http://en.wikipedia.org/wiki/Headache#cite_note-12http://en.wikipedia.org/wiki/Headache#cite_note-12http://en.wikipedia.org/wiki/Endorphinshttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Headache#cite_note-13http://en.wikipedia.org/wiki/Headache#cite_note-13http://en.wikipedia.org/wiki/Headache#cite_note-13http://en.wikipedia.org/wiki/Aura_(symptom)http://en.wikipedia.org/wiki/Human_craniumhttp://en.wikipedia.org/wiki/Cerebral_cortexhttp://en.wikipedia.org/wiki/Occipital_cortexhttp://en.wikipedia.org/wiki/Headache#cite_note-B-14http://en.wikipedia.org/wiki/Headache#cite_note-B-14http://en.wikipedia.org/wiki/Birth_control_pillshttp://en.wikipedia.org/wiki/Hormone_replacement_therapy_(menopause)http://en.wikipedia.org/wiki/Hormone_replacement_therapy_(menopause)http://en.wikipedia.org/wiki/American_College_of_Emergency_Physicianshttp://en.wikipedia.org/wiki/Headache#cite_note-ACEP2008-11http://en.wikipedia.org/wiki/Headache#cite_note-ACEP2008-11http://en.wikipedia.org/wiki/Headache#cite_note-ACEP2008-11http://en.wikipedia.org/wiki/Electroencephalogramhttp://en.wikipedia.org/wiki/Headache#cite_note-17http://en.wikipedia.org/wiki/Headache#cite_note-17http://en.wikipedia.org/wiki/Headache#cite_note-17http://en.wikipedia.org/w/index.php?title=Headache&action=edit&section=9http://en.wikipedia.org/w/index.php?title=Headache&action=edit&section=9http://en.wikipedia.org/wiki/Headache#cite_note-17http://en.wikipedia.org/wiki/Electroencephalogramhttp://en.wikipedia.org/wiki/Headache#cite_note-ACEP2008-11http://en.wikipedia.org/wiki/American_College_of_Emergency_Physicianshttp://en.wikipedia.org/wiki/Hormone_replacement_therapy_(menopause)http://en.wikipedia.org/wiki/Hormone_replacement_therapy_(menopause)http://en.wikipedia.org/wiki/Birth_control_pillshttp://en.wikipedia.org/wiki/Headache#cite_note-B-14http://en.wikipedia.org/wiki/Occipital_cortexhttp://en.wikipedia.org/wiki/Cerebral_cortexhttp://en.wikipedia.org/wiki/Human_craniumhttp://en.wikipedia.org/wiki/Aura_(symptom)http://en.wikipedia.org/wiki/Headache#cite_note-13http://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Endorphinshttp://en.wikipedia.org/wiki/Headache#cite_note-12http://en.wikipedia.org/wiki/Blood_vesselshttp://en.wikipedia.org/wiki/Stress_(biology)

7/27/2019 HEADACHE.docx

5/5

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.[18]

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

In recurrent unexplained headaches keeping a "headachediary" with entries on type of headache,

associated symptoms, precipitating and aggravating factors may be helpful. This may reveal

specific patterns, such as an association withmedication,menstruation orabsenteeism 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 ofcluster

headaches.[19]

Acupuncture has been found to be beneficial in chronic headaches[20]

of both tension type[21]

and

migraine type.[22]

Research comparing acupuncture to 'sham' acupuncture has shown that theresults of acupuncture may be due to theplacebo effect.

[22]

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.[23]

There are however two types of treatment for chronic headaches, i.e. 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. For 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 involvestaking medication on a daily basis for at least 3 months and in some cases, for over 6

months.[24]

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, onlyamitriptyline,fluoxetine,gabapentin,tizanidine,topiramate,andbotulinum 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

includesValproate.[24]

Psychological treatments are usually considered in comorbid patients or in those who are

unresponsive to the medication.

http://en.wikipedia.org/wiki/Headache#cite_note-18http://en.wikipedia.org/wiki/Headache#cite_note-18http://en.wikipedia.org/wiki/Headache#cite_note-18http://en.wikipedia.org/wiki/Headache#cite_note-ACEP2008-11http://en.wikipedia.org/wiki/Headache#cite_note-ACEP2008-11http://en.wikipedia.org/wiki/Headache#cite_note-ACEP2008-11http://en.wikipedia.org/wiki/Diaryhttp://en.wikipedia.org/wiki/Medicationhttp://en.wikipedia.org/wiki/Menstruationhttp://en.wikipedia.org/wiki/Absenteeismhttp://en.wikipedia.org/wiki/Cluster_headachehttp://en.wikipedia.org/wiki/Cluster_headachehttp://en.wikipedia.org/wiki/Headache#cite_note-19http://en.wikipedia.org/wiki/Headache#cite_note-19http://en.wikipedia.org/wiki/Headache#cite_note-19http://en.wikipedia.org/wiki/Acupuncturehttp://en.wikipedia.org/wiki/Headache#cite_note-20http://en.wikipedia.org/wiki/Headache#cite_note-20http://en.wikipedia.org/wiki/Headache#cite_note-20http://en.wikipedia.org/wiki/Headache#cite_note-21http://en.wikipedia.org/wiki/Headache#cite_note-21http://en.wikipedia.org/wiki/Headache#cite_note-21http://en.wikipedia.org/wiki/Headache#cite_note-ReferenceA-22http://en.wikipedia.org/wiki/Headache#cite_note-ReferenceA-22http://en.wikipedia.org/wiki/Headache#cite_note-ReferenceA-22http://en.wikipedia.org/wiki/Placebo_effecthttp://en.wikipedia.org/wiki/Headache#cite_note-ReferenceA-22http://en.wikipedia.org/wiki/Headache#cite_note-ReferenceA-22http://en.wikipedia.org/wiki/Headache#cite_note-ReferenceA-22http://en.wikipedia.org/wiki/Headache#cite_note-23http://en.wikipedia.org/wiki/Headache#cite_note-23http://en.wikipedia.org/wiki/Headache#cite_note-23http://en.wikipedia.org/wiki/Headache#cite_note-emedicine.medscape.com-24http://en.wikipedia.org/wiki/Headache#cite_note-emedicine.medscape.com-24http://en.wikipedia.org/wiki/Headache#cite_note-emedicine.medscape.com-24http://en.wikipedia.org/wiki/Amitriptylinehttp://en.wikipedia.org/wiki/Fluoxetinehttp://en.wikipedia.org/wiki/Gabapentinhttp://en.wikipedia.org/wiki/Tizanidinehttp://en.wikipedia.org/wiki/Topiramatehttp://en.wikipedia.org/wiki/Botulinum_toxin_type_ahttp://en.wikipedia.org/wiki/Botulinum_toxin_type_ahttp://en.wikipedia.org/wiki/Antiepilepticshttp://en.wikipedia.org/wiki/Valproatehttp://en.wikipedia.org/wiki/Headache#cite_note-emedicine.medscape.com-24http://en.wikipedia.org/wiki/Headache#cite_note-emedicine.medscape.com-24http://en.wikipedia.org/wiki/Headache#cite_note-emedicine.medscape.com-24http://en.wikipedia.org/wiki/Headache#cite_note-emedicine.medscape.com-24http://en.wikipedia.org/wiki/Valproatehttp://en.wikipedia.org/wiki/Antiepilepticshttp://en.wikipedia.org/wiki/Botulinum_toxin_type_ahttp://en.wikipedia.org/wiki/Botulinum_toxin_type_ahttp://en.wikipedia.org/wiki/Topiramatehttp://en.wikipedia.org/wiki/Tizanidinehttp://en.wikipedia.org/wiki/Gabapentinhttp://en.wikipedia.org/wiki/Fluoxetinehttp://en.wikipedia.org/wiki/Amitriptylinehttp://en.wikipedia.org/wiki/Headache#cite_note-emedicine.medscape.com-24http://en.wikipedia.org/wiki/Headache#cite_note-23http://en.wikipedia.org/wiki/Headache#cite_note-ReferenceA-22http://en.wikipedia.org/wiki/Placebo_effecthttp://en.wikipedia.org/wiki/Headache#cite_note-ReferenceA-22http://en.wikipedia.org/wiki/Headache#cite_note-21http://en.wikipedia.org/wiki/Headache#cite_note-20http://en.wikipedia.org/wiki/Acupuncturehttp://en.wikipedia.org/wiki/Headache#cite_note-19http://en.wikipedia.org/wiki/Cluster_headachehttp://en.wikipedia.org/wiki/Cluster_headachehttp://en.wikipedia.org/wiki/Absenteeismhttp://en.wikipedia.org/wiki/Menstruationhttp://en.wikipedia.org/wiki/Medicationhttp://en.wikipedia.org/wiki/Diaryhttp://en.wikipedia.org/wiki/Headache#cite_note-ACEP2008-11http://en.wikipedia.org/wiki/Headache#cite_note-18