Headache overview
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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
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.