Overview of Headaches
Headache is a general term for pain anywhere in the region of the head, face, or neck. Several parts of the face and head contain pain-sensitive structures, such as nerves, skin, muscles, arteries, veins, and the meninges covering the brain. Inflammation, compression, or dysfunction of any of these structures can lead to a headache or facial pain. The characteristics of the pain and its associated features can help a headache specialist accurately diagnose the specific type of headache disorder, which can help lead to an appropriate treatment.
There exist two very broad classes of headache: primary and secondary. Secondary headache disorders are head pains attributable to an underlying condition, like a disease, trauma, or substance (ie medication or drug). Primary headache disorders, on the other hand, are head and facial pains that are not caused by an underlying disease, trauma, or drug. Primary headaches are much more common than secondary headaches.
Some may consider there to be a third group of headache disorders, the cranial neuralgias. These refer to pain specific to certain nerves that innervate the head, neck, and face regions. The cranial neuralgias are sometimes caused by nerve compression due to surrounding structures or lesions somewhere in the brain, or they may exist and occur without any clear cause.
Types of primary headaches:
- Migraine headache can cause intense throbbing or pulsing pain in one area of the head, and it is often accompanied by other symptoms such as nausea, vomiting, and sensitivity to light and sound. The duration of the migraine attack can vary significantly from patient to patient, as can the frequency.
- Tension headache is the most common type of headache in the general population. It is characterized by mild to moderate pain located around the head or neck. Although it may feel as if tension headache is caused by tightening muscles around the head, its true physiological cause remains unclear.
- Trigeminal autonomic cephalgias, the most common being cluster headache, tend to have predominant autonomic signs and symptoms on one side of the face during headache attacks, like eyelid droopiness (i.e., ptosis), tearing from the eye (i.e., lacrimation), pupil constriction, runny nose or congestion, facial sweating, and/or swelling or redness around the eye. These autonomic symptoms may be accompanied by a feeling of restlessness or agitation during the headache attack, which is often different from other primary headache disorders. The duration of the headache is often most helpful in differentiating between the four trigeminal autonomic cephalgia subtypes.
Secondary headaches may result from the following:
- Overuse of pain medication
- Cerebrovascular disorder
- Brain tumor
- Head injury
- Abnormally high or low intracranial pressure
- Nerve dysfunction
Headache disorders differ from each other in terms of the location of the pain produced (i.e., front, side, or back of head) and other symptoms that accompany the pain (e.g., nausea and vomiting in migraine).
More specific symptom information for each type of headache disorder is available by following the links below:
- Cluster headaches
- Chronic daily headaches
- Trigeminal neuralgia
- Occipital neuralgia
- Cerebrospinal fluid leak
- Idiopathic intracranial hypertension
- Intracranial hypotension
Headaches can sometimes be a sign of a more serious medical problem. Contact a medical professional if you are having frequent or severe headaches.
Treatment for headache disorders exists in various forms: prescription and over-the-counter medications, supplements, procedures, physical therapy, and psychological therapy. Optimizing sleep, exercise, diet, and mood are extremely important in the treatment of headache. Some patients have certain triggers to their headaches, so recognizing and avoiding triggers can be helpful as well.
The treatment of secondary headache disorders is specific to whatever is the underlying cause of the headache, in most cases. There may be symptomatic treatment options for secondary headaches if the underlying cause is not something that can be corrected.
How common headache disorders?
Headache disorders are among the most common neurological disorders. It has been estimated that 50 percent of adults worldwide have experienced a headache disorder at least once within the last year. About 15% of the U.S. population experiences migraine and 1% has chronic migraine (headache on 15 or more days per month).
Who gets headache disorders?
Headache disorders affect men and women of all ages. Depending on the type of headache, there may exist a female or male predominance of that particular headache type in the general population.
How are headache disorders diagnosed?
To diagnose a headache disorder, your doctor will gather a detailed and thorough history and perform a physical and neurological examination. A review of your personal and family medical histories is also often relevant. Depending on the characteristics of the headache or the findings on the physical examination, imaging studies or other tests may be indicated.