A ('''cephalgia''' in medical terminology) 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.
The vast majority of headaches are benign and self-limiting. Common causes are
Tension ,
Migraine ,
Eye Strain ,
Dehydration , low blood sugar, and
Sinusitis . Much rarer are headaches due to life-threatening conditions such as
Meningitis ,
Encephalitis ,
Cerebral Aneurysm s, and
Brain Tumor s. 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.
Treatment of uncomplicated headache is usually symptomatic with
Over-the-counter Painkillers such as
Aspirin ,
Paracetamol (acetaminophen), or
Ibuprofen , although some specific forms of headaches (e.g.,
Migraines ) may demand other, more suitable treatment. It may be possible to relate the occurrence of a headache to other particular triggers (such as stress or particular foods), which can then be avoided.
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.
There are five types of headache: vascular, myogenic (muscle tension), cervicogenic, traction, and inflammatory.
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. After migraine, the most common type of vascular headache is the
"toxic" Headache produced by fever.
Other kinds of vascular headaches include ''
Cluster Headache s'', which cause repeated episodes of intense pain, and headaches resulting from ''
High Blood Pressure '' (rare).
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.
Cervicogenic headaches originate from disorders of the neck, 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 and inflammatory headaches are symptoms of other disorders, ranging from stroke to sinus infection.
Specific types of headaches include:
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.
While, statistically, headaches are most likely to be harmless and self-limiting, some specific headache syndromes may demand specific treatment or may be warning signals of more serious disorders. Some headache subtypes are characterized by a specific pattern of symptoms, and no further testing may be necessary, while others may prompt further diagnostic tests.
Headache associated with specific symptoms may warrant urgent medical attention, particularly sudden, severe headache or sudden headache associated with a
Stiff Neck ; headaches associated with
Fever ,
Convulsion s or accompanied by confusion or
Loss Of Consciousness ; headaches following a blow to the head, or associated with pain in the eye or ear; persistent headache in a person with no previous history of headaches; and recurring headache in children.
The most important step in diagnosing a headache is for the physician to take a careful history and to examine the patient. In the majority of cases the diagnosis will be tension headache or migraine, both of which can be managed on the basis of a clear-cut clinical picture. Where doubt remains, or if there are abnormalities detected on examination, further investigations are justified.Detsky ME, McDonald DR, Baerlocher MO, Tomlinson GA, McCrory DC, Booth CM. Does this patient with headache have a migraine or need neuroimaging? JAMA 2006;296:1274-83
Computed Tomography (CT/CAT) scans of the brain or sinuses are commonly performed, or
Magnetic Resonance Imaging (MRI) in specific settings.
Blood Test s may help narrow down the
Differential Diagnosis , but are rarely confirmatory of specific headache forms.
Not all headaches require medical attention, and respond with simple
Analgesia (painkillers) such as
Paracetamol /
Acetaminophen or members of the
NSAID class (such as
Aspirin /acetylsalicylic acid or
Ibuprofen ).
In recurrent unexplained headaches, healthcare professionals may recommend keeping a "headache
Diary " with entries on type of headache, associated symptoms, precipitating and aggravating factors. This may reveal specific patterns, such as an association with
Medication ,
Menstruation or
Absenteeism 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 of cluster headaches.
Brain Stimulation May Ease Headaches .
Reuters ,
March 9 ,
2007 .
Some forms of headache, such as
Migraine , may be amenable to preventative treatment. On the whole, long-term use of painkillers is discouraged as this may lead to "rebound headaches" on withdrawal.
Caffeine , a
Vasoconstrictor , is sometimes prescribed or recommended as a remedy or supplement to pain killers in the case of extreme migraine. This has led to the development of
Paracetamol /
Caffeine Analgesic . One popular herbal preventive treatment for migraines is
Feverfew . Magnesium, Vitamin B2, and Coenzyme Q10 are "natural" supplements that have shown some efficacy for migraine prevention(5).Mauskop A. Alternative therapies in headache: Is there a role? Med Clin North Am 2001;85(4):1077-1084. PMID 11480259.
A controversial approach to headache treatment is
Chiropractic care. Most research supporting the chiropractic adjustment (also known as
Spinal Manipulation by the scientific community) has been self-funded by the chiropractic profession.
The most compelling study of , for the treatment of Migraine Headache. During the 4-week trial, both groups reduced in symptoms. After withdrawal of treatment, the medical group relapsed or got worse, whereas the group receiving chiropractic care maintained their improvements. The amitriptyline is more cost-effective as it is cheaper than the cost of visiting a doctor, but freedom from symptoms or a reduction in frequency only happened in the chiropractic group.
Independent (non-chiropractic) researchers reviewed research on many different types of behavioral and physical treatments for tension-type and cervicogenic headaches
"Evidence Report: Behavioral and Physical Treatments for Tension-type and Cervicogenic Headache." Duke University Evidence-based Practice Center, Center for Clinical Health Policy Research. and found that cervical spinal manipulation was associated with improvement in cervicogenic headache outcomes (but not for tension-type headache), and was superior to soft-tissue therapies like
Massage .
