Headache is the symptom of pain in the face, head, or neck. It can occur as a migraine, tension-type headache, or cluster headache. Frequent headaches can affect relationships and employment. There is also an increased risk of depression in those with severe headaches. Headaches can occur as a result of many conditions.
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Cluster headache (CH) is a neurological disorder characterized by recurrent severe headaches on one side of the head, typically around the eye. There is often accompanying eye watering, nasal congestion, or swelling around the eye on the affected side.
A migraine is a primary headache disorder characterized by recurrent headaches that are moderate to severe. Typically, the headaches affect one half of the head, are pulsating in nature, and last from a few hours to 3 days.
- Signs and symptoms
- Risk factors
Tension headache, also known as stress headache, or tension-type headache, is the most common type of primary headache. The pain can radiate from the lower back of the head, the neck, eyes or other muscle groups in the body typically affecting both sides of the head. Tension-type headaches account for nearly 90% of all headaches. Pain medication, such as aspirin and ibuprofen, are effective for the treatment of tension headache. Tricyclic antidepressants appear to be useful for prevention. Evide
According to the third edition of the International Classification of Headache Disorders, the attacks must meet the following criteria: 1. A duration of between 30 minutes and 7 days. 2. At least two of the following four characteristics: bilateral location pressing or tightening quality mild or moderate intensity not aggravated by routine physical activity such as walking or climbing stairs 3. Both of the following: no nausea or vomiting no more than one of photophobia or phonophobia Tension-ty
Various precipitating factors may cause tension-type headaches in susceptible individuals: 1. Anxiety 2. Stress 3. Sleep problems 4. Young age 5. Poor health
Although the musculature of the head and neck and psychological factors such as stress may play a role in the overall pathophysiology of TTH, neither is currently believed to be the sole cause of the development of TTH. The pathologic basis of TTH is most likely derived from a combination of personal factors, environmental factors, and alteration of both peripheral and central pain pathways. Peripheral pain pathways receive pain signals from pericranial myofascial tissue and alteration of this p
With TTH the physical exam is expected to be normal with perhaps the exception of either pericranial tenderness upon palpation of the cranial muscles, or presence of either photophobia or phonophobia.
Drinking water and avoiding dehydration helps in preventing tension headache. Using stress management and relaxing often makes headaches less likely. Drinking alcohol can make headaches more likely or severe. Good posture might prevent headaches if there is neck pain. People who
People who have 15 or more headaches in a month may be treated with certain types of daily antidepressants which act to prevent continued tension headaches from occurring. In those who are predisposed to tension type headaches the first-line preventative treatment is amitriptylin
The second edition of the International Headache Classification (ICHD-2) defines more than 220 different types of headaches in three categories: Primary headaches, for example migraine, tension headache and cluster headache. Secondary headaches; Cranial neuralgias, central and primary facial pain and other headaches
A headache is called "thunderclap headache" if it is severe in character and reaches maximum severity within seconds to minutes of onset. In many cases, there are no other abnormalities, but the various causes of thunderclap headaches may lead to a number of neurological symptoms.
- Lone acute severe headache
Cervicogenic headache is a type of headache characterised by chronic hemicranial pain referred to the head from either the cervical spine or soft tissues within the neck. The main symptoms of cervicogenic headaches include pain originating in the neck that can travel to the head or face, headaches that get worse with neck movement, and limited ability to move the neck.
- Tension headaches. If you have a tension headache, you may feel a dull, aching sensation all over your head. It isn’t throbbing. Tenderness or sensitivity around your neck, forehead, scalp, or shoulder muscles also might occur.
- Cluster headaches. Cluster headaches are characterized by severe burning and piercing pain. They occur around or behind one eye or on one side of the face at a time.
- Migraine. Migraine pain is an intense pulsing from deep within your head. This pain can last for days. The headache significantly limits your ability to carry out your daily routine.
- Allergy or sinus headaches. Headaches sometimes happen as a result of an allergic reaction. The pain from these headaches is often focused in your sinus area and in the front of your head.
Headache accounts for ~2.2% of all ED visitsThe majority of these have a benign cause, but serious causes can be devastating, and a thorough H&P with an eye toward "red flag" symptoms is important in ED evaluation.
- Clinical Features
- See Also
1. Time to maximal onset 2. Location 2.1. Occipital - Cerebellar lesion, muscle spasm, cervical radiculopathy 2.2. Orbital - Optic neuritis, cavernous sinus thrombosis 2.3. Facial - Sinusitis, carotid artery dissection 3. Prior headache history
1. Scalp and temporal artery palpation 2. Sinus tap / transillumination 3. EBQ: Jolt Test 4. Neuro exam
1. Horizontal rotation of the head at frequency of 2 rotations/second - exacerbation of pre-existing headache is positive test. 2. Although a 1991 study showed high sensitivity with this test, multiple newer studies have cast doubt on its sensitivity. Although it may be clinically useful in the right subset of patients, it should not be considered to be 100% Sn
1. If suspect temporal arteritis→ ESR 2. If suspect meningitis → CSF studies 2.1. Cannot use CBC to rule-out meningitis 2.2. Add India Ink, cryptococcal antigen if suspect AIDS-related infection 3. If suspect CO poisoning→ carboxyhemoglobin level 4. If concern for ICH → non-contrast CT Brain ± Lumbar puncture
1. Consider non-contrast head CT in patients with: 1.1. Thunderclap headache 1.2. Worst headache of life 1.3. Different headache from usual 1.4. Meningeal signs 1.5. Headache + intractable vomiting 1.6. New-onset headache in patients with: 1.6.1. Age > 50yrs 1.6.2. Malignancy 1.6.3. HIV 1.6.4. Neurological deficits (other than migraine with aura) 2. Consider CXR 2.1. 50% of patients with pneumococcal meningitis have evidence of pneumoniaon CXR
If known, treat specific headache type; avoid opioidmedications if at all possible 1. 1st line: prochlorperazine (compazine) 10 mg IV (+/- diphenhydramine 25-50 mg IV) + 1 L normal saline IV bolus 1.1. Place prochlorperazine in IV bag to reduce chances of side effects from rapid administration 1.2. Alternative metoclopramide 10 mg IV (diphenhydramine addition shows no clinical benifit) 2. AcetaminophenIV or PO, 325-1000 mg 3. Ketorolac 10-30 mg IV (30-60mg IM) 3.1. Lower doses are shown to be...Outpatient referral to primary care or neurology for recurrent, recalcitrant headachesAdmission for status migrainosus or dangerous underlying etiology
Trigeminal autonomic cephalalgia (TAC), such as cluster headache and paroxysmal hemicrania; A few headache patterns also are generally considered types of primary headache, but are less common. These headaches have distinct features, such as an unusual duration or pain associated with a certain activity.