A Headache is defined as a pain in the head or upper neck.

There are three major categories of headaches:

1. primary headaches,

2. secondary headaches, and

3. cranial neuralgias, facial pain, and other headaches

Primary headaches include migraine, tension, and cluster headaches, as well as a variety of other less
common types of headache.

 Tension headaches are the most common type of primary headache. Up to 90% of adults have had or
will have tension headaches. more commonly among women than men.

 Migraine headaches Primary headaches include migraine, tension, and cluster headaches, as well as
a variety of other less common types of headache.
 Tension headaches are the most common type of primary headache. Up to 90% of adults have had or
will have tension headaches. Tension headaches occur more commonly among women than men. Tension
headaches are painful, and patients may be upset that the diagnosis is "only" a tension headache. Even
though it is not life-threatening, a tension headache can affect the activities of daily life.

Most people successfully treat themselves with over-the–counter (OTC) pain medications to control tension
headaches. The following work well for most people:

 aspirin,
 ibuprofen (Motrin, Advil),
 acetaminophen (Tylenol) and
 naproxen (Aleve)
If these fail, other supportive treatments are available. Recurrent headaches should be a signal to seek
medical help. Massage, biofeedback, and stress management can all be used as adjuncts to help with
control of tension headaches.
It is important to remember that OTC medications, while safe, are medications and may have side effects and
potential interactions with prescription medications. It always is wise to ask your health care practitioner or
pharmacist if you have questions about OTC medications and their use. This is especially important with OTC
pain medications, because patients use them so frequently.

It is important to read the listing of ingredients in OTC pain medications. Often an OTC medication is a
combination of ingredients, and the second or third ingredient may have the potential for drug interaction or
contraindication with medications a patient is currently taking. For example:

 Some OTC medications include caffeine, which may trigger rapid heartbeats in some patients.
 In night time preparations, diphenhydramine (Benadryl) may be added. This may cause drowsiness,
and driving or using heavy machinery may not be appropriate when taking the medication.
Other examples where caution should be used include the following:

 Aspirin should not be used in children and teenagers because of the risk of Reye's Syndrome, a
disease where coma, brain damage, and death can occur if there is a viral like illness when the and
aspirin is used.
 Aspirin and ibuprofen are irritating to the stomach and may cause bleeding. They should be used
 with caution in patients who have peptic ulcer disease or who take blood thinners
like warfarin (Coumadin) and clopidogrel bisulfate (Plavix).
 Acetaminophen, if used in large amounts, can cause liver damage or failure. It should be used with
caution in patients who drink significant amounts of alcohol or who have liver disease.
 One cause of chronic tension headaches is overuse of medications for pain. When pain medications
are used for a prolonged period of time, headaches can recur as the effects of the medication wear
off. Thus, the headache becomes a symptom of the withdrawal of medication (rebound headache).


 Migraine headaches are the second most common type of primary headache. is a form of vascular
headache. Migraine headache is caused by vasodilatation (enlargement of blood vessels) that causes
the release of chemicals from nerve fibers that coil around the large arteries of the brain.
Enlargement of these blood vessels stretches the nerves that coil around them and causes the nerves
to release chemicals. The chemicals cause inflammation, pain, and further enlargement of the artery.
The increasing enlargement of the arteries magnifies the pain. many of the symptoms associated
with migraine attacks; for example, the increased sympathetic nervous activity in the intestine
causes nausea,vomiting, and diarrhea.
 Cluster headaches are a rare type of primary headache affecting 0.1% of the population (1 in a 1,000
people). It more commonly affects men in their late 20s though women and children can also suffer these
types of headache.

Primary headaches can affect the quality of life. Some people have occasional headaches that resolve quickly
while others are debilitated. While these headaches are not life-threatening, they may be associated with
symptoms that can mimic strokes or intracerebral bleeding. It end to run in families and this suggests that
there may be a genetic role;

 may be triggered by changes in sleeppatterns;

 may be triggered by medications (for example, nitroglycerin, used for heart disease).
If an individual is in a susceptible period for cluster headache, cigarette smoking, alcohol, and some
foods (for example, chocolate) also can be potential causes for headache.

What are the symptoms of cluster headaches?

Cluster headaches are headaches that come in groups (clusters) lasting weeks or months, separated by pain-
free periods of months or years.

 During the period in which the cluster headaches occur, pain typically occurs once or twice daily, but some
patients may experience pain more than twice daily.

 Each episode of pain lasts from 30 to 90 minutes.

 Attacks tend to occur at about the same time every day and often awaken the patient at night from a
sound sleep.

 The pain typically is excruciating and located around or behind one eye.

 Some patients describe the pain as feeling like a hot poker in the eye. The affected eye may become red,
inflamed, and watery.

 The nose on the affected side may become congested and runny.

Unlike patients with migraine headaches, patients with cluster headaches tend to be restless. They often
pace the floor, bang their heads against a wall, and can be driven to desperate measures. Cluster headaches
are much more common in men than women.

treatment options may include the following:

 inhalation of high concentrations of oxygen (though this will not work if the headache is well established);

 injection of tryptan medications, for example, sumatriptan (Imitrex),zolmitriptan (Zomig),

and rizatriptan(Maxalt) which are commonly used for migraine treatments as well;
 injection of lidocaine, a local anesthetic, into the nostril;

 dihydroergotamine (DHE, Migranal), a medication that causes blood vessels to constrict;

 caffeine

Prevention of the next cluster headache may include the following:

 calcium channel blockers [for example, verapamil (Calan, Verelan, Verelan PM, Isoptin, Covera-
HS), diltiazem (Cardizem, Dilacor, Tiazac)]
 prednisone (Deltasone, Liquid Pred)
 antidepressant medications
 lithium (Eskalith, Lithobid)
 valproic acid, divalproex (Depakote, Depakote ER, Depakene, Depacon), andtopiramate (Topamax)
(often used for seizure control)

Secondary headaches are those that are due to an underlying structural problem in the head or neck. There
are numerous causes of this type of headache ranging from bleeding in the brain, tumor, or meningitis and
encephalitis. Causes may include:

Head and neck trauma

 Injuries to the head may cause bleeding in the spaces between the layers of tissue that surround the brain
(subdural, epidural and subarachnoid spaces) or within the brain tissue itself.

 Concussions, where head injury occurs without bleeding

 A symptom of whiplash and neck injury
Blood vessel problems in the head and neck

 Stroke or transient ischemic attack (TIA)

 Arteriovenous malformations (AVM) may cause headache before they leak
 Carotid artery inflammation

 Temporal arteritis (inflammation of the temporal artery)

Non-blood vessel problems of the brain

 Brain tumors, either primary, originating in the brain, or metastatic from a cancerthat began in
another organ
 Seizures
 Idiopathic intracranial hypertension, once named pseudotumor cerebri, where the pressure is too high in
the cerebrospinal fluid within the spinal canal.

Medications and drugs (including withdrawal from those drugs)

Infection

 Meningitis
 Encephalitis
 HIV/AIDS
 Systemic infections (for example, pneumonia or influenza)
Changes in the body's environment

 High blood pressure (hypertension)

 Dehydration
 Hypothyroidism
 Renal dialysis
Problems with the eyes, ears, nose throat, teeth and neck

Psychiatric disorders

When should I seek medical care for a headache?

A patient should seek medical care if their headache is:

 The "worst headache of your life." This is the wording often used in textbooks as a cue for medical
practitioners to consider the diagnosis of a subarachnoid hemorrhage due to aruptured cerebral
aneurysm. The amount of pain will often be taken in context with the appearance of the patient and
other associated signs and symptoms.
 Different than your usual headaches

 Starts suddenly or is aggravated by exertion, coughing, bending over, or sexual activity

 Associated with persistent nausea and vomiting

 Associated with fever or stiff neck

 Associated with seizures

 Associated with recent head trauma or a fall

 Associated with changes in vision, speech, or behavior

 Associated with weakness or change in sensation

 Not responding to treatment and is getting worse

 Requires more than the recommended dose of over-the-counter medications for pain

 Disabling and interfering with work and quality of life

Headache At A Glance
 The head is one of the most common sites of pain in the body.

 The most common types of headache can be classified as 1) primary, 2) secondary, and 3) cranial
neuralgias, facial pain, and other headaches.

 The most common types of primary headaches are 1) tension, 2) migraine, and 3) cluster.

 Tension headaches are the most common type of primary headache and usually are treated with over-the-
counter medications for pain

 Secondary headaches are a symptom of an injury or an underlying illness.

 Patients should seek medical care for new onset headaches, fever, stiff neck, change in behavior,
vomiting, weakness or change in sensation.