Headache

Headache
Other namesCephalalgia
Migraine.jpg
Woman with a headache
SpecialtyNeurology

Headache is the symptom of pain anywhere in the region of the head or neck. It can occur as a migraine, tension-type headache, or cluster headache.[1] Frequent headaches can affect relationships and employment.[1] There is also an increased risk of depression in those with severe headaches.[1]

Headaches can occur as a result of many conditions whether serious or not. There are a number of different classification systems for headaches. The most well-recognized is that of the International Headache Society. Causes of headaches may include dehydration, fatigue, sleep deprivation, stress, the effects of medications, the effects of recreational drugs, viral infections, loud noises, common colds, head injury, rapid ingestion of a very cold food or beverage, and dental or sinus issues.

Treatment of a headache depends on the underlying cause, but commonly involves pain medication. A headache is one of the most commonly experienced of all physical discomforts.

About half of adults have a headache in a given year.[1] Tension headaches are the most common, affecting about 1.6 billion people (21.8% of the population) followed by migraine headaches which affect about 848 million (11.7%).[2]

Cause

There are more than 200 types of headaches. Some are harmless and some are life-threatening. The description of the headache and findings on neurological examination, determine whether additional tests are needed and what treatment is best.[3]

Headaches are broadly classified as "primary" or "secondary".[4] Primary headaches are benign, recurrent headaches not caused by underlying disease or structural problems. For example, migraine is a type of primary headache. While primary headaches may cause significant daily pain and disability, they are not dangerous. Secondary headaches are caused by an underlying disease, like an infection, head injury, vascular disorders, brain bleed or tumors. Secondary headaches can be harmless or dangerous. Certain "red flags" or warning signs indicate a secondary headache may be dangerous.[5]

Primary

90% of all headaches are primary headaches. Primary headaches usually first start when people are between 20 and 40 years old.[6] The most common types of primary headaches are migraines and tension-type headaches.[6] They have different characteristics. Migraines typically present with pulsing head pain, nausea, photophobia (sensitivity to light) and phonophobia (sensitivity to sound). Tension-type headaches usually present with non-pulsing "bandlike" pressure on both sides of the head, not accompanied by other symptoms.[7] Other very rare types of primary headaches include:[5]

  • cluster headaches: short episodes (15–180 minutes) of severe pain, usually around one eye, with autonomic symptoms (tearing, red eye, nasal congestion) which occur at the same time every day. Cluster headaches can be treated with triptans and prevented with prednisone, ergotamine or lithium.
  • trigeminal neuralgia or occipital neuralgia: shooting face pain
  • hemicrania continua: continuous unilateral pain with episodes of severe pain. Hemicrania continua can be relieved by the medication indomethacin.
  • primary stabbing headache: recurrent episodes of stabbing "ice pick pain" or "jabs and jolts" for 1 second to several minutes without autonomic symptoms (tearing, red eye, nasal congestion). These headaches can be treated with indomethacin.
  • primary cough headache: starts suddenly and lasts for several minutes after coughing, sneezing or straining (anything that may increase pressure in the head). Serious causes (see secondary headaches red flag section) must be ruled out before a diagnosis of "benign" primary cough headache can be made.
  • primary exertional headache: throbbing, pulsatile pain which starts during or after exercising, lasting for 5 minutes to 24 hours. The mechanism behind these headaches is unclear, possibly due to straining causing veins in the head to dilate, causing pain. These headaches can be prevented by not exercising too strenuously and can be treated with medications such as indomethacin.
  • primary sex headache: dull, bilateral headache that starts during sexual activity and becomes much worse during orgasm. These headaches are thought to be due to lower pressure in the head during sex. It is important to realize that headaches that begin during orgasm may be due to a subarachnoid hemorrhage, so serious causes must be ruled out first. These headaches are treated by advising the person to stop sex if they develop a headache. Medications such as propranolol and diltiazem can also be helpful.
  • hypnic headache: moderate-severe headache that starts a few hours after falling asleep and lasts 15–30 minutes. The headache may recur several times during night. Hypnic headaches are usually in older women. They may be treated with lithium.

Secondary

Headaches may be caused by problems elsewhere in the head or neck. Some of these are not harmful, such as cervicogenic headache (pain arising from the neck muscles). Medication overuse headache may occur in those using excessive painkillers for headaches, paradoxically causing worsening headaches.[3]

More serious causes of secondary headaches include:[5]

  • meningitis: inflammation of the meninges which presents with fever and meningismus, or stiff neck
  • bleeding inside the brain (intracranial hemorrhage)
  • subarachnoid hemorrhage (acute, severe headache, stiff neck without fever)
  • ruptured aneurysm, arteriovenous malformation, intraparenchymal hemorrhage (headache only)
  • brain tumor: dull headache, worse with exertion and change in position, accompanied by nausea and vomiting. Often, the person will have nausea and vomiting for weeks before the headache starts.
  • temporal arteritis: inflammatory disease of arteries common in the elderly (average age 70) with fever, headache, weight loss, jaw claudication, tender vessels by the temples, polymyalgia rheumatica
  • acute closed angle glaucoma (increased pressure in the eyeball): headache that starts with eye pain, blurry vision, associated with nausea and vomiting. On physical exam, the person will have a red eye and a fixed, mid dilated pupil.
  • Post-ictal headaches: Headaches that happen after a convulsion or other type of seizure, as part of the period after the seizure (the post-ictal state)

Gastrointestinal disorders may cause headaches, including Helicobacter pylori infection, celiac disease, non-celiac gluten sensitivity, irritable bowel syndrome, inflammatory bowel disease, gastroparesis, and hepatobiliary disorders.[8][9][10] The treatment of the gastrointestinal disorders may lead to a remission or improvement of headaches.[10]

Other Languages
Afrikaans: Hoofpyn
Alemannisch: Kopfschmerz
العربية: صداع
aragonés: Cefalea
অসমীয়া: মূৰৰ বিষ
asturianu: Cefalalxa
azərbaycanca: Baş ağrısı
Bân-lâm-gú: Thâu-thiàⁿ
башҡортса: Баш ауыртыуы
беларуская: Галаўны боль
беларуская (тарашкевіца)‎: Галаўны боль
български: Главоболие
Boarisch: Schädlweh
bosanski: Glavobolja
brezhoneg: Poan-benn
català: Cefalàlgia
čeština: Bolest hlavy
Cymraeg: Cur pen
dansk: Hovedpine
Deutsch: Kopfschmerz
ދިވެހިބަސް: ބޮލުގައި ރިހުން
eesti: Peavalu
Ελληνικά: Πονοκέφαλος
español: Cefalea
Esperanto: Kapdoloro
euskara: Zefalea
فارسی: سردرد
français: Céphalée
Frysk: Pineholle
Gaeilge: Tinneas cinn
galego: Cefalalxia
客家語/Hak-kâ-ngî: Thèu-thung
한국어: 두통
հայերեն: Գլխացավ
Արեւմտահայերէն: Գլխացաւ
हिन्दी: सिरदर्द
hrvatski: Glavobolja
Ilokano: Sakit ti ulo
Bahasa Indonesia: Sakit kepala
Ирон: Сæрниз
íslenska: Höfuðverkur
italiano: Cefalea
עברית: כאב ראש
қазақша: Бас ауыруы
Кыргызча: Баш оору
latviešu: Galvassāpes
lietuvių: Galvos skausmas
Limburgs: Koppien
македонски: Главоболка
മലയാളം: തലവേദന
मराठी: डोकेदुखी
Bahasa Melayu: Sakit kepala
Mìng-dĕ̤ng-ngṳ̄: Tàu-tiáng
မြန်မာဘာသာ: ခေါင်းကိုက်ခြင်း
Nederlands: Hoofdpijn
Nedersaksies: Kopzeerte
日本語: 頭痛
norsk: Hodepine
norsk nynorsk: Hovudverk
occitan: Cefalèa
oʻzbekcha/ўзбекча: Bosh ogʻrigʻi
ਪੰਜਾਬੀ: ਸਿਰ ਪੀੜ
پنجابی: سر پیڑ
polski: Ból głowy
português: Cefaleia
română: Cefalee
Runa Simi: Uma nanay
संस्कृतम्: शिरोवेदना
සිංහල: හිසරදය
Simple English: Headache
slovenčina: Bolesť hlavy
slovenščina: Glavobol
کوردی: سەرئێشە
српски / srpski: Главобоља
srpskohrvatski / српскохрватски: Glavobolja
svenska: Huvudvärk
Tagalog: Sakit ng ulo
தமிழ்: தலைவலி
తెలుగు: తలనొప్పి
Türkçe: Baş ağrısı
Thuɔŋjäŋ: Aɣaarnhom
українська: Головний біль
اردو: سر درد
Tiếng Việt: Đau đầu
Winaray: Sakit han ulo
吴语: 头痛
ייִדיש: קאפוויי
粵語: 頭刺
žemaitėška: Galvuos suopiejėms
中文: 頭痛