Symptom/Sign: Headache
Classifications and external resources

ICD-10	R51.
ICD-9	784.0

A headache (cephalalgia in medical terminology) is a condition of pain in the head; sometimes neck or upper back pain may also be interpreted as a headache. A symptom' (from Greek σύμπτωμα, "accident misfortune that which befalls" from συμπίπτω, "I befall" from A Sign is an indication of some fact or quality and a medical sign is an objective indication of some medical fact or quality that is detected by a Physician The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings R00-R69 - Symptoms and Signs (R00-R09 Circulatory and Respiratory systems ( Abnormalities of Heart beat The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. In Anatomy, the head of an Animal is the Rostral part (from Anatomical position that usually comprises the Brain, Eyes The neck is the part of the Body on many limbed Vertebrates that distinguishes the head from the Torso or trunk It ranks amongst the most common local pain complaints and may be frequent for many people.

The vast majority of headaches are benign and self-limiting. Common causes are tension, migraine, eye strain, dehydration, low blood sugar, and sinusitis. Tension headaches, which were renamed tension-type headaches by the International Headache Society in 1988 are the most common type of primary Headaches Migraine is a neurological Syndrome characterized by altered bodily experiences painful headaches and nausea Asthenopia (aesthenopia or eye strain is an ophthalmological condition that manifests itself through nonspecific Symptoms such as fatigue red eyes eye strain pain Dehydration ( hypohydration) is the removal of Water ( hydro in ancient Greek) from an object Sinusitis is an Inflammation of the Paranasal sinuses which may or may not be as a result of infection from Bacterial fungal, viral Much rarer are headaches due to life-threatening conditions such as meningitis, encephalitis, cerebral aneurysms, extremely high blood pressure, and brain tumors. Meningitis is Inflammation of the protective membranes covering the Brain and Spinal cord, known collectively as the Meninges. Encephalitis is an acute Inflammation of the Brain, commonly caused by a viral Infection. A cerebral aneurysm or brain aneurysm is a cerebrovascular disorder in which weakness in the wall of a cerebral Artery or Vein A hypertensive emergency is severe Hypertension (high blood pressure with acute impairment of an Organ system (especially the Central nervous system A brain tumor is any intracranial Tumor created by abnormal and uncontrolled cell division, normally either in the Brain itself ( Neurons When the headache occurs in conjunction with a head injury the cause is usually quite evident. Traumatic brain injury. THIS PAGE IS FOR INFORMATION ON HEAD INJURY (NOT SPECIFICALLY THE BRAIN--> Head injury is A large percentage of headaches among women are caused by ever-fluctuating estrogen during menstrual years. Estrogens (US otherwise oestrogens or œstrogens) are a group of Steroid compounds named for their importance in the Estrous cycle, See also "Mensuration" a term sometimes used to describe Measurement, particularly in the context of Forestry. This can occur prior to, or even during midcycle menstruation.

Treatment of an uncomplicated headache is usually symptomatic with over-the-counter painkillers such as aspirin, paracetamol (acetaminophen), or ibuprofen, although some specific forms of headaches (e. Over-the-counter (OTC drugs are medicines that may be sold without a prescription, in contrast to Prescription drugs The name "over-the-counter" Aspirin, or acetylsalicylic acid (ASA (əˌsɛtɨlsælɨˌsɪlɨk ˈæsɨd is a Salicylate drug, often used as an Analgesic to relieve Paracetamol ( INN) (ˌpærəˈsiːtəmɒl -ˈsɛtə- or acetaminophen ( USAN) is a widely-used Analgesic and Antipyretic Medication Ibuprofen ( INN) (ˌaɪbjuːˈpɹəʊfɛn (from the now outdated nomenclature i so- bu tyl- pro panoic- phen olic acid is a Non-steroidal g. , migraines) may demand other, more suitable treatment. Migraine is a neurological Syndrome characterized by altered bodily experiences painful headaches and nausea 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.

Pathophysiology

The brain in itself is not sensitive to pain, because it lacks nociceptors. The brain is the center of the Nervous system in animals All Vertebrates and the majority of Invertebrates have a brain Pain, in the sense of physical pain, is a typical sensory experience that may be described as the unpleasant awareness of a noxious stimulus or bodily harm A nociceptor is a Sensory receptor that sends signals that cause the perception of Pain in response to a potentially damaging stimulus 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. The meninges (singular meninx) is the system of membranes which envelops the Central nervous system. Headaches often result from traction to or irritation of the meninges and blood vessels. The membrane surrounding the brain and spinal cord, called the dura mater, is innervated with nociceptors. The dura mater (from the Latin "hard mother" or pachymeninx, is the tough and inflexible outermost of the three layers of the Meninges surrounding the Stimulation of these dural nociceptors is thought to be involved in producing headaches. Similarly the muscles of the head may be sensitive to pain.

Types

There are five types of headache: vascular, myogenic (muscle tension), cervicogenic, traction, and inflammatory.

Vascular

Main article: vascular headache

The most common type of vascular headache is migraine. A vascular headache is an outdated term to describe certain types of Headache which were thought to be related to Blood vessel swelling and Hyperemia Migraine is a neurological Syndrome characterized by altered bodily experiences painful headaches and nausea 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. A toxic headache is the least common type of Vascular headache that usually comes from a Fever from acute illnesses such as Measles, Mumps

Other kinds of vascular headaches include cluster headaches, which are very severe recurrent short lasting headaches, often located through or around the either eye and often wake the sufferers up at the same time every night. Cluster headache is a neurological disease that involves as its most prominent feature an immense degree of pain Unlike migraines, these headaches are more common in men than in women.

Muscular/myogenic

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. Tension headaches, which were renamed tension-type headaches by the International Headache Society in 1988 are the most common type of primary Headaches

Cervicogenic

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/inflammatory

Positron emission tomography functional imaging shows activation of specific brain areas during a cluster headache. Positron emission tomography ( PET) is a Nuclear medicine imaging technique which produces a three-dimensional image or map of functional processes in the

Traction and inflammatory headaches are symptoms of other disorders, ranging from stroke to sinus infection. Specific types of headaches include:

• Tension headache
• Migraine
• Idiopathic intracranial hypertension (headache with visual symptoms due to raised intracranial pressure)
• Ictal headache
• Cluster headache
• "Brain freeze" (also known as: ice cream headache)
• Thunderclap headache
• Vascular headache
• Toxic headache
• Coital cephalalgia (also known as: sex headache)
• Hemicrania continua
• Rebound headache (also called medication overuse headache, abbreviated MOH)
• Red wine headache
• "Spinal headache" (or: post-dural puncture headaches) after lumbar puncture or related procedure that will lower the intracranial pressure
• Hangover (caused by heavy alcohol consumption)

A headache may also be a symptom of sinusitis. Tension headaches, which were renamed tension-type headaches by the International Headache Society in 1988 are the most common type of primary Headaches Migraine is a neurological Syndrome characterized by altered bodily experiences painful headaches and nausea Idiopathic intracranial hypertension (IIH sometimes called benign intracranial hypertension (BIH or pseudotumor cerebri (PTC is a Neurological disorder Intracranial pressure, ( ICP) is the pressure exerted by the Cranium on the Brain tissue Cerebrospinal fluid (CSF and the brain's circulating Ictal headaches are Headaches associated with Seizure activity Cluster headache is a neurological disease that involves as its most prominent feature an immense degree of pain Brain freeze, primarily known as ice cream headache, but also cold headache, shakeache, frigid face, freezie, frozen brain A thunderclap headache is a Headache that is severe and sudden (like a thunderclap) A vascular headache is an outdated term to describe certain types of Headache which were thought to be related to Blood vessel swelling and Hyperemia A toxic headache is the least common type of Vascular headache that usually comes from a Fever from acute illnesses such as Measles, Mumps Also known as "sexual headaches" coital cephalalgia is a rare type of severe Headache that occurs at the base of the Skull before Orgasm during Hemicrania continua (HC is a persistent Unilateral Headache that responds to Indomethacin. Rebound headaches, also known as medication overuse headaches, occur when pain medications ( Analgesics) are taken too frequently to relieve Headache. Red wine headache ("RWH" is a bad Headache often accompanied by Nausea and flushing that occurs in many people after drinking even a single glass Post dural puncture headache (PDPH or "low Cerebralspinal Fluid (CSF pressure headache" is a complication of Spinal anesthesia, diagnostic spinal In Medicine, a lumbar puncture (colloquially known as a spinal tap) is a Diagnostic and at times therapeutic procedure that is performed in order Intracranial pressure, ( ICP) is the pressure exerted by the Cranium on the Brain tissue Cerebrospinal fluid (CSF and the brain's circulating A hangover ( veisalgia) describes the sum of unpleasant physiological effects following heavy consumption of drugs particularly Alcoholic beverages The most commonly Sinusitis is an Inflammation of the Paranasal sinuses which may or may not be as a result of infection from Bacterial fungal, viral

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. Inflammation ( Latin, inflamatio, to set on fire is the complex biological response of vascular tissues to harmful stimuli such as Pathogens Meningitis is Inflammation of the protective membranes covering the Brain and Spinal cord, known collectively as the Meninges.

Diagnosis

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, convulsions 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. Meningism is the triad of nuchal rigidity Photophobia (intolerance of bright light and Headache. Fever (also known as pyrexia, from the Greek pyretos meaning fire or a febrile response, from the Latin word Febris An epileptic seizure is caused by excessive and/or hypersynchronous electrical Neuronal activity and is usually self-limiting See also Unconscious mind. Unconsciousness, more appropriately referred to as loss of Consciousness or lack of consciousness is

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 a "primary headache" which means that the headache, whilst unpleasant is not an occurring as a manifestation of a more serious condition. The main types of primary headache are tension headache, migraine and the trigeminal autonomic cephalalgias of which cluster headache is an example. As it is often difficult for patients to recall the precise details regarding each headache, it is often useful for the sufferer to fill-out a "headache diary" detailing the characteristics of the headache. When the headache does not clearly fit into one of the recognized primary headache syndromes or when atypical symptoms or signs are present then further investigations are justified. ^[1] Computed tomography (CT/CAT) scans of the brain or sinuses are commonly performed, or magnetic resonance imaging (MRI) in specific settings. Computed tomography (CT is a Medical imaging method employing Tomography. Blood tests may help narrow down the differential diagnosis, but are rarely confirmatory of specific headache forms. A blood test is a laboratory analysis performed on a Blood sample that is usually extracted from a Vein in the arm using a needle, or via A differential diagnosis (sometimes abbreviated DDx, ddx

Treatment

Not all headaches require medical attention, and many respond with simple analgesia (painkillers) such as paracetamol/acetaminophen or members of the NSAID class (such as aspirin/acetylsalicylic acid or ibuprofen). Paracetamol ( INN) (ˌpærəˈsiːtəmɒl -ˈsɛtə- or acetaminophen ( USAN) is a widely-used Analgesic and Antipyretic Medication Paracetamol ( INN) (ˌpærəˈsiːtəmɒl -ˈsɛtə- or acetaminophen ( USAN) is a widely-used Analgesic and Antipyretic Medication Non-steroidal anti-inflammatory drugs, usually abbreviated to NSAID s or NAID s, are drugs with Analgesic, Antipyretic and in higher Aspirin, or acetylsalicylic acid (ASA (əˌsɛtɨlsælɨˌsɪlɨk ˈæsɨd is a Salicylate drug, often used as an Analgesic to relieve Ibuprofen ( INN) (ˌaɪbjuːˈpɹəʊfɛn (from the now outdated nomenclature i so- bu tyl- pro panoic- phen olic acid is a Non-steroidal

In recurrent unexplained headaches, healthcare professionals may recommend keeping a "headache diary" with entries on type of headache, associated symptoms, precipitating and aggravating factors. For other uses of the term 'diary' see Diary (disambiguation. This may reveal specific patterns, such as an association with medication, menstruation or absenteeism or with certain foods. Medication, also referred to as medicine, can be loosely defined as any substance intended for use in the diagnosis cure mitigation treatment or prevention of disease See also "Mensuration" a term sometimes used to describe Measurement, particularly in the context of Forestry. Absenteeism is a habitual pattern of absence from a duty or obligation 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. ^[2]

Prevention

Some forms of headache, such as migraine, may be amenable to preventative treatment. Migraine is a neurological Syndrome characterized by altered bodily experiences painful headaches and nausea 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. Caffeine is a bitter white crystalline Xanthine Alkaloid that acts as a Psychoactive Stimulant Drug and a mild Diuretic Vasoconstriction is the narrowing of the blood vessels resulting from contraction of the muscular wall of the vessels particularly the large Arteries, Arterioles This has led to the development of paracetamol/caffeine analgesic. Paracetamol ( INN) (ˌpærəˈsiːtəmɒl -ˈsɛtə- or acetaminophen ( USAN) is a widely-used Analgesic and Antipyretic Medication Caffeine is a bitter white crystalline Xanthine Alkaloid that acts as a Psychoactive Stimulant Drug and a mild Diuretic One popular herbal preventive treatment for migraines is Feverfew. Feverfew ( Tanacetum parthenium; syn Chrysanthemum parthenium ( L Magnesium, Vitamin B2, and Coenzyme Q10 are "natural" supplements that have shown some efficacy for migraine prevention(5). ^[3]

Massage therapy

A 2002 study found that massage therapy targeted at neck and shoulder muscles reduced headache frequency and duration, starting in the first week and continuing through the eight-week study, though it did not find a change in headache intensity. The study authors concluded that "the muscle-specific massage therapy technique" they used "has the potential to be a functional, nonpharmacological intervention for reducing the incidence of chronic tension headache. "^[4]

References

External links

• National Headache Foundation
• IHS - The International Headache Classification (ICHD-2)