Definition of "Headache"

Last modified: about 1 month



Headache (aka cephalalgia) is pain anywhere in the region of the head or neck.

Patient information

Is headache where your head hurts?
Yeah. And also your neck. It can be hard to exact things

Pathophysiology

Brain tissue itself is not receptive to pain as it lacks pain receptors, but is caused by disturbance of pain-sensitive structures around the brain, including:

  • Cranium (periosteum) of the skull
  • Muscles
  • Nerves
  • Arteries and veins
  • Subcutaneus tissues
  • Eyes
  • Ears
  • Sinuses
  • Mucous membranes

Patient information

What makes your head hurt? Is it the braaaaain?
Lots of people think this. But the brain actually can't feel anything. But it's eveything around the brain that can cause problems. The bones. Muscles. Nerves. Vessels. So any and all tissue. Even the eyes, and ears.

Classifications

Primary headaches, which are 90% of headaches, starting between 20-40yo. It includes:

  • Migraine, the most common, presenting with pulsing head pain, nausea, photophobia, phonophobia (senstivity to sound)
  • Tension headache, presenting with non-pulsing band-like pressure on both sides of head. No systemic Sx (no nausea/vomiting, aura)
  • Cluster headache, short episodes (15 mins-3 hours) of severe pain, usually around one eye, with autonomous Sx (tearing, red eye, nasal congestion)
  • Trigeminal neuralgia, shooting face pain
  • Primary cough headache, starts suddenly, lasting for several minutes after coughing, sneezing, straining, or anything that increases pressure in the head

Patient information

How do you classify headaches?
There's primary and secondary. Primary is where headache is the main thing going on. Secondary is where something else is causing the headache.

OK. So what are the types of headaches, where it's the main thing going on?
Migraine is the biggie, that's a pulsating headache, where you might be sensitive to sound or light. There's tension headache, that feels like a band on both sides of the head. There's cluster headache, which are short episodes of massive pain usually around 1 eye in particular, and it can cause fever type symptoms, like tearing, a red eye, blocked nose. Trigeminal neuralgia is a shooting face pain.

Headache is a non-specific Sx so has many causes, including:

  • Fatigue
  • Sleep deprivation
  • Stress
  • Effects of medications and recreational drugs
  • Viral infections and common colds
  • Head injury
  • Rapid ingestion of very cold food or beverage
  • Dental or sinus issues

Secondary headaches, are caused by problems elsewhere in the head or neck. Causes include:

  • Meningitis, inflammation of meninges which presents with → fever, stiff neck
  • Intracranial hemorrhage
  • Subarachnoid hemorrhage, acute, severe headache, stiff neck, without fever
  • Brain tumor, dull headache, worse with exertion and change in position, accompanied by nausea and vomiting
  • Temporal arteritis, inflammatory disease of the large and medium arteries of the head, common in elderly (average 70yo) with fever, headache, weight loss, jaw claudication, tender vessels by the temples
  • Acute closed angle glaucoma, increased pressure in the eyeball, starting with eye pain, blurry vision, associated with nausea/vomiting. Pt will have red eye and fixed, mid dilated pupil

Patient information

Headache can also be caused by other diseases. What are these?
Inflammation of the 3 layers covering the brain and spinal cord, called meningitis. Any bleeding within the skull, called intracranial hemorrhage. Cancer of the brain. Inflammation of the arteries of the head, called temporal arteritis. Increased pressure in the eyeball, called glaucoma.

Ix
  • Hx, including:
    • Neck stiffness, photophobia → meningitis
    • Transient neurological deficit → migraine
    • Jaw claudication → temporal arteritis
    • Facial tenderness → chronic sinusitis
    • Eye irritation → cluster headache
  • Neurological exam

Patient information

How do you look further into a headache?
You can ask things on the history to see if some things are more or less likely. Like you might see a stiff neck and dislike of light in meningitis. Pain in jaw when chewing in temporal arterities. Face pain in sinusitis. Pain particularly around 1 eye in cluster headache. You also want to do a neurological exam, to rule out problems with the brain.

Tx
  • Pain killers

Patient information

What can you do about headache?
Give something to kill the pain!.


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Definition of Headache | Autoprac


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