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Headache

   Headache definition and facts

   What is a headache?

   How are headaches classified?

   What are primary headaches?

   What are secondary headaches?

   What are cranial neuralgias, facial pain, and other headaches?

   17 types of headaches

   What causes headaches?

   What causes tension headaches?

   What are the signs and symptoms of tension headaches?

   How are tension headaches diagnosed?

   How are tension headaches treated?

   What causes cluster headaches?

   What are the symptoms of cluster headaches?

   How are cluster headaches diagnosed?

   How are cluster headaches treated?

   Can cluster headaches be prevented?

   What diseases cause secondary headaches?

   How are secondary headaches diagnosed?

   What are the exams and tests for secondary headaches?

   When should I seek medical care for a headache?

   How do you get rid of a headache? Are home remedies effective for headaches?

   Headache Center

   A Visual Guide to Migraine Headaches Slideshow

   Headache and Migraine Triggers Slideshow

   Take the Migraines Quiz

   Headaches FAQs

   Patient Comments: Headache - Effective Treatments

   Patient Comments: Headache - Symptoms

   Patient Comments: Headache - Remedies

   Patient Comments: Headache - Causes

   Patient Comments: Headache - Nausea

   Patient Comments: Headache - Experience

   Find a local Neurologist in your town

   Headache definition and facts

   What is a headache?

   How are headaches classified?

   What are primary headaches?

   What are secondary headaches?

   What are cranial neuralgias, facial pain, and other headaches?

   17 types of headaches

   What causes headaches?

   What causes tension headaches?

   What are the signs and symptoms of tension headaches?

   How are tension headaches diagnosed?

   How are tension headaches treated?

   What causes cluster headaches?

   What are the symptoms of cluster headaches?

   How are cluster headaches diagnosed?

   How are cluster headaches treated?

   Can cluster headaches be prevented?

   What diseases cause secondary headaches?

   How are secondary headaches diagnosed?

   What are the exams and tests for secondary headaches?

   When should I seek medical care for a headache?

   How do you get rid of a headache? Are home remedies effective for headaches?

Headache definition and facts

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   The head is one of the most common sites of pain in the body.

   Headache or head pain sometimes can be difficult to describe, but some common symptoms include throbbing, squeezing, constant, unrelenting, or intermittent. The location may be in one part of the face or skull, or may be generalized involving the whole head.

   Headache may arise spontaneously or may be associated with activity or exercise. It may have an acute onset or it may be chronic in nature with or without episodes of increasing severity.

   Headache is often associated with nausea and vomiting. This is especially true with migraine headaches.

   Head pain can be classified as being one of three types: 1) primary headache, 2) secondary headache, and 3) cranial neuralgias, facial pain, and other headaches.

   Common primary headaches include tension, migraine, and cluster headaches.

   Home remedies for tension headaches, the most common type of primary headache, include rest and over-the-counter (OTC) medications for pain.

   Secondary headaches are usually a symptom of an injury or an underlying illness. For example, sinus headaches are considered a secondary headache due to increased pressure or infection in the sinuses.

   Medication overuse headache (rebound headache) is a condition where frequent use of pain medications can lead to persistent head pain. The headache may improve for a short time after medication is taken and then recur (The term "rebound headache" has been replaced by the term "medication overuse headache")

   Individuals. should seek medical care for new onset headaches or if headaches are associated with fever, stiff neck, weakness, change in sensation on one side of the body, change in vision, vomiting or change in behavior that may be caused by the development of serious infections.

What is a headache?

Headache is defined as a pain arising from the head or upper neck of the body. The pain originates from the tissues and structures that surround the skull or the brain because the brain itself has no nerves that give rise to the sensation of pain (pain fibers). The thin layer of tissue (periosteum) that surrounds bones, muscles that encase the skull, sinuses, eyes, and ears, as well as thin tissues that cover the surface of the brain and spinal cord (meninges), arteries, veins, and nerves, all can become inflamed or irritated and cause headache. The pain may be a dull ache, sharp, throbbing, constant, intermittent, mild, or intense.

How are headaches classified?

In 2013, the International Headache Society released its latest classification system for headache. Because so many people suffer from headaches, and because treatment is difficult sometimes, it was hoped that the new classification system would help health-care professionals make a more specific diagnosis as to the type of headache a patient has, and allow better and more effective options for treatment.

The guidelines are extensive and the Headache Society recommends that health-care professionals consult the guidelines frequently to make certain of the diagnosis.

There are three major categories of headache based upon the source of the pain.

   Primary headaches

   Secondary headaches

   Cranial neuralgias, facial pain, and other headaches

The guidelines also note that a patient may have symptoms that are consistent with more than one type of headache, and that more than one type of headache may be present at the same time.

Quick GuideMigraine or Headache? Migraine Symptoms, Triggers, Treatment

Migraine or Headache? Migraine Symptoms, Triggers, Treatment

Migraine Triggers

A migraine is a throbbing painful headache, usually on one side of the head, that is often initiated or "triggered" by specific compounds or situations (environment, stress, hormones, and many others). They occur more often in women (75%, approximately) and may affect a person's ability to do common tasks.

Migraine headaches are often triggered to occur when the person is exposed to a specific set of circumstances.

   flashing lights

   anxiety and stress

   lack of food or sleep

   hormonal changes

   foods (red wine, cheese, chocolate, soy sauce, processed meat, and MSG)

   tyramine

   caffeine

Read more about migraine triggers »

What are primary 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. Tension headaches occur more commonly among women than men. According to the World Health Organization, 1 in 20 people in the developed world suffer with a daily tension headache.

   Migraine headaches are the second most common type of primary headache. Migraine headaches affect children as well as adults. Before puberty, boys and girls are affected equally by migraine headaches, but after puberty, more women than men are affected.

   Cluster headaches are a rare type of primary headache. It more commonly affects men in their late 20s though women and children can also suffer from this type of headache.

Primary headaches can affect the quality of life. Some people have occasional headaches that resolve quickly while others are debilitating. While these headaches are not life threatening, they may be associated with symptoms that can mimic strokes.

Many patients equate severe headache with migraine, but the amount of pain does not determine the diagnosis of migraine. Read our Migraine Headache article for more information about the symptoms, causes, and treatment of migraines.

What are secondary headaches?

Secondary headaches are those that are due to an underlying structural or infectious problem in the head or neck. This is a very broad group of medical conditions ranging from dental pain from infected teeth or pain from an infected sinus, to life-threatening conditions like bleeding in the brain or infections like encephalitis or meningitis.

Traumatic headaches fall into this category including post-concussion headaches.

This group of headaches also includes those headaches associated with substance abuse and excess use of medications used to treat headaches (medication overuse headaches). "Hangover" headaches fall into this category as well. People who drink too much alcohol may waken with a well-established headache due to the effects of alcohol and dehydration.

What are cranial neuralgias, facial pain, and other headaches?

Neuralgia means nerve pain (neur=nerve + algia=pain). Cranial neuralgia describes inflammation of one of the 12 cranial nerves coming from the brain that control the muscles and carry sensory signals (such as pain) to and from the head and neck. Perhaps the most commonly recognized example is trigeminal neuralgia, which affects cranial nerve V (the trigeminal nerve), the sensory nerve that supplies the face and can cause intense facial pain when irritated or inflamed.

Migraine Headaches:Symptoms, Triggers and Treatment

A Visual Guide to Migraine Headaches Slideshow

Headaches & Migraines: Surprising Headache & Migraine Triggers

Headache and Migraine Triggers Slideshow

Take the Migraines Quiz

17 types of headaches

The different types of headaches depend upon the class to which they belong. Some common types include:

   Primary tension headaches that are episodic

   Primary tension headaches that are chromic

   Primary muscle contraction headaches

   Primary migraine headaches with aura

   Primary migraine headaches without aura

   Primary cluster headache

   Primary paroxysmal hemicrania (a type of cluster headache)

   Primary cough headache

   Primary stabbing headache

   Primary headache associated with sexual intercourse

   Primary thunderclap headache

   Hypnic headache (headaches that awaken a person from sleep)

   Hemicrania continua (headaches that are persistently on one side only. right or left [unilateral])

   New daily-persistent headache (NDPH) (a type of chronic headache)

   Headache from exertion

   Trigeminal neuralgia and other cranial nerve inflammation

   Secondary headaches due to:

       Trauma

       Disorders

       Infection

       Structural problems with the bones of the face, teeth, eyes, ears, nose, sinuses or other structures

       Substance abuse or withdrawal

What causes headaches?

Migraine headache is caused by inflammation or irritation of structures that surround the brain or affect its function. While the brain itself has no pain nerve fibers, everything else above the shoulders, from the neck, skull, and face, can cause a person to have of head pain. Systemic illnesses, including infection or dehydration, can have associated headache. These are known as toxic headache. Changes in circulation and blood flow or trauma can also cause headache.

Changes in brain chemistry may also be associated with headache: medication reactions, drug abuse and drug withdrawal can all cause pain.

Every person is different so the history of the headache is important. Recognizing patterns or precipitating (foods eaten, stress, etc.) factors, in combination with the physical examination and associated symptoms, can help identify the cause for each individual's specific headache.

What causes tension headaches?

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While tension headaches are the most frequently occurring type of headache, their cause is not known. The most likely cause is contraction of the muscles that cover the skull. When the muscles covering the skull are stressed, they may become inflamed, go into spasm, and cause pain. Common sites include the base of the skull where the trapezius muscles of the neck insert, the temples where muscles that move the jaw are located, and the forehead.

There is little research to confirm the exact cause of tension headaches. It is believed that tension headaches occur because of physical stress on the muscles of the head. For example, these stressors can cause the muscles surrounding the skull to clench the teeth and go into spasm. Physical stressors include difficult and prolonged manual labor, or sitting at a desk or computer concentrating for long periods. Emotional stress also might cause tension headaches by causing the muscles surrounding the skull to contract.

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What are the signs and symptoms of tension headaches?

Common signs and of tension headaches include:

   Pain that begins in the back of the head and upper neck and is often described as a band-like tightness or pressure. It may spread to encircle the head.

   The most intense pressure may be felt at the temples or over the eyebrows where the temporalis and frontal muscles are located.

   The pain may vary in intensity but usually is not disabling, meaning that the sufferer may continue with daily activities. The pain usually is bilateral (affecting both sides of the head).

   The pain is not associated with an aura (see below), nausea, vomiting, or sensitivity to light and sound.

   The pain occurs sporadically (infrequently and without a pattern) but can occur frequently and even daily in some people.

   The pain allows most people to function normally, despite the headache.

How are tension headaches diagnosed?

The key to making the diagnosis of any headache is the history given by the patient. The health-care professional will ask questions about the headache to try to help make the diagnosis. Those questions will try to define the quality, quantity, and duration of the pain, as well as any associated symptoms. The person with a tension headache will usually complain of mild-to-moderate pain that is located on both sides of the head. People with tension headaches describe the pain as a non-throbbing tightness, that is not made worse with activity. There usually are no associated symptoms like nausea, vomiting, or light sensitivity.

The physical examination, particularly the neurologic portion of the examination, is important in tension headaches because to make the diagnosis, it should be normal. However, there may be some tenderness of the scalp or neck muscles. If the health-care professional finds an abnormality on neurologic exam, then the diagnosis of tension headache should be put on hold until the potential for other causes of headaches has been investigated.

Migraine Headaches:Symptoms, Triggers and Treatment

A Visual Guide to Migraine Headaches Slideshow

Headaches & Migraines: Surprising Headache & Migraine Triggers

Headache and Migraine Triggers Slideshow

Take the Migraines Quiz

How are tension headaches treated?

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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 make daily activities more difficult to accomplish. 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, Panadol) and

   naproxen (Aleve).

If these fail, other supportive treatments are available. Recurrent headaches should be a signal to seek medical help. Physical therapy, 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 a health care professional or pharmacist if one has questions about OTC medications and their use. This is especially important with OTC pain medications, because they are used 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 listed ingredient may have the potential interfering with the action of other drugs based upon a patient's other medical issues For example:

   Some OTC medications include caffeine, which may trigger rapid heartbeats in some patients.

   In nighttime preparations, diphenhydramine (Benadryl) may be added. This may cause sedation, and driving or using heavy machinery may not be appropriate when taking a sedative medication.

   Some OTC cold medications have pseudoephedrine mixed in with the pain medication. This drug can cause elevated blood pressure and palpitations.

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 life threatening complication that may occur when a viral infection is present and aspirin is taken.

   Aspirin, ibuprofen, and naproxen are anti-inflammatory medications that can be irritating to the stomach and may cause intestinal bleeding. They should be used with caution in patients who have peptic ulcer disease.

   Most anti-inflammatory medicines also cause the potential for bleeding elsewhere in the body, and you should not take them if you also take blood thinners. Talk with your doctor or other health care professional about the benefits and risks of anti-inflamatory drugs. Blood thinners include warfarin (Coumadin), heparin (Lovenox), dabigatran (Pradaxa), apixaban (Eliquis), rivaroxaban (Xarelto), edoxaban (Savaysa), clopidogrel bisulfate (Plavix), ticagrelor (Brilinta), and prasugrel (Effient).

   Overuse of aspirin, ibuprofen, and naproxen also may cause kidney damage.

   Acetaminophen, if used in amounts greater than recommended, can cause liver damage or failure. It also should be used with caution in patients who drink significant amounts of alcohol or who have liver disease because even lesser doses than are normally recommended may be dangerous.

   Medication overuse headache can be mistaken for chronic tension headaches. When pain medications are used for a prolonged period headaches may recur because the effects of the medication wear off. (This type of headache was referred to as a "rebound headache," and is classified as a secondary headache.)

Quick GuideMigraine or Headache? Migraine Symptoms, Triggers, Treatment

Migraine or Headache? Migraine Symptoms, Triggers, Treatment

What causes cluster headaches?

Cluster headaches are so named because they tend to occur daily for periods of a week or more followed by long periods of time -- months to years -- with no headaches. They occur at the same time of day, often waking the patient in the middle of the night.

The cause of cluster headaches is uncertain but may be due to a sudden release of the chemicals histamine and serotonin in the brain. The hypothalamus, an area located at the base of the brain, is responsible for the body's biologic clock and may be the source for this type of headache. When brain scans are performed on patients who are in the midst of a cluster headache, abnormal activity has been found in the hypothalamus.

Cluster headaches also:

   tend to run in families and this suggests that there may be a role for genetics;

   may be triggered by changes in sleep patterns; and

   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, and foods high in nitrites like smoked meats) also are potential causes for headache.

What are the symptoms of cluster headaches?

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Cluster headaches are headaches that come in groups (clusters) separated by pain-free periods of months or years. A patient may experience a headache on a daily basis for weeks or months and then be pain-free for years. This type of headache affects men more frequently. They often begin in adolescence but can extend into middle age.

   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 people with migraine headaches, those with cluster headaches tend to be restless. They often pace the floor and/or bang their heads against a wall. People with cluster headaches can be driven to desperate measures, including suicidal thoughts.

How are cluster headaches diagnosed?

The diagnosis of cluster headache is made by taking the patient's history. The description of the pain and its clock-like recurrence is usually enough to make the diagnosis.

If examined in the midst of an attack, the patient usually is in a painful crisis and may have the eye and nose watering as described previously. If the patient is seen when the pain is not present, the physical examination is normal and the diagnosis will depend upon the history.

Migraine Headaches:Symptoms, Triggers and Treatment

A Visual Guide to Migraine Headaches Slideshow

Headaches & Migraines: Surprising Headache & Migraine Triggers

Headache and Migraine Triggers Slideshow

Take the Migraines Quiz

How are cluster headaches treated?

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Cluster headaches may be very difficult to treat, and it may take trial and error to find the specific treatment regimen that will work for each patient. Since the headache recurs daily, there are two treatment needs. The pain of the first episode needs to be controlled, and the headaches that follow need to be prevented.

Initial treatment options may include one or more of the following:

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

   injection of triptan medications, like, sumatriptan (Imitrex), zolmitriptan (Zomig), and rizatriptan (Maxalt) which are common migraine medications;

   Spraying or dripping lidocaine, a local anesthetic, into the nostril;

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

   caffeine.

Prevention of the next cluster headache may include

   calcium channel blockers, for example, verapamil (Calan, Verelan, Verelan PM, Isoptin, Covera-HS) and diltiazem (Cardizem, Dilacor, Tiazac);

   prednisone (Deltasone, Liquid Pred);

   antidepressant medications;

   lithium (Eskalith, Lithobid); and

   antiseizure medications including valproic acid, divalproex (Depakote, Depakote ER, Depakene, Depacon), and topiramate (Topamax).

Can cluster headaches be prevented?

Since cluster headache episodes may be spaced years apart, and since the first headache of a new cluster episode can't be predicted, daily medication may not be warranted.

Lifestyle changes may help minimize the risk of a cluster headache flare. Stopping smoking and minimizing alcohol may prevent future episodes of cluster headache.

Quick GuideMigraine or Headache? Migraine Symptoms, Triggers, Treatment

Migraine or Headache? Migraine Symptoms, Triggers, Treatment

What diseases cause secondary headaches?

Headache is a symptom associated with many illnesses. While head pain itself is the issue with primary headaches, secondary headaches are due to an underlying disease or injury that needs to be diagnosed and treated. Controlling the headache symptom will need to occur at the same time that diagnostic testing is performed to identify the underlying disease. Some of the causes of secondary headache may be potentially life threatening and deadly. Early diagnosis and treatment is essential if damage is to be limited.

The International Headache Society lists eight categories of secondary headache. A few examples in each category are noted (This is not a complete list.).

Head and neck trauma

   Injuries to the head may cause bleeding in the spaces between the meninges, the layers of tissue that surround the brain (subdural, epidural, and subarachnoid spaces) or within the brain tissue itself (intracerebral hemorrhage: intra=within + cerebral=brain, hemorrhage=bleeding).

   Edema or swelling within the brain, not associated with bleeding, may cause pain and a change in mental function.

   Concussions, where head injury occurs without bleeding. Headache is one of the hallmarks of post-concussion syndrome.

   Whiplash and neck injury also cause head pain.

Blood vessel problems in the head and neck

   Stroke or transient ischemic attack (TIA).

   Arteriovenous malformations (AVM) when they leak.

   Cerebral aneurysm and subarachnoid hemorrhage. An aneurysm, or a weakened area in a blood vessel wall, can expand and leak a small amount of blood causing what is called a sentinel headache. This may be a warning sign of a future catastrophic bleed into the brain.

   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 cancer that began in another organ

   Seizures

   Idiopathic intracranial hypertension, historically called pseudotumor cerebri, where pressure within the spinal canal increases. The cause is unknown and while it can occur in all ages, it often affects young, obese females. Idiopathic intracranial hypertension can cause significant headache and if left untreated may, on occasion, lead to blindness.

Medications and drugs (including withdrawal from those drugs)

Oral contraceptives, medications used to treat erectile dysfunction, blood pressure or other cardiac medications can all lead to or cause headaches. Medication overuse headache, occurring when pain medications are taken too frequently, can be caused by acetaminophen (Tylenol and others), aspirin, ibuprofen (Advil and others), OTC analgesics with caffeine (Excedrin®, etc.), as well as narcotic analgesics and other prescription pain medications.

Infection

   Meningitis

   Encephalitis

   HIV/AIDS

   Systemic infections (for example, pneumonia or influenza)

Changes in the body's environment

   High blood pressure (hypertension)

   Dehydration

   Hypothyroidism

   Kidney dialysis

Problems with the eyes, ears, nose throat, teeth, sinuses, and neck

   Sinus infection

   Dental pain

   Glaucoma

   Iritis

How are secondary headaches diagnosed?

If there is time, the diagnosis of secondary headache begins with a complete patient history followed by a physical examination and laboratory and radiology tests as appropriate.

However, some patients present in crisis with a decreased level of consciousness or unstable vital signs due to the underlying cause of the headache. In these situations, the health-care professional may decide to treat a specific cause without waiting for tests to confirm the diagnosis.

For example, a patient with headache, fever, stiff neck, and confusion may have meningitis. Since meningitis can be rapidly fatal, antibiotic therapy may be started before blood tests and a lumbar puncture are performed to confirm the diagnosis. It may be that another diagnosis ultimately is found, for example, a brain tumor or subarachnoid hemorrhage, but the benefit of early antibiotics outweighs the risk of not giving them promptly.

What are the exams and tests for secondary headaches?

The patient history and physical examination provide the initial direction for determining the cause of secondary headaches. Therefore, it is extremely important that a patient with new, severe headache seeks medical care and gives their health-care professional an opportunity to assess their condition. Tests that may be useful in making the diagnosis of the underlying disease causing the headaches will depend upon the doctor's evaluation and what specific disease, illness, or injury is being considered as the cause of the headaches (the differential diagnosis). Common tests that are considered include the following:

   blood tests;

   computerized tomography (CT scan) of the neck;

   magnetic resonance imaging (MRI) scans of the head; and

   lumbar puncture (spinal tap).

Specific tests will depend upon what potential issues the health-care professional and patient want to address.

Blood tests

Blood tests provide helpful information in association with the history and physical examination in pursuing a diagnosis. For example, an infection or inflammation in the body may cause a rise in the white blood cell count, the erythrocyte sedimentation rate (ESR), or C-reactive protein (CRP). These two tests are very nonspecific; that is, they may be abnormal with any infection or inflammation, and abnormalities do not point to a specific diagnosis of the cause of the infection or inflammation. The ESR is often used to make the tentative diagnosis of temporal arteritis, a condition that affects an older patient, usually over the age of 65, who presents with a sharp, stabbing temporal headache, due to inflammation of the arteries on one side of the head.

Blood tests may be used to assess electrolyte imbalance, and a variety of other potential problems involving organs like the liver, kidney, and thyroid.

Toxicology tests may be helpful if the patient is suspected of abusing alcohol, prescription, or other drugs of abuse.

Computerized tomography of the head

Computerized tomography (CT scan) is able to detect bleeding, swelling, and some tumors within the skull and brain. It also can show evidence of a previous stroke. With intravenous contrast injection, (angiogram) it may also be used to look at the arteries of the brain for aneurysms.

Magnetic resonance imaging (MRI) of the head

MRI is able to show the anatomy of the brain and the layers that cover the brain and the spinal cord (meninges). It is more precise than computerized tomography. This type of scan is not available at all hospitals. Moreover, it takes much longer to perform, requires the patient to cooperate by holding still, and requires that the patient have no metal in their body (for example, a heart pacemaker or metal foreign objects in the eye).

Lumbar puncture

Cerebrospinal fluid, the fluid that surrounds the brain and spinal cord, can be obtained with a needle that is inserted into the spine in the lower back. Examination of the fluid looks for infection (such as meningitis due to bacteria, virus, fungus, or tuberculosis) or blood from hemorrhage. In almost all cases, computerized tomography is done prior to lumbar puncture to make certain there is no bleeding, swelling, or tumor within the brain. Pressure within the space can be measured when the lumbar puncture needle is inserted. Elevated pressures may make the diagnosis of idiopathic intracranial hypertension (previously known as pseudotumor cerebri) in combination with the appropriate history and physical examination.

When should I seek medical care for a headache?

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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 a ruptured cerebral aneurysm. The amount of pain will often be taken in context with the appearance of the patient and other associated signs and symptoms. Too often, patients are prompted to use this expression by a health-care professional and do not routinely volunteer the phrase.

   Different than their 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. A stiff neck may be due to meningitis or blood from a ruptured aneurysm. However, most patients who complain of a stiff neck have muscle spasm and inflammation as the cause.

   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 on one side of their body that may be a sign of stroke.

   Not responding to treatment or 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

How do you get rid of a headache? Are home remedies effective for headaches?

It is important to consider that an unusual headache may need to be evaluated by a health-care professional, but in most instances, primary tension headaches may be initially treated at home.

   First steps include maximizing rest and staying well hydrated.

   Recognizing and minimizing stressful situations may be of help, if that is one of the contributing causes of the headache.

   If there has been a cold or runny nose recently, humidifying air may be helpful in allowing sinuses to drain.

   Rubbing or massaging the temples or the muscles at the back of the neck may be soothing, as might warm compresses.

   Over-the-counter pain medication may be helpful, in moderation.

Those with migraine headaches often have a treatment plan that will allow treatment at home. Prescription medications are available to abort or stop the headache. Other medications are available to treat the nausea and vomiting. Most patients with migraine headaches get much relief after resting in a dark room and falling asleep.

Patients who have secondary headaches will often need to seek medical care.

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Medically Reviewed on 8/16/2017

References

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Symptoms

Headache

By Mayo Clinic Staff

Headache is pain in any region of the head. Headaches may occur on one or both sides of the head, be isolated to a certain location, radiate across the head from one point, or have a viselike quality.

A headache may appear as a sharp pain, a throbbing sensation or a dull ache. Headaches can develop gradually or suddenly, and may last from less than an hour to several days.

Your headache symptoms can help your doctor determine its cause and the appropriate treatment. Most headaches aren't the result of a serious illness, but some may result from a life-threatening condition requiring emergency care.

Headaches are generally classified by cause:

Primary headaches

A primary headache is caused by overactivity of or problems with pain-sensitive structures in your head. A primary headache isn't a symptom of an underlying disease.

Chemical activity in your brain, the nerves or blood vessels surrounding your skull, or the muscles of your head and neck (or some combination of these factors) can play a role in primary headaches. Some people may also carry genes that make them more likely to develop such headaches.

Seek emergency care

A headache can be a symptom of a serious condition, such as a stroke, meningitis or encephalitis.

Go to a hospital emergency room or call 911 or your local emergency number if you're experiencing the worst headache of your life, a sudden, severe headache or a headache accompanied by:

   Confusion or trouble understanding speech

   Fainting

   High fever, greater than 102 F to 104 F (39 C to 40 C)

   Numbness, weakness or paralysis on one side of your body

   Stiff neck

   Trouble seeing

   Trouble speaking

   Trouble walking

   Nausea or vomiting (if not clearly related to the flu or a hangover)

Schedule a doctor's visit

See a doctor if you experience headaches that:

   Occur more often than usual

   Are more severe than usual

   Worsen or don't improve with appropriate use of over-the-counter drugs

   Keep you from working, sleeping or participating in normal activities

   Cause you distress, and you would like to find treatment options that enable you to control them better

   Ferri FF. Ferri's Clinical Advisor 2016. Philadelphia, Pa.: Mosby Elsevier; 2016. https://www.clinicalkey.com. Accessed Feb. 29, 2016.

   Digre KB. Headaches and other head pain. In: Goldman-Cecil Medicine. 25th ed. Philadelphia, Pa.: Saunders Elsevier; 2016. http://www.clinicalkey.com. Accessed March 2, 2016

   Secondary headaches. American Headache Society Committee for Headache Education. http://www.achenet.org/resources/secondary_headaches/. Accessed March 2, 2016.

   Wong ET, et al. Clinical presentation and diagnosis of brain tumors. http://www.uptodate.com/home. Accessed March 2, 2016.

   NINDS meningitis and encephalitis information page. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/encephalitis_meningitis/encephalitis_meningitis.htm. Accessed March 3, 2016.

   NINDS stroke information page. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/stroke/stroke.htm. Accessed March 3, 2016.

   Cutrer FM. Primary cough headache. http://www.uptodate.com/home. Accessed March 3, 2016.

   Garza I, et al. Overview of chronic daily headache. http://www.uptodate.com/home. Accessed March 3, 2016.

   Friedman BW, et al. Headache emergencies: Diagnosis and management. Neurological Clinics. 2012;30:43.

   Headache hygiene tips. American Headache Society Committee for Headache Education. http://www.achenet.org/resources/trigger_avoidance_information /. Accessed March 8, 2016.

   Flu symptoms & severity. Centers for Disease Control and Prevention. http://www.cdc.gov/flu/about/disease/symptoms.htm. Accessed March 8, 2016.

   Cutrer FM, et al. Cough, exercise, and sex headaches. Neurologic Clinics. 2014:32:433.

   Bajwa ZH, et al. Evaluation of headache in adults. http://www.uptodate.com/home. Accessed March 2, 2016.

   Evans RW, et al. Postconcussion syndrome. http://www.uptodate.com/home. Accessed March 2, 2016.

   Green MW. Secondary headaches. In: Continuum Lifelong Learning Neurology. 2012;18:783.

   Simon RA. Allergic and asthmatic reactions to food additives. http://www.uptodate.com/home. Accessed March 8, 2016.

   External compression headache. International Headache Society. http://ihs-classification.org/en/02_klassifikation/04_teil3/13.10.00_facialpain.html. Accessed March 8, 2016.

   Seifert T. Headache in sports. Current Pain and Headache Reports. 2014;18:448.

   The elusive hangover cure. British Columbia Drug and Poison Information Centre. http://dpic.org/article/professional/elusive-hangover-cure. Accessed March 8, 2016.

   Headache: Hope through research. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/headache/detail_headache.htm#142883138. Accessed March 8, 2016.

   When to see a physician for your headache. National Headache Foundation. http://www.headaches.org/when-to-see-a-physician-for-your-headache/. Accessed March 8, 2016.

Jan. 11, 2018

Original article: http://www.mayoclinic.org/symptoms/headache/basics/definition/sym-20050800

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What is causing this headache?

Last updated Mon 13 November 2017

By James McIntosh

Reviewed by University of Illinois-Chicago, School of Medicine

   Causes Types Treatment Home remedies Symptoms Diagnosis

Headaches are one of the most common medical complaints; most people experience them at some point in their life. They can affect anyone regardless of age, race, and gender.

The World Health Organization (WHO) reports that almost half of all adults worldwide will experience a headache in any given year.

A headache can be a sign of stress or emotional distress, or it can result from a medical disorder, such as migraine or high blood pressure, anxiety, or depression. It can lead to other problems. People with chronic migraine headaches, for example, may find it hard to attend work or school regularly.

Causes

[headache]

Headache is a common complaint worldwide.

A headache can occur in any part of the head, on both sides of the head, or in just one location.

There are different ways to define headaches.

The International Headache Society (IHS) categorize headaches as primary, when they are not caused by another condition, or secondary, when there is a further underlying cause.

Primary headaches

Primary headaches are stand-alone illnesses caused directly by the overactivity of, or problems with, structures in the head that are pain-sensitive.

This includes the blood vessels, muscles, and nerves of the head and neck. They may also result from changes in chemical activity in the brain.

Common primary headaches include migraines, cluster headaches, and tension headaches.

Secondary headaches

Secondary headaches are symptoms that happen when another condition stimulates the pain-sensitive nerves of the head. In other words, the headache symptoms can be attributed to another cause.

A wide range of different factors can cause secondary headaches.

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These include:

   alcohol-induced hangover

   brain tumor

   blood clots

   bleeding in or around the brain

   "brain freeze," or ice-cream headaches

   carbon monoxide poisoning

   concussion

   dehydration

   glaucoma

   teeth-grinding at night

   influenza

   overuse of pain medication, known as rebound headaches

   panic attacks

   stroke

As headaches can be a symptom of a serious condition, it is important to seek medical advice if they become more severe, regular, or persistent.

For example, if a headache is more painful and disruptive than previous headaches, worsens, or fails to improve with medication or is accompanied by other symptoms such as confusion, fever, sensory changes, and stiffness in the neck, a doctor should be contacted immediately.

Types

There are different types of headache.

Tension headaches

[brain freeze]

Eating something very cold can lead to a "brain freeze."

Tension headaches are the most common form of primary headache. Such headaches normally begin slowly and gradually in the middle of the day.

The person can feel:

   as if they have a tight band around the head

   a constant, dull ache on both sides

   pain spread to or from the neck

Tension-type headaches can be either episodic or chronic. Episodic attacks are usually a few hours in duration, but it can last for several days. Chronic headaches occur for 15 or more days a month for a period of at least 3 months.

Migraines

A migraine headache may cause a pulsating, throbbing pain usually only on one side of the head. The aching may be accompanied by:

   blurred vision

   light-headedness

   nausea

   sensory disturbances known as auras

Migraine is the second most common form of primary headache and can have a significant impact on the life of an individual. According to the WHO, migraine is the sixth highest cause of days lost due to disability worldwide. A migraine can last from a few hours to between 2 and 3 days.

Rebound headaches

Rebound or medication-overuse headaches stem from an excessive use of medication to treat headache symptoms. They are the most common cause of secondary headaches. They usually begin early in the day and persist throughout the day. They may improve with pain medication, but worsen when its effects wear off.

Along with the headache itself, rebound headaches can cause:

   neck pain

   restlessness

   a feeling of nasal congestion

   reduced sleep quality

Rebound headaches can cause a range of symptoms, and the pain can be different each day.

Cluster headaches

Cluster headaches usually last between 15 minutes and 3 hours, and they occur suddenly once per day up to eight times per day for a period of weeks to months. In between clusters, there may be no headache symptoms, and this headache-free period can last months to years.

The pain caused by cluster headaches is:

   one-sided

   severe

   often described as sharp or burning

   typically located in or around one eye

The affected area may become red and swollen, the eyelid may droop, and the nasal passage on the affected side may become stuffy and runny.

Thunderclap headaches

These are sudden, severe headaches that are often described as the "worst headache of my life." They reach maximum intensity in less than one minute and last longer than 5 minutes.

A thunderclap headache is often secondary to life-threatening conditions, such as intracerebral hemorhage, cerebral venous thrombosis, ruptured or unruptured aneurysms, reversible cerebral vasoconstriction syndrome (RVS), meningitis, and pituitary apoplexy.

People who experience these sudden, severe headaches should seek medical evaluation immediately.

Treatment

The most common ways of treating headaches are rest and pain relief medication.

Generic pain relief medication is available over the counter (OTC), or doctors can prescribe preventative medication, such as tricyclic antidepressants, serotonin receptor agonists, anti-epileptic drugs, and beta-blockers.

It is important to follow the doctor's advice because overusing pain relief medication can lead to rebound headaches. The treatment of rebound headaches involves the reducing or stopping pain relief medication. In extreme cases, a short hospital stay may be needed to manage withdrawal safely and effectively.

Alternative treatments

[acupuncture for headache]

Acupuncture is an alternative therapy that may help relieve headaches.

Several alternative forms of treatment for headaches are available, but it is important to consult a doctor before making any major changes or beginning any alternative forms of treatment.

Alternative approaches include:

   acupuncture

   cognitive behavior therapy

   herbal and nutritional health products

   hypnosis

   meditation

Research has not provided evidence to confirm that all these methods work.

Sometimes, a headache may result from a deficiency of a particular nutrient or nutrients, especially magnesium and certain B vitamins. Nutrient deficiencies can be due to a poor quality diet, underlying malabsorption issues, or other medical conditions.

Home remedies

A number of steps can be taken to reduce the risk of headaches and to ease the pain if they do occur:

   Apply a heat pack or ice pack to your head or neck, but avoid extreme temperatures.

   Avoid stressors, where possible, and develop healthy coping strategies for unavoidable stress.

   Eat regular meals, taking care to maintain stable blood sugar.

A hot shower can help, although in one rare condition hot water exposure can trigger headaches. Exercising regularly and getting enough rest and regular sleep contributes to overall health and stress reduction.

Symptoms

Headaches can radiate across the head from a central point or have a vise-like quality. They can be sharp, throbbing or dull, appear gradually or suddenly. They can last from less than an hour up to several days.

The symptoms of a headache depend to some extent on what type of headache it is.

Tension headache: There may be general, mild to moderate pain that can feel like a band around the head. They tend to affect both sides of the head.

Migraine headache: There is often a severe throbbing pain in one part of the head, often the front or the side. There may be nausea and vomiting, and the person may feel especially sensitive to light or noise.

Cluster headaches: These can cause intense pain, often around one eye. They usually happen around a particular time of year, possibly over a period of 1 to 2 months.

Diagnosis

A doctor will usually be able to diagnose a particular type of headache through a description of the condition, the type of pain, and the timing and pattern of attacks. If the nature of the headache appears to be complex, tests may be carried out to eliminate more serious causes.

Further testing could include:

   blood tests

   X-rays

   brain scans, such as CT and MRI

The WHO points out that headaches are often not taken seriously because they are sporadic, most headaches do not lead to death, and they are not contagious.

They call for more resources to be allocated for the treatment of headache disorders, because of the huge health burden they represent.

Related coverage

What you need to know about occipital neuralgia A look at occipital neuralgia, a condition also known as a tension headache. Included are details on how they differ from other headaches and prevention. Read now

What is this pain in the back of my head? Learn about five causes of pain in the back of the head. We also look at the triggers and treatment options for each of these headache types. Read now

What to know about frontal lobe headaches Several types of headache can cause pain at the front of the head. Read on to learn more about causes, ways to find relief, and when to see a doctor. Read now

What is a vestibular migraine? We take a look at vestibular migraines, a type of migraine that involves dizziness and vertigo. Learn about the symptoms, causes, and treatment options. Read now

What different types of headaches are there? Learn about some different primary and secondary headaches, including their causes and triggers. For each, we also examine the available treatment options. Read now

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Headache / Migraine

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Additional information

   Article last updated by Yvette Brazier on Mon 13 November 2017.

   Visit our Headache / Migraine category page for the latest news on this subject, or sign up to our newsletter to receive the latest updates on Headache / Migraine.

   All references are available in the References tab.

References

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