II. Epidemiology: Prevalence
- Episodic Headaches: 50% of U.S. adults suffer from Headaches at any period of time
- Chronic Headaches: 2-4% of U.S. Adults
- Chronic daily symptoms in up to 30% of those with chronic Headaches
-
Headaches are a common trigger for medical care visits
- Acute Headache is the fourth most common reason for Emergency Department evaluation
- Half of Migraine Headache visits are to primary care
III. Pathophysiology: Headache Central Sensitization
- Frequent episodic Headaches may progress to chronic Headaches without management
- Results in central sensitization and Neuronal dysfunction
- Central sensitization Inappropriate response to low level stimuli
- Lower thresholds trigger pain response
- Exaggerated stimulus response
- Pain persists after trigger is removed
- Risk Factors for progression from episodic Headache to chronic Headache are specific to Headache type
IV. Causes: Urgent Headaches
V. Causes: Primary Headaches
- See Acute Recurrent Headache
- See Chronic Nonprogressive Headache
- Common Headaches
- Tension Headache (50% of acute Headaches)
- Common Migraine Headache (10% of acute Headaches)
- Other Primary Headaches
- Migraine with Aura (Classic Migraine)
- Cluster Headache and other trigeminal autonomic Cephalgias (<1%)
- Sexual Headache
VI. Causes: Secondary Headaches
- See Headache Red Flag
-
Acute Localized Headache
- Sinus Headache (e.g. Acute Sinusitis)
- Myofacial pain
- Ophthalmologic Headache
- Acute Angle-Closure Glaucoma (severe Eye Pain)
- Generalized Headache
- Life-treatening secondary causes
- Meningitis or Encephalitis
- Carbon Monoxide Poisoning
- Subarachnoid Hemorrhage
- Acute or chronic Subdural Hematoma
- Cerebellar infarction
- Temporal Arteritis
- Cerebral or dural venous sinus thrombosis
- Cervical Artery Dissection (carotid dissection, Vertebrobasilar Dissection)
- Preeclampsia (Pregnancy Induced Hypertension)
- Intracranial Mass
- Pituitary apoplexy
- Miscellaneous secondary causes
VII. History
- See Headache History
VIII. Exam
IX. Differential Diagnosis
- See Headache Causes
- See Headache Red Flag
- See Organic Headache
X. Diagnostics
XI. Management
- See Nonpharmacologic Headache Treatment
- See Chronic Daily Headache
- Musculoskeletal Headaches
- Migraine Headache Management
- Iatrogenic Headaches and medication overuse
- Trigeminal Nerve Syndromes
- Organic Headaches
- Headache Management in women
-
Headaches in other specific cohorts
- See Headache in HIV