II. Epidemiology: Prevalence

  1. Episodic Headaches: 50% of U.S. adults suffer from Headaches at any period of time
    1. Progress to chronic Headaches in 3-4% of episodic Headache patients (Central Sensitization)
  2. Chronic Headaches: 2-4% of U.S. Adults
    1. Chronic daily symptoms in up to 30% of those with chronic Headaches
  3. Headaches are a common trigger for medical care visits
    1. Acute Headache is the fourth most common reason for Emergency Department evaluation
    2. Half of Migraine Headache visits are to primary care

III. Pathophysiology: Headache Central Sensitization

  1. Frequent episodic Headaches may progress to chronic Headaches without management
  2. Results in Central Sensitization and Neuronal dysfunction
  3. Central Sensitization Inappropriate response to low level stimuli
    1. Lower thresholds trigger pain response
    2. Exaggerated stimulus response
    3. Pain persists after trigger is removed
  4. Risk Factors for progression from episodic Headache to chronic Headache are specific to Headache type
    1. See Migraine Headache
    2. See Tension Headache

IV. Causes: Primary Headaches

  1. See Acute Recurrent Headache
  2. See Chronic Nonprogressive Headache
  3. Common Primary Headaches
    1. Tension Headache (50% of acute Headaches)
    2. Common Migraine Headache (10% of acute Headaches)
  4. Other Primary Headaches
    1. Migraine with Aura (Classic Migraine)
    2. Cluster Headache and other trigeminal autonomic Cephalgias (<1%)
    3. Sexual Headache

VI. History

VII. Exam

VIII. Differential Diagnosis

  1. See Headache Causes
  2. See Headache Red Flag
  3. See Organic Headache

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