Headache Causes

Aka: Headache Causes, Primary Headache, Headache Central Sensitization

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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

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: Urgent Headaches

  1. Subarachnoid Hemorrhage
  2. Vertebral Artery Dissection
  3. Carotid Artery Dissection
  4. Hypertensive Emergency
  5. Giant Cell Arteritis
  6. Bacterial Meningitis
  7. Acute angle closure Glaucoma

V. Causes: Primary Headaches

  1. See Acute Recurrent Headache
  2. See Chronic Nonprogressive Headache
  3. Common 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
    3. Sexual Headache

VI. Causes: Secondary Headaches

  1. See Headache Red Flag
  2. Acute Localized Headache
    1. Sinus Headache (e.g. Acute Sinusitis)
    2. Myofacial pain
      1. Cervical Spine disorder (Cervical Spondylosis)
      2. Temporomandibular Joint Dysfunction
    3. Ophthalmologic Headache
      1. Acute Angle-Closure Glaucoma (severe Eye Pain)
  3. Generalized Headache
    1. See Acute Generalized Headache
    2. See Chronic Progressive Headache (Organic Headache)
    3. See Headache Red Flags
  4. Life-treatening secondary causes
    1. Meningitis or Encephalitis
    2. Carbon Monoxide Poisoning
    3. Subarachnoid Hemorrhage
    4. Acute or chronic Subdural Hematoma
    5. Cerebellar infarction
    6. Temporal Arteritis
    7. Cerebral or dural venous sinus thrombosis
    8. Cervical Artery Dissection (carotid dissection, Vertebrobasilar Dissection)
    9. Preeclampsia (Pregnancy Induced Hypertension)
    10. Intracranial Mass
    11. Pituitary apoplexy
  5. Miscellaneous secondary causes
    1. Hormonal Headache
      1. Menstrual Migraine
      2. Estrogen in Oral Contraceptive
    2. Benign Intracranial Hypertension: Pseudotumor Cerebri (esp. in women with Obesity)
    3. Post-Traumatic Headache (Postconcussion Syndrome)
    4. Obstructive Sleep Apnea
    5. Temporomandibular Joint Disorder
    6. Frontal Sinusitis

VII. History

  1. See Headache History

VIII. Exam

  1. See Headache Examination

IX. Differential Diagnosis

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

X. Diagnostics

  1. See Headache Diagnostic Testing
  2. See Neuroimaging in Headache

XI. Management

  1. See Nonpharmacologic Headache Treatment
  2. See Chronic Daily Headache
  3. Musculoskeletal Headaches
    1. See Tension Headache
    2. See Occipital Headache
  4. Migraine Headache Management
    1. See Migraine Headache Management
    2. See Migraine Abortive Treatment
    3. See Migraine Headache Prophylaxis
    4. See Migraine Headache Management in Children
    5. See Emergency Department Migraine Headache Care
  5. Iatrogenic Headaches and medication overuse
    1. See Rebound Headache
    2. See Spinal Headache (Post-Dural Puncture Headache)
  6. Trigeminal Nerve Syndromes
    1. See Trigeminal Neuralgia
    2. See Cluster Headache
    3. See SUNCT Syndrome
    4. See Paroxysmal Hemicrania
    5. See Hemicrania Continua
  7. Organic Headaches
    1. See Headache Red Flag
    2. See Subarachnoid Hemorrhage (Thunderclap Headache)
    3. See Pseudotumor Cerebri
    4. See Exertional Headache
    5. See Temporal Arteritis
  8. Headache Management in women
    1. Hypertensive Disorders of Pregnancy
    2. See Migraine Medications in Pregnancy
    3. See Migraine Medications in Breast Feeding
    4. See Headache in Pregnancy
    5. See Menstrual Migraine
  9. Headaches in other specific cohorts
    1. See Headache in HIV

XII. References

  1. Mayans (2018) Am Fam Physician 97(4): 243-51 [PubMed]
  2. Walling (2020) Am Fam Physician 101(7):419-28 [PubMed]

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Related Studies

Ontology: Headache (C0018681)

Definition (MSHCZE) Symptom bolesti v kraniální oblasti. Může se projevit izolovaně nebo jako součást nejrůznějších onemocnění souvisejících s hlavou.
Definition (MEDLINEPLUS)

Almost everyone has had a headache. Headache is the most common form of pain. It's a major reason people miss days at work or school or visit the doctor.

The most common type of headache is a tension headache. Tension headaches are due to tight muscles in your shoulders, neck, scalp and jaw. They are often related to stress, depression or anxiety. You are more likely to get tension headaches if you work too much, don't get enough sleep, miss meals, or use alcohol.

Other common types of headaches include migraines, cluster headaches, and sinus headaches. Most people can feel much better by making lifestyle changes, learning ways to relax and taking pain relievers.

Not all headaches require a doctor's attention. But sometimes headaches warn of a more serious disorder. Let your health care provider know if you have sudden, severe headaches. Get medical help right away if you have a headache after a blow to your head, or if you have a headache along with a stiff neck, fever, confusion, loss of consciousness, or pain in the eye or ear.

NIH: National Institute of Neurological Disorders and Stroke
Definition (NCI_CTCAE) A disorder characterized by a sensation of marked discomfort in various parts of the head, not confined to the area of distribution of any nerve.
Definition (NCI) Pain in various parts of the head, not confined to the area of distribution of any nerve.
Definition (CSP) pain in the cranial region that may occur as an isolated and benign symptom or as a manifestation of a wide variety of conditions.
Definition (MSH) The symptom of PAIN in the cranial region. It may be an isolated benign occurrence or manifestation of a wide variety of HEADACHE DISORDERS.
Concepts Sign or Symptom (T184)
MSH D006261
ICD9 784.0
ICD10 R51
SnomedCT 206946005, 271329006, 158296002, 139490008, 158298001, 162209005, 206948006, 25064002
LNC MTHU020860, LA15903-0, LA15854-5
English Headache, Headaches, CEPHALALGIA, CEPHALGIA, Cephalgia, HEAD PAIN, Cephalalgia, Cephalodynia, [D]Headache (context-dependent category), [D]Pain in head NOS (context-dependent category), [D]Headache, [D]Pain in head NOS, cephalalgia, cephalodynia, headache, Cephalalgias, Cephalgias, headache (symptom), headache, cephalalgia, Pain head, Headache NOS, Cephalodynias, Cranial Pain, Cranial Pains, Pain, Cranial, Pains, Cranial, Head Pain, Head Pains, Pain, Head, Pains, Head, Headache [Disease/Finding], cranial pain, headaches, pain in head, Pain;head, cephalgias, head pained, head ache, ache head, head pains, [D]Headache (situation), [D]Pain in head NOS (situation), HEADACHE, Have headaches, Head pain, Pain in head, HA - Headache, Headache (finding), cephalgia, head; pain, pain; head, Headache, NOS, Pain in head NOS, head pain
Portuguese CEFALEIA, Dor na cabeça, Cefalalgia, Dor de cabeça, Cefaleia NE, CEFALALGIA, CEFALGIA, DOR DE CABECA, Cefaleia, Dor de Cabeça, Cefaleias, Cefalgia
Spanish CEFALALGIA, Dolor de cabeza, Cefalea NEOM, [D]dolor en la cabeza, SAI (categoría dependiente del contexto), [D]cefalea (categoría dependiente del contexto), CABEZA, DOLOR, CEFALEA, CEFALGIA, [D]dolor en la cabeza, SAI, [D]cefalea, [D]dolor en la cabeza, SAI (situación), [D]cefalea (situación), Cefalalgia, cefalalgia, cefalea (hallazgo), cefalea, cefalgia, cefalodinia, dolor de cabeza, Cefaleas, Cefalea, Cefalgia
German KOPFSCHMERZEN, Kopfschmerzen NNB, Schmerz Kopf, CEPHALGIE, KOPF SCHMERZHAFT, KOPFWEH, Kopfschmerzerkrankungen, Cephalgia, Zephalgie, Kopfschmerz, Cephalalgia
Italian Cefalee, Dolore al capo, Cefalea NAS, Cefalodinia, Cefalgia, Cefalalgia, Dolore craniale, Mal di testa, Cefalea
Dutch hoofdpijn NAO, cefalalgie, pijn hoofd, cefalgie, hoofd; pijn, pijn; hoofd, hoofdpijnen, hoofdpijn, Cefalalgie, Hoofdpijn, Pijn, hoofd-
French Céphalée SAI, Céphalgie, Douleur dans la tête, CEPHALALGIE, CEPHALEES, GENE DANS LA TETE, MAL DE TETE, Céphalées, Céphalée, Mal de tête, Maux de tête, Céphalalgie, Céphalodynie, Douleur crânienne
Japanese 頭痛ＮＯＳ, ｽﾞﾂｳ, ｽﾞﾂｳNOS, 頭痛, 片側頭痛
Swedish Huvudvärk
Finnish Päänsärky
Russian GOLOVNAIA BOL', ГОЛОВНАЯ БОЛЬ
Czech Cefalalgie, Bolesti hlavy, Bolest hlavy, Bolest hlavy NOS, Cefalgie, cefalodynie, cefalalgie, cefalgie, bolest hlavy, cefalea, bolesti hlavy, hlava - bolesti
Korean 두통
Croatian GLAVOBOLJA
Polish Ból głowy
Hungarian Fejfájás, Fejfájdalom, Fejfájás k.m.n., Cephalalgia, Cephalgia, Főfájás, Fejfájások
Norwegian Hodepine, Cephalalgi, Cephalalgia
Derived from the NIH UMLS (Unified Medical Language System)

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