II. Epidemiology

  1. Incidence
    1. ER Visits in U.S annually: 3 Million (15% of all ER Visits)
    2. Secondary Headaches (e.g. Subarachnoid Hemorrhage, Meningitis) represent 2% of cases
  2. Costs
    1. Cost due to lost work per year US: $5-17 Billion

III. Precautions

  1. See Headache Red Flag
  2. Relieving acute Headache pain does not obviate the need to distinguish primary from Secondary Headache
  3. Discerning Secondary Headache is critical in the Headache Evaluation
    1. Although <2% of acute Headaches, missing Secondary Headache can have devastating consequences

IV. Findings

VI. Differential Diagnosis

  1. See Headache Causes
  2. Primary Headache (98% of Headaches in the Emergency Department)
    1. Migraine Headache (80% are without aura)
    2. Cluster Headache
    3. Tension Headache
  3. Secondary Headache (important selected causes)
    1. See Headache Red Flag
    2. Localized Headache
      1. Temporal Arteritis (temporal pain in over age 50 years)
      2. Acute Angle-Closure Glaucoma (severe Eye Pain)
    3. Fever
      1. Encephalitis
      2. Bacterial Meningitis
    4. Exposure related
      1. Carbon Monoxide Poisoning (typically furnace in winter)
      2. Post-Traumatic Headache (post-Concussion Headache)
    5. Young Women
      1. Pregnancy Induced Hypertension
      2. Pseudotumor Cerebri (Obesity)
    6. Thunderclap Headaches (severe sudden-onset)
      1. Subarachnoid Hemorrhage
      2. Cervical Artery Dissection (carotid dissection, Vertebrobasilar Dissection)
      3. Venous sinus thrombosis
      4. Pituitary apoplexy
    7. Anatomic neurologic deficits
      1. Intracranial Mass
      2. Cerebellar infarction
    8. Trauma
      1. Acute or chronic Subdural Hematoma
    9. Other common benign Secondary Headaches
      1. Temporomandibular Joint Disorder
      2. Frontal Sinusitis
      3. Cervical Spondylosis

VIII. Management

  1. See Headache General Measures
  2. Management directed at specific Headache type

IX. Resources

  1. National Headache Foundation
    1. http://www.headaches.org

X. References

  1. Cutrer in Goldman (2000) Cecil Medicine, p. 2066
  2. Henry in Marx (2002) Rosen's Emergency Medicine, p. 152
  3. Pruitt in Goroll (2000) Primary Care Medicine, p. 931-9
  4. Clinch (2001) Am Fam Physician 63(4):685-92 [PubMed]
  5. Coutin (1996) Am Fam Physician 54(7):2247-52 [PubMed]
  6. Saper (1999) Med Clin North Am 83(3):663-90 [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, ズツウ, ズツウNOS, 頭痛, 片側頭痛
Swedish Huvudvärk
Finnish Päänsärky
Czech Cefalalgie, Bolesti hlavy, Bolest hlavy, Bolest hlavy NOS, Cefalgie, cefalodynie, cefalalgie, cefalgie, bolest hlavy, cefalea, bolesti hlavy, hlava - bolesti
Korean 두통
Polish Ból głowy
Hungarian Fejfájás, Fejfájdalom, Fejfájás k.m.n., Cephalalgia, Cephalgia, Főfájás, Fejfájások
Norwegian Hodepine, Cephalalgi, Cephalalgia

Ontology: Headache Disorders (C0393735)

Definition (MSH) Various conditions with the symptom of HEADACHE. Headache disorders are classified into major groups, such as PRIMARY HEADACHE DISORDERS (based on characteristics of their headache symptoms) and SECONDARY HEADACHE DISORDERS (based on their etiologies). (International Classification of Headache Disorders, 2nd ed. Cephalalgia 2004: suppl 1)
Concepts Disease or Syndrome (T047)
MSH D020773
SnomedCT 395602009, 230461009
Swedish Huvudvärksproblem
English HEADACHE DIS, headache syndromes, headache syndromes (diagnosis), Cephalgia Syndrome, Cephalgia Syndromes, Headache Disorder, Headache Disorders [Disease/Finding], headache disorders, headaches syndromes, disorders headache, headache syndrome, disorders headaches, headaches syndrome, Headache disorder, Headache disorder (disorder), headache; syndrome, syndrome; headache, Headache Syndrome, Headache Syndromes, Syndrome, Headache, Headache Disorders
Czech syndromy bolesti hlavy, cefalgie - syndromy
Finnish Päänsärkysairaudet
Italian Sindromi da cefalea, Sindromi da cefalgia, Disturbi da cefalea, Cefalee
Japanese 慢性頭痛, 頭痛症候群, 頭痛障害, 頭痛-慢性
Norwegian Hodepinesykdommer, Hodeverkforstyrrelser, Hodeverksyndromer, Kefalgisyndromer, Hodeverksykdommer, Hodepinesyndromer, Cefalalgisyndromer, Hodepineforstyrrelser
Polish Bóle głowy
Portuguese Transtornos da Cefaleia, Cefalgia Crônica, Cefalalgia Crônica, Transtornos da Cefalalgia, Transtornos da Cefalgia, Síndromes de Cefalgia
Dutch hoofdpijn; syndroom, syndroom; hoofdpijn, Cefalgiesyndroom, Hoofdpijnsyndromen, Hoofdpijnsyndroom, Syndromen, hoofdpijn-, Syndroom, hoofdpijn-
Spanish trastorno relativo a la cefalea (trastorno), trastorno relativo a la cefalea, Síndromes de Cefalgia, Trastornos de Cefalalgia
German Kopfschmerz-Erkrankungen, Zephalgie-Syndrome
French Céphalées, Algies céphaliques, Céphalalgies, Syndromes céphalalgiques