Headache

Considerations:
Although painful and annoying, the vast majority of headaches do not indicate a serious disorder. Tension headache and migraine headaches account for 90% of all headaches.

The different types of headaches are usually caused by muscle contraction ( tension headaches), vascular problems (migraine headache or cluster headache ), or a combination.

A headache that signals a potentially serious problem is one that:
  • involves sudden, violent pain
  • gets worse over time and includes other symptoms such as nausea and vomiting , speech changes, personality changes, etc.
    • although rare, it could be a brain tumor or a TIA (

      Common Causes:
      Tension headache is a common headache pattern that may or may not be associated with psychosocial stressors. Tension headaches are characterized by:
      • pain usually felt in the back of the head and neck, and usually not one-sided.
      • pain that lasts for weeks or months with only brief periods of relief, although it may fluctuate in severity.
      • attacks that begin at any time of the day.
      • Pain that is often described as a

        Home Care:
        Over-the-counter pain medications are often effective headache relievers. Avoid giving aspirin or other salicylates to children, because of the risk of Reye's syndrome and other disorders.

        A massage or heat applied to the back of the upper neck can be effective in relieving tension headaches.

        Headaches may be relieved by resting with the eyes closed and head supported, or by relaxation techniques such as meditation.

        Call Your Healthcare Provider If:
        (Serious, see the health care provider promptly!):
        • the headache comes on suddenly and is explosive or violent.
        • the headache gets worse over time or is associated with visual difficulties , slurring of speech , problems in moving arms or legs, or similar problems.
        • The headache is associated with fever and a very stiff neck .
        • The headache is associated with head injury .
        • The headache is the worst you have ever had and comes on suddenly.

        (See the health care provider soon, but not emergency):

        • the headache has persisted more than a few days.
        • The headaches are worse in the morning, no other symptoms are present.
        • you have headaches frequently and there is no known cause such as allergies or chronic sinusitis .



        What to Expect:
        A history will be obtained and an examination of head, eyes, ears, nose, throat, neck, and nervous system will be performed.

        The diagnosis is usually based on the history given by the patient. A "headache diary" may be helpful for recording information about headaches over a period of time. Medical history questions documenting headache in detail may include:

        • location
          • Is the headache located in the forehead or around the eyes (frontal or periorbital)?
          • Is the headache located in the back of the head (occipital)?
          • Is the headache located near the temples (temporal)?
          • Is the headache behind the eyeball (retrobulbar)?
          • Is the headache all over (generalized)?
          • Is the headache on one side only (unilateral)?
            • Is the headache always on same side?

        • quality/type
          • Is this the worst headache in the patient's experience?
          • Is this a new type of headache for the patient?
          • Would the headache be described as pulsating ( throbbing )?
          • Is it severe?
          • Is it moderately severe?
          • Is there a pressure or band-like sensation?

        • time pattern
          • Does the headache occur upon awakening in the morning?
          • The headaches begin with this episode of illness?
          • How long have you had headaches?
          • How long does each headache last?
          • Does the headache awaken the patient from sleep?
          • Did other symptoms begin shortly after the headaches began?
          • Did the headaches begin suddenly?
          • Do headaches occur repeatedly (recurrent)?
            • Do they occur multiple times daily?
            • Do they occur over a period of weeks?
          • Are the headaches worse during the day and better at night?
          • Does the headache reach maximum intensity over 1 to 2 hours?
          • Did they develop rapidly?
          • At what age did headaches begin?

        • aggravating factors
          • Are the headaches worse when lying down or in a reclining position?
          • Are the headaches worse when standing up?
          • Are the headaches worse when coughing , sneezing , straining, lifting (Valsalva maneuver)?
          • Are headaches triggered by reminders of a traumatic event ?
          • Do they occur at a specific time related to your menstrual period (women)?

        • relieving factors
          • What home treatment have you tried?
          • How effective was it?
          • Is the headache relieved by medication that contains ergotamine?

        • associated complaints
          • Does nausea or vomiting accompany the headache?
          • Is the headache preceded by a pop/snap in the skull?
          • Do neurological symptoms ( weakness , loss of speech, etc.) occur when you have a headache?
          • Is the headache preceded by temporary loss of half of the visual field ?
          • Does the headache cause the eye to tear on the same side as where the headache is?
          • Is there nasal discharge or stuffiness on the same side?
          • What other symptoms are present?

        Diagnostic tests that may be performed include:

        Intervention:
        If migraine is diagnosed, medications that contain ergot may be indicated. Temporal arteritis must be treated with steroids to help prevent blindness . Other disorders are treated as appropriate.

        After seeing your health care provider:
        If a diagnosis was made by your health care provider related to a headache, you may want to note that diagnosis in your personal medical record.


        This is an illustration of the major areas of the brain. Each area has one or more specific functions.