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What is headache?

Headache is pain or discomfort in any region of the head or face. Headaches vary greatly in terms of location, intensity of pain and frequency of occurrence. It may occur on one or both sides of the head, isolated to a certain part of the head, or radiate across the head from one point to the others. Headache may appear as a sharp pain, a throbbing sensation or a dull ache in the head. The brain tissue doesn't have pain-sensitive nerve fibers and doesn't feel pain. Other parts of the head and face can be responsible for headache, these include: network of nerves that extends over the scalp, facial nerve running through the mouth and throat, muscles of head, neck and shoulders, blood vessels along the surface and the base of the brain and the dura mater. Headache is not a disease but a symptom of an underlying disease or disorder.


Classification of headache

1. Primary (Idiopathic) headache: this is headache of undiagnosed cause presenting as the main and only disorder, also called psychosomatic headache.

2. Secondary headache: this is headache or facial pain as a result of an underlying disorder.

3. Acute headache:  this starts and stops abruptly, within intervals ranging from hours to days, and can be cured with treatment of the underlying disorder.

4. Chronic headache: this class of headache is continuous from a period of 15 days to 3 months. Some could be short episodes and some over 4 hours, until the main underlying factor is managed.


Epidemiology of headache

Globally, headache has an estimated prevalence among adults. Adults of current headache disorder (symptomatic at least once in a year) is about 50%. Half to three quarter of adults aged 16 -70 years in the world have headache at least once a year and out of these individuals, 35% or more have reported migraine. 2 to 5% of the world adult population have headache for 15 or more days every month. Irrespective of region, headache disorders are a worldwide problem affecting people of all ages, races, income levels and geographical areas.


Types of headache

There are over 150 types of headaches. Below are some of them:

Common headache 

Tension headache, Cluster headache, Chronic daily headache, Migraine headache, Sinus headache (typical for sinusitis) and post-traumatic headache.

Less common headache: Exercise headache, Hemicrania continua(chronic and remitting), hormonal headache, daily persistent headache, rebound headache.

Rare headache: Ice pick headache, spinal headache(typical for spinal tap), Thunderclap headache(typical for intracerebral hemorrhage).

What Causes Headaches?

Headaches comes from mix of signals between brain blood vessels and nearby nerves. Specific nerves on blood vessels, dura mater and head muscles switch on and send pain signals to the brain. 

Major causes of headache

- Illness; infections, toothache, sinusitis

- Trauma; traumatic brain injury, head injury and cervical injury

- Environmental; secondary smoking, allergens, strong smells from chemicals, weather changes, lighting and noise.

- Chemical Imbalance; electrolyte imbalance and anemia.

- Genetics; headache can be familial running in families through generations, especially migraine.

- Stress; emotional stress, depression, use of alcohol and skipping meals.

- Neoplasm; neoplasm in the head and neck.


Right diagnosis is the first step to treating headache; starting with a proper history taking (anamnesis morbi and vitae), triggers and preventin, physical examination, blood analysis, some cases may need radiological diagnosis- Computer tomography or Magnetic resonance imaging looking for neoplasm.


- Patient education on avoiding triggers.

- Simple lifestyle modification( diet, sleep routine, and exercise).

- Medication: analgesics, specific anti migraine medication, prophylactic medications.

- Management of underlying disorder.



- Morning headache is common for brain neoplasm caused by increased intracranial pressure.

- Headache at the back of the head (occipital area) is usually hypertension.       

- Don’t underestimate any type of headache, visit a doctor.

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