Headache

Pain/discomfort arising from pain-sensitive structures in the head.

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Epidemiology

Worldwide, the condition has been ranked among the ten most disabling conditions by the World Health organization (WHO). In the global population, the prevalence of active headache disorder is 47%, migraine 10%, tension-type headache (TTH) 38% and chronic headache 3%; the disability attributable to TTH is larger worldwide than that due to migraine. Furthermore, headache is the most common neurological symptom presented by patients to general practitioners and neurologists

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Pathophysiology

Pain sensitive cranial structures:

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Classification

Primary headaches:

Not caused by another disease with normal general physical and neurological examinations

• Migraine
• Tension headache
• Trigeminal autonomic cephalalgias (of which cluster headache is the most prominent variety)
• Group 4 ‘other primary headache disorders’: Consists of 10 rare headache syndromes with well-established primary nature
  • Benign exertional headaches
  • Primary stabbing headaches (“jabs and jolts syndrome”)

Secondary headaches:

Symptom of another disease; Any headache that does not fit into any of the four primary headache types is a secondary and therefore potentially dangerous headache.

• Red flags for identifying a secondary headache: SSNOOP
  • Systemic symptoms (fever or weight loss)
  • Systemic disease (HIV infection, malignancy)
  • Neurologic symptoms or signs
  • Onset sudden (thunderclap headache)
  • Onset after age 40 years
  • Previous headache history (first, worst, or different headache)