{"id":3627,"date":"2023-11-21T11:50:00","date_gmt":"2023-11-21T16:50:00","guid":{"rendered":"https:\/\/mickeylieberman.com\/headaches\/?p=3627"},"modified":"2023-10-28T07:55:42","modified_gmt":"2023-10-28T12:55:42","slug":"what-are-headaches-cephalalgia","status":"publish","type":"post","link":"https:\/\/mickeylieberman.com\/headaches\/what-are-headaches-cephalalgia\/","title":{"rendered":"What are Headaches (Cephalalgia)?"},"content":{"rendered":"

Headaches (Cephalalgia)<\/span><\/p>\n

A headache or cephalalgia is pain anywhere in the region of the head or neck. It can be a symptom of a number of different conditions of the head and neck.<\/span><\/p>\n

The brain tissue itself is not sensitive to pain as it lacks pain receptors. Rather, the pain is caused by a disturbance of the pain-sensitive structures around the brain.<\/span><\/p>\n

Nine areas of the head and neck have these pain-sensitive structures, which are the cranium (the periosteum of the skull), muscles, nerves, arteries and veins, subcutaneous tissues, eyes, ears, sinuses, and mucous membranes.<\/span><\/p>\n

There are a number of different classification systems for headaches. The most well-recognized is that of the International Headache Society. Headache is a non-specific symptom, which means that it has many possible causes.<\/span><\/p>\n

Treatment of a headache depends on the underlying cause but commonly involves pain killers.<\/span><\/p>\n

There are more than 200 types of headaches. Some are harmless and some are life-threatening. <\/span><\/p>\n

The description of the headache and findings on neurological examination determine whether additional tests are needed and what treatment is best.<\/span><\/p>\n

Headaches are broadly classified as “Primary” or “Secondary”.<\/span><\/p>\n

Primary headaches are benign, recurrent headaches not caused by an underlying disease or structural problems.<\/span><\/p>\n

For example, a migraine is a type of primary headache. While primary headaches may cause significant daily pain and disability, they are not dangerous.<\/span><\/p>\n

Secondary headaches are caused by an underlying disease, like a tumor, brain bleed, or infection. Secondary headaches can be harmless or dangerous. <\/span><\/p>\n

Certain “red flags” or warning signs indicate a secondary headache may be dangerous.<\/span><\/p>\n

Primary headaches<\/span><\/p>\n

90% of all headaches are primary headaches. Primary headaches usually first start when patients are between 20 and 40 years old. <\/span><\/p>\n

The most common types of primary headaches are migraines and tension-type headaches. They have different characteristics.<\/span><\/p>\n

Migraines typically present with pulsing head pain, nausea, photophobia (sensitivity to light), and phonophobia (sensitivity to sound).<\/span><\/p>\n

Tension-type headaches usually present with non-pulsing \u201cbandlike\u201d pressure on both sides of the head, not accompanied by other symptoms.<\/span><\/p>\n

Other very rare types of primary headaches include:<\/span><\/p>\n

Cluster headaches: short episodes (15\u2013180 minutes) of severe pain, usually around one eye, with autonomic symptoms (tearing, red eye, nasal congestion) which occur at the same time every day.<\/span><\/p>\n

Cluster headaches can be treated with triptans and prevented with prednisone, ergotamine, or lithium.<\/span><\/p>\n

Headaches may be caused by problems elsewhere in the head or neck. <\/span><\/p>\n

Some of these are not harmful, such as cervicogenic headache (pain arising from the neck muscles).<\/span><\/p>\n

Medication overuse headache may occur in those using excessive painkillers for headaches, paradoxically causing worsening headaches.<\/span><\/p>\n

More serious causes of secondary headaches include:<\/span><\/p>\n

meningitis: inflammation of the meninges which presents with fever and meningismus, or stiff neck<\/span><\/p>\n

bleeding inside the brain (intracranial hemorrhage)<\/span><\/p>\n

subarachnoid hemorrhage (acute, severe headache, stiff neck WITHOUT fever)<\/span><\/p>\n

ruptured aneurysm, arteriovenous malformation, intraparenchymal hemorrhage (headache only)<\/span><\/p>\n

brain tumor: dull headache, worse with exertion and change in position, accompanied by nausea and vomiting. <\/span><\/p>\n

Often, the patient will have nausea and vomiting for weeks before the headache starts.<\/span><\/p>\n

temporal arteritis: inflammatory disease of arteries common in the elderly (average age 70) with fever, headache, weight loss, jaw claudication, tender vessels by the temples, polymyalgia rheumatica.<\/span><\/p>\n

acute closed-angle glaucoma (increased pressure in the eyeball): a headache that starts with eye pain, blurry vision, associated with nausea and vomiting. <\/span><\/p>\n

On physical exam, the patient will have red-eye and a fixed, mid dilated pupil.<\/span><\/p>\n

A number of characteristics make it more likely that the headache is due to potentially dangerous secondary causes which may be life-threatening or cause long-term damage.<\/span><\/p>\n

These “red flag” symptoms mean that a headache warrants further investigation with neuroimaging and lab tests.<\/span><\/p>\n

In general, patients complaining of their \u201cfirst\u201d or \u201cworst\u201d headache warrant imaging and further workup.<\/span><\/p>\n

Patients with progressively worsening headaches also warrant imaging, as they may have a mass or a bleed that is gradually growing, pressing on surrounding structures and causing worsening pain.<\/span><\/p>\n

Patients with neurological findings on exam, such as weakness, also need further workup.<\/span><\/p>\n

The American Headache Society recommends using “SSNOOP”, a mnemonic to remember the red flags for identifying a secondary headache:<\/span><\/p>\n

Systemic symptoms (fever or weight loss)<\/span>
\nSystemic disease (HIV infection, malignancy)<\/span>
\nNeurologic symptoms or signs<\/span>
\nOnset sudden (thunderclap headache)<\/span>
\nOnset after age 40 years<\/span>
\nPrevious headache history (first, worst, or different headache)<\/span><\/p>\n

Old headaches are usually primary headaches and are not dangerous. They are most often caused by migraines or tension headaches.<\/span><\/p>\n

Migraines are often unilateral, pulsing headaches accompanied by nausea and\/or vomiting. <\/span><\/p>\n

There may be an aura (visual symptoms, numbness, or tingling) 30\u201360 minutes before the headache, warning the patient of a headache.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

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