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What is headache?
Reading File
Finding Sources
Reading File
Reading File
Finding Sources
Reading File
Reading File
Here is a comprehensive overview of headache based on authoritative medical textbooks:
Headache
Definition
Headache refers to pain perceived in the head or upper neck region. It is one of the most common medical complaints and can arise from a wide range of causes — from benign tension to life-threatening conditions such as subarachnoid hemorrhage.
Classification: Primary vs. Secondary
The clinician's first step is determining whether a headache is primary or secondary:
| Category | Description |
|---|---|
| Primary headache | Head pain is the disorder itself — no underlying structural or systemic cause |
| Secondary headache | Head pain is a symptom of an underlying condition (brain tumor, infection, hemorrhage, etc.) |
Primary headache disorders (the most common):
- Migraine — most important and frequent; often frontoparietal, pulsatile, with nausea/photophobia
- Tension-type headache — diffuse, pressure-like; the most common headache overall
- Cluster headache — unilateral, periorbital, severe; associated with autonomic features
- Medication-overuse headache — chronic headache from frequent analgesic use
Secondary headaches are caused by conditions such as:
- Brain tumors
- Increased or decreased intracranial pressure
- Meningitis / subarachnoid hemorrhage
- Sinus disease
- Vascular malformations
Episodic vs. Chronic
- Episodic: < 15 days/month
- Chronic: ≥ 15 days/month
Red Flags ("Warning Signs" Requiring Urgent Evaluation)
The following features should prompt immediate imaging or further workup:
- Thunderclap headache — sudden-onset, reaches maximum intensity within 1 minute ("worst headache of my life") → must rule out subarachnoid hemorrhage
- New severe headache with no prior headache history
- Progressively worsening headache (increasing frequency or severity)
- Headache always localized to one side
- Headache with fever, altered mental status, or focal neurological deficit
- Headache in a cancer patient or immunocompromised patient (e.g., HIV)
- Headache waking the patient at night (except cluster)
- Headache worse lying flat (suggests raised ICP) or only when upright (suggests CSF leak)
- New onset in an older patient without prior headache history
- Abnormal neurological findings on examination
Causes of Thunderclap Headache (a medical emergency)
- Subarachnoid hemorrhage
- Intracerebral hemorrhage
- Stroke / TIA
- Cerebral venous thrombosis
- Unruptured vascular malformation (aneurysm)
- Arterial dissection
- Reversible cerebral vasoconstriction syndrome
- Meningitis
- Pituitary apoplexy
Key Principle
Accurate diagnosis is critical because each headache type has different treatments. — Goldman-Cecil Medicine
Sources:
- Goldman-Cecil Medicine, International Edition
- Adams and Victor's Principles of Neurology, 12th Ed.
- Bradley and Daroff's Neurology in Clinical Practice
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