What is headache?

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headache types classification causes overview

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headache types classification diagram

This orthopaedic anatomical diagram illustrates the Chiron classification (2004) for femoral head fractures, shown across five categorized types (Type I to Type V). Each type is presented using a dry bone model of the proximal femur from two perspectives: a lateral/oblique view and a frontal view of the femoral head. Fracture lines are demarcated by solid black lines to indicate the morphology and size of the fracture fragments. Type I displays small osteochondral fragments at the superior-lateral aspect. Type II shows a 1/4 head fragment on the anterior-superior surface. Type III demonstrates a 1/3 head fragment extending from superior to posterior. Type IV depicts a vertical fracture dividing approximately 1/2 of the femoral head. Type V illustrates cranial cartilage impaction with multiple intersecting lines across the superior articular surface. The classification is clinically relevant for orthopedic surgeons and residents for determining the severity of femoral head trauma and informing surgical decisions, such as fragment fixation versus excision based on size and location.

This orthopaedic anatomical diagram illustrates the Chiron classification (2004) for femoral head fractures, shown across five categorized types (Type I to Type V). Each type is presented using a dry bone model of the proximal femur from two perspectives: a lateral/oblique view and a frontal view of the femoral head. Fracture lines are demarcated by solid black lines to indicate the morphology and size of the fracture fragments. Type I displays small osteochondral fragments at the superior-lateral aspect. Type II shows a 1/4 head fragment on the anterior-superior surface. Type III demonstrates a 1/3 head fragment extending from superior to posterior. Type IV depicts a vertical fracture dividing approximately 1/2 of the femoral head. Type V illustrates cranial cartilage impaction with multiple intersecting lines across the superior articular surface. The classification is clinically relevant for orthopedic surgeons and residents for determining the severity of femoral head trauma and informing surgical decisions, such as fragment fixation versus excision based on size and location.

Educational diagram illustrating the Judet-Letournel classification of acetabular fractures using anatomical specimens of the hemipelvis. The visual is divided into two rows: 'Elementary' and 'Associated' fracture types. White lines superimposed on the specimens delineate specific fracture patterns. The 'Elementary' row features five simple patterns: Anterior column (vertical line through the pelvic brim), Anterior wall (localized articular segment), Posterior column (ischiadic notch through obturator foramen), Posterior wall (localized posterior rim), and Transverse (horizontal line bisecting the acetabulum). The 'Associated' row demonstrates complex configurations: Both column, Transverse plus posterior wall, Posterior column plus posterior wall, Anterior column with posterior hemitransverse (a vertical anterior column line joined by a horizontal posterior component), and T-type (a transverse fracture with an additional vertical stem extending through the obturator foramen). This orthopedic diagram serves as a clinical reference for orthopedic surgeons and medical students to understand pelvic trauma morphology and surgical planning.

Educational diagram illustrating the Judet-Letournel classification of acetabular fractures using anatomical specimens of the hemipelvis. The visual is divided into two rows: 'Elementary' and 'Associated' fracture types. White lines superimposed on the specimens delineate specific fracture patterns. The 'Elementary' row features five simple patterns: Anterior column (vertical line through the pelvic brim), Anterior wall (localized articular segment), Posterior column (ischiadic notch through obturator foramen), Posterior wall (localized posterior rim), and Transverse (horizontal line bisecting the acetabulum). The 'Associated' row demonstrates complex configurations: Both column, Transverse plus posterior wall, Posterior column plus posterior wall, Anterior column with posterior hemitransverse (a vertical anterior column line joined by a horizontal posterior component), and T-type (a transverse fracture with an additional vertical stem extending through the obturator foramen). This orthopedic diagram serves as a clinical reference for orthopedic surgeons and medical students to understand pelvic trauma morphology and surgical planning.

This educational infographic details the Echinococcus multilocularis Ulm Classification for Computed Tomography (EMUC-CT), a standardized system for evaluating hepatic Alveolar Echinococcosis (AE). The diagram is divided into two sections: Primary Morphology and Patterns of Calcification.

The left section illustrates five morphological types (I-V) using axial CT cross-sections of the liver. Type I (diffuse infiltrating) and Type II (primarily circumscribed, tumor-like) are sub-categorized by the presence or absence of a cystoid portion. Type III (primarily cystoid) distinguishes between intermediate and widespread involvement, further categorized by solid peripheral portions. Type IV displays small-cystoid, metastasis-like lesions, while Type V represents mainly calcified, inactive lesions.

The right panel illustrates six distinct calcification patterns within hepatic lesions: feathery (branching), focal (isolated spots), diffuse (widespread), edge-weighted (peripheral), and central. The classification system is designed to improve diagnostic accuracy and clinical assessment of disease activity in patients with Alveolar Echinococcosis.

This educational infographic details the Echinococcus multilocularis Ulm Classification for Computed Tomography (EMUC-CT), a standardized system for evaluating hepatic Alveolar Echinococcosis (AE). The diagram is divided into two sections: Primary Morphology and Patterns of Calcification. The left section illustrates five morphological types (I-V) using axial CT cross-sections of the liver. Type I (diffuse infiltrating) and Type II (primarily circumscribed, tumor-like) are sub-categorized by the presence or absence of a cystoid portion. Type III (primarily cystoid) distinguishes between intermediate and widespread involvement, further categorized by solid peripheral portions. Type IV displays small-cystoid, metastasis-like lesions, while Type V represents mainly calcified, inactive lesions. The right panel illustrates six distinct calcification patterns within hepatic lesions: feathery (branching), focal (isolated spots), diffuse (widespread), edge-weighted (peripheral), and central. The classification system is designed to improve diagnostic accuracy and clinical assessment of disease activity in patients with Alveolar Echinococcosis.

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Here is a thorough overview of headache, drawn from authoritative medical textbooks:

Headache

Definition

A headache is pain or discomfort arising from pain-sensitive structures in or around the head. It is among the most common reasons patients seek medical attention and is responsible, on a global basis, for more disability than any other neurologic problem.
  • Harrison's Principles of Internal Medicine (22E), p. 1631

Anatomy and Physiology - How Headaches Arise

Relatively few cranial structures are pain-producing. These include:
  • The scalp, meningeal arteries, dural sinuses, falx cerebri, and proximal segments of large pial arteries
Structures that are not pain-producing include: the ventricular ependyma, choroid plexus, pial veins, and much of the brain parenchyma.
The key pathways involved in primary headache are:
  1. Large intracranial vessels and dura mater - with peripheral terminals of the trigeminal nerve that innervate these structures
  2. The trigeminocervical complex - caudal trigeminal nucleus extending into the dorsal horns of the upper cervical spinal cord (receives input from C1-C2 nerve roots)
  3. Rostral pain-processing regions - ventroposteromedial thalamus and cortex
  4. Pain-modulatory systems - hypothalamus and brainstem structures (periaqueductal grey matter, rostral ventromedial medulla, locus ceruleus, dorsal raphe nuclei)
  • Harrison's Principles of Internal Medicine (22E), p. 1634-1636
  • Bradley and Daroff's Neurology in Clinical Practice, p. 4026

Classification (ICHD-3, 2018)

The International Headache Society (IHS) classifies headaches into four main parts via the International Classification of Headache Disorders, 3rd edition (ICHD-3):

Part 1: Primary Headaches

(Head pain occurs in the absence of underlying structural disease - the headache IS the disorder)
TypePrevalence (%)
Tension-type headache~69% - most common overall
Migrainesecond most common
Trigeminal autonomic cephalalgias (TACs)includes cluster headache (least common)
Other primary headachesthunderclap, stabbing, hypnic, cough, exercise-related, etc.
Tension-type headache: Bilateral, pressing/tightening quality, mild-to-moderate intensity, not aggravated by routine physical activity. Often linked to stress, poor posture, or muscle tension.
Migraine: Typically unilateral, pulsating, moderate-to-severe, aggravated by activity. May include nausea, vomiting, photophobia, and phonophobia. About one-third of patients have an "aura" (visual or sensory phenomena preceding the headache).
Cluster headache: Severe, strictly unilateral, periorbital/temporal pain with ipsilateral autonomic features (tearing, nasal congestion, ptosis). Occurs in clusters lasting weeks to months.

Part 2: Secondary Headaches

(Head pain is a symptom of an underlying disease)
CategoryCommon Examples
Trauma/injuryPost-concussion headache, whiplash
Vascular disordersSubarachnoid hemorrhage, stroke, giant cell arteritis
Non-vascular intracranialIncreased/decreased intracranial pressure, tumors
Substances/withdrawalMedication overuse headache, caffeine withdrawal
InfectionMeningitis, encephalitis, sinusitis
Homeostasis disordersHypertension, hypoxia, dialysis
Cranial/cervical structuresCervicogenic headache, glaucoma
Psychiatric disordersSomatization, depression-associated

Part 3: Painful Cranial Neuropathies and Other Facial Pain

  • Trigeminal neuralgia
  • Other cranial nerve pain syndromes

Red Flags (Require Urgent Investigation)

The following features should raise concern and prompt imaging (usually MRI):
  • Thunderclap headache - sudden-onset severe headache (rule out aneurysm rupture)
  • "Worst headache of life"
  • New headache in a cancer patient
  • Progressive worsening in frequency or severity
  • Headache always localized to one area
  • Not responding to treatment
  • Associated with fever, altered mental status, or focal neurological deficit
  • Bradley and Daroff's Neurology in Clinical Practice, p. 2082

Epidemiology

  • Primary headache disorders (migraine, tension, cluster) account for nearly 98% of all headaches
  • Chronic daily headache (headache on 15+ days/month) affects about 4% of the population
  • Secondary headaches, while less common, are important to recognize as they can be life-threatening

Key Takeaway

Most headaches are benign primary disorders that can be managed in primary care with correct clinical diagnosis and no special investigation. However, the presence of red flags necessitates prompt evaluation to rule out serious secondary causes.
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