What is headache explain types and cure in details

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Headache: A Complete Medical Guide

What is a Headache?

A headache is defined as pain anywhere in the region of the head or neck. It is one of the most common symptoms encountered in clinical medicine and affects virtually everyone at some point in life. Pain arises from activation of pain-sensitive structures - the large intracranial vessels, the dura mater, and pericranial muscles are all innervated by the trigeminal nerve (the trigeminovascular system). The brain parenchyma itself has no pain receptors.

From the perspective of prevalence, Harrison's Principles of Internal Medicine (22nd Ed.) places tension-type headache at 69% of all headaches, migraine at 16%, while brain tumor causes headache in only 0.1% - meaning the vast majority of headaches are benign.

Classification: Primary vs Secondary

The most important clinical distinction is between primary and secondary headaches, per the International Classification of Headache Disorders, 3rd Edition (ICHD-3):

Headache classification mind map showing Primary (Tension, Migraine, Cluster) and Secondary (Intracranial: Vascular, Infectious, Tumor, CSF; and Extracranial) categories

Category	Definition	Examples
Primary	Headache IS the disorder; no underlying cause	Tension-type, Migraine, Cluster
Secondary	Headache is a symptom of another condition	Meningitis, SAH, tumor, hypertension

Part I: Primary Headaches (Detailed)

1. Tension-Type Headache (TTH) - Most Common (69%)

Description: The classic "everyday headache" - a steady, dull, bilateral ache often described as a band tightening around the head. Renamed from "tension headache" because it is not primarily caused by muscle tension or stress.

Features:

Bilateral location
Quality: pressing, tightening (non-pulsating)
Mild to moderate intensity - does not stop daily activity
No nausea, no vomiting
May have mild photophobia OR phonophobia (not both)
Lasts 30 minutes to several days

Subtypes:

Infrequent episodic - less than 1 day/month
Frequent episodic - 1-14 days/month
Chronic - 15+ days/month for 3+ months; can run continuously for years and is associated with depression

Causes/Triggers: Stress, fatigue, poor posture, sleep deprivation, hunger, dehydration, eye strain, anxiety

Treatment:

Approach	Options
Mild/acute	Acetaminophen (paracetamol), NSAIDs (ibuprofen, naproxen, aspirin)
Non-pharmacologic	Muscle relaxation techniques, massage, moist heat, biofeedback, cognitive behavioral therapy
Chronic prevention	Tricyclic antidepressants (amitriptyline 10-25 mg at night, up to 1 mg/kg)
Lifestyle	Regular sleep, regular meals, regular exercise (150 min/week moderate aerobic activity), stress management

Note: Frequent use of over-the-counter analgesics (more than 10-15 days/month) leads to medication overuse headache (MOH), a major complication.

2. Migraine - Second Most Common (16%)

Description: Migraine is a brain disorder - not simply a vascular headache. It involves complex neurological sensitization and the trigeminovascular system. Functional neuroimaging shows it involves the brainstem and hypothalamus.

Diagnostic Features (ICHD-3 criteria - at least 2 of 4):

Unilateral location
Pulsating/throbbing quality
Moderate to severe intensity
Aggravated by routine physical activity

Plus at least 1 of:

Nausea and/or vomiting
Photophobia AND phonophobia

Duration: 4-72 hours (untreated)

Clinical tip (mnemonic = PIN): Migraine can be diagnosed with 93% positive predictive value when 2 of 3 features are present: Photosensitivity, Incapacitation, Nausea. (Neuroanatomy through Clinical Cases, 3rd Ed.)

Subtypes:

Subtype	Key Feature
Migraine without aura ("common migraine")	Most common (80% of migraines); meets above criteria
Migraine with aura ("classic migraine")	Preceded by reversible focal neurologic symptoms (aura) developing over 5-20 min, lasting <60 min; occurs in ~20% of migraineurs; most commonly visual (fortification spectra, scotomata)
Chronic migraine	≥15 headache days/month, with migraine features on ≥8 days/month
Hemiplegic migraine	Motor weakness as part of aura
Brainstem aura migraine	Dysarthria, vertigo, tinnitus, diplopia

Aura: Typically visual - zigzag patterns (fortification spectra), blind spots (scotomata), or sensory paresthesias spreading over 5-20 minutes. Aura without headache also occurs.

Triggers: Menstruation, stress, sleep changes (too much or too little), certain foods (aged cheese, red wine, caffeine withdrawal), weather changes, strong odors, bright lights

Phases of a Migraine Attack:

Prodrome (hours to days before) - mood changes, yawning, neck stiffness, food cravings
Aura (if present) - reversible neurologic symptoms
Headache phase - the main pain
Postdrome - fatigue, "migraine hangover"

Treatment:

Abortive (acute attack) therapy:

Severity	First-line Options
Mild-moderate	NSAIDs (ibuprofen, naproxen, aspirin), caffeine-containing combination analgesics (e.g., Excedrin)
Moderate-severe	Triptans (5-HT1B/D agonists): sumatriptan, rizatriptan, zolmitriptan, eletriptan - take at headache onset
Severe/refractory	Ergotamine/dihydroergotamine (DHE), CGRP antagonists ("gepants": ubrogepant, rimegepant), ditans (lasmiditan - 5-HT1F agonist)
With nausea/vomiting	Metoclopramide IV (also treats headache directly); prochlorperazine as second-line; dopamine blockers
Quiet environment	Rest in dark, quiet room is effective for milder attacks

Preventive therapy (indicated when attacks are frequent or disabling):

Drug Class	Examples
Beta-blockers	Propranolol, metoprolol
Calcium channel blockers	Flunarizine, verapamil
Antiepileptics	Topiramate, valproate
Tricyclic antidepressants	Amitriptyline, nortriptyline
CGRP monoclonal antibodies (newest)	Erenumab, fremanezumab, galcanezumab - effective and well-tolerated in chronic migraine
CGRP receptor antagonists (gepants)	Atogepant (oral, daily)
Candesartan (ARB)	Emerging evidence
Botulinum toxin (Botox)	For chronic migraine (≥15 days/month)

3. Cluster Headache - Most Painful Primary Headache

Description: Cluster headache belongs to the Trigeminal Autonomic Cephalalgias (TACs) - primary headache disorders with unilateral trigeminal pain plus ipsilateral cranial autonomic features. It is less than 1/10th as common as migraine, but the pain is described as one of the most severe known to medicine (nicknamed "suicide headache").

Key Features:

Prevalence: ~0.1% of population; 4:1 male predominance
Unilateral, strictly one-sided retro-orbital or periorbital severe pain
Quality: boring, stabbing, "red hot poker through the eye"
Duration: 15-180 minutes per attack
Frequency: 1-8 attacks per day, occurring in "clusters" (daily attacks for weeks to months), then remission for months

Ipsilateral Autonomic Features (at least one required):

Lacrimation (tearing)
Conjunctival injection (red eye)
Ptosis and miosis (partial Horner's syndrome)
Rhinorrhea / nasal congestion
Facial sweating/flushing
Aural fullness

Pathophysiology: Functional neuroimaging shows posterior hypothalamic activation during attacks - the hypothalamus acts as the "pacemaker" of cluster cycles.

Subtypes:

Episodic - clusters separated by ≥1 month remission
Chronic - attacks for >1 year without remission, or remissions <1 month

Other TACs:

Paroxysmal hemicrania - like cluster but shorter (2-30 min), more frequent (>5/day), predominantly female; exquisitely responsive to indomethacin
SUNCT/SUNA - very short attacks (seconds to minutes), extremely frequent; often requires lamotrigine or gabapentin
Hemicrania continua - continuous unilateral headache, responds only to indomethacin

Treatment:

Approach	Options
Acute abortion	100% oxygen at 7-12 L/min via non-rebreather mask for 15-20 min (effective in ~70%)
Acute	Subcutaneous sumatriptan 6 mg (fastest onset), intranasal zolmitriptan or sumatriptan
Prevention during cluster period	Verapamil (first-line), oral corticosteroids (short bridge), lithium, topiramate, melatonin
Refractory	Greater occipital nerve block (GONB), sphenopalatine ganglion (SPG) stimulation

4. Other Primary Headache Types

Type	Key Features	Treatment
Hemicrania continua	Continuous moderate unilateral headache for ≥3 months; autonomic features; periods of exacerbation	Indomethacin (diagnostic and therapeutic)
Ice pick headache (primary stabbing)	Brief, intense stabs lasting seconds; "ice pick" in the eye	Indomethacin for prevention
Thunderclap headache (primary)	Sudden maximal headache within <1 min; diagnosis of exclusion after ruling out SAH	Exclude secondary causes first (CT urgently); nimodipine for RCVS
Hypnic headache	Awakens from sleep ("alarm clock headache"); elderly; bilateral	Caffeine before bed, lithium
Exertional headache	Triggered by physical activity	Indomethacin, propranolol
Coital headache	Sudden severe headache at orgasm	Exclude SAH; propranolol for prevention

Part II: Secondary Headaches

Secondary headaches are symptoms of underlying disease. The management is treatment of the underlying cause.

Red Flags ("SNOOP4" criteria) - Require urgent evaluation:

Warning Sign	Concern
Sudden-onset / "worst headache of life" / thunderclap	Subarachnoid hemorrhage (SAH)
First severe headache ever	SAH, meningitis
Fever + stiff neck + altered consciousness	Meningitis, encephalitis
Progressive worsening over days/weeks	Tumor, subdural hematoma
New headache in cancer patient / HIV	Brain metastasis, CNS infection
Onset after age 55	Giant cell arteritis, tumor
Vomiting preceding headache	Raised intracranial pressure
Pain worsens on bending/coughing/Valsalva	Raised ICP, Chiari malformation
Abnormal neurologic exam	Any structural lesion
Pain over temporal artery (tender) in elderly	Giant cell arteritis

Key Secondary Headache Types:

1. Subarachnoid Hemorrhage (SAH)

"Worst headache of life," maximal within seconds
Stiff neck, but no fever
Caused by ruptured aneurysm
Emergency CT, then LP if CT negative → look for xanthochromia

2. Meningitis

Severe headache + stiff neck + fever + photophobia
LP is mandatory (after CT to rule out mass)
IV antibiotics immediately if suspected

3. Intracranial Tumor

Headache in ~50% of brain tumor patients
Typically bifrontal (worse on tumor side), similar to tension headache in quality
Worse on bending; associated with nausea/vomiting; may be worse in morning
MRI is investigation of choice

4. Medication Overuse Headache (MOH)

Paradoxically caused by frequent use of headache medications
Occurs with analgesics >15 days/month, or triptans/ergotamines >10 days/month
Daily or near-daily headache
Treatment: gradual withdrawal of offending medication

5. Giant Cell Arteritis (Temporal Arteritis)

Elderly patients (>50 years), new unilateral headache
Tender temporal artery, jaw claudication, elevated ESR/CRP
Risk of sudden blindness if untreated
Treat immediately with oral corticosteroids; confirm with temporal artery biopsy

6. Idiopathic Intracranial Hypertension (Pseudotumor Cerebri)

Obese young women; chronic daily headache; papilledema; normal MRI
Opening pressure >25 cm H2O on LP
Treatment: weight loss, acetazolamide, LP drainage, shunt surgery for refractory cases

7. Hypertensive Headache

Occurs with severe hypertension (BP >180/120 mmHg)
Occipital, present on waking
Resolves with blood pressure control

8. Post-Dural Puncture (Spinal) Headache

After lumbar puncture, epidural procedures
Orthostatic - worse when sitting/standing, better lying flat
CSF leak causes decreased intracranial pressure
Treatment: bed rest, hydration, caffeine; epidural blood patch for severe/persistent cases

9. Cervicogenic Headache

Pain referred from cervical spine/neck structures
Unilateral, starts in neck/occiput, radiates to forehead
Restricted cervical movement
Treatment: physiotherapy, NSAIDs, nerve blocks

Non-Pharmacologic Treatments (General)

Applicable across multiple headache types:

Regular sleep schedule (avoid both too much and too little sleep)
Regular meals (avoid skipping meals - hypoglycemia triggers headache)
Adequate hydration
Regular aerobic exercise (150 min/week)
Stress management, biofeedback, mindfulness
Identify and avoid personal triggers (keep a headache diary)
Acupuncture (evidence-based for tension and migraine prevention)
Cognitive behavioral therapy (CBT)
Physical therapy for cervicogenic and tension headaches

Summary Table: Quick Comparison of the 3 Major Primary Headaches

Feature	Tension-Type	Migraine	Cluster
Prevalence	69%	16%	0.1%
Sex	Equal	F > M (3:1)	M > F (4:1)
Location	Bilateral	Unilateral (often)	Unilateral, periorbital
Quality	Pressing, tightening	Throbbing, pulsating	Boring, stabbing
Severity	Mild-moderate	Moderate-severe	Severe (worst possible)
Duration	30 min - days	4-72 hours	15-180 min
Nausea	No	Yes	Uncommon
Autonomic features	No	Sometimes	YES (defining)
Activity	Not worsened	Worsened	Restlessness, pacing
Acute treatment	NSAIDs, acetaminophen	Triptans, NSAIDs, gepants	O2, subcutaneous sumatriptan
Prevention	Amitriptyline	Beta-blockers, topiramate, CGRP mAbs	Verapamil

Latest Evidence (PubMed, 2024-2026)

A landmark 2024 BMJ network meta-analysis (PMID: 39293828) comparing drug interventions for acute migraine in adults confirmed triptans remain highly effective for aborting attacks, with newer CGRP antagonists (gepants) offering comparable efficacy with fewer cardiovascular concerns - important for patients who cannot take triptans.

Sources: Harrison's Principles of Internal Medicine 22E (2025); Neuroanatomy through Clinical Cases 3rd Ed.; Frameworks for Internal Medicine; Bradley and Daroff's Neurology in Clinical Practice; ICHD-3 classification; Karlsson et al., BMJ 2024 (PMID: 39293828)

Create a PDF quick reference guide for distinguishing migraine from tension headache

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mkdir -p /home/daytona/workspace/headache-guide && ls /home/daytona/workspace/

Writing File

~/headache-guide/create_headache_guide.py

from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.units import mm, cm
from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle,
    HRFlowable, KeepTogether
)
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY
from reportlab.platypus import BaseDocTemplate, PageTemplate, Frame
from reportlab.lib.colors import HexColor

# ── Colour palette ──────────────────────────────────────────────────────────
MIGRAINE_DARK   = HexColor("#6B21A8")   # deep purple
MIGRAINE_MID    = HexColor("#9333EA")   # purple
MIGRAINE_LIGHT  = HexColor("#EDE9FE")   # lavender tint
TENSION_DARK    = HexColor("#0369A1")   # deep blue
TENSION_MID     = HexColor("#0EA5E9")   # sky blue
TENSION_LIGHT   = HexColor("#E0F2FE")   # light blue tint
HEADER_BG       = HexColor("#1E1B4B")   # dark indigo
ACCENT_RED      = HexColor("#DC2626")   # red for warnings
ACCENT_ORANGE   = HexColor("#EA580C")   # orange for caution
GREEN_DARK      = HexColor("#166534")
GREEN_LIGHT     = HexColor("#DCFCE7")
GREY_LIGHT      = HexColor("#F8FAFC")
GREY_MID        = HexColor("#E2E8F0")
GREY_DARK       = HexColor("#475569")
WHITE           = colors.white
BLACK           = colors.black

# ── Page setup ───────────────────────────────────────────────────────────────
PAGE_W, PAGE_H = A4
MARGIN = 18 * mm

def build_styles():
    base = getSampleStyleSheet()

    styles = {
        "title": ParagraphStyle(
            "title",
            fontName="Helvetica-Bold",
            fontSize=22,
            textColor=WHITE,
            alignment=TA_CENTER,
            spaceAfter=2,
        ),
        "subtitle": ParagraphStyle(
            "subtitle",
            fontName="Helvetica",
            fontSize=11,
            textColor=HexColor("#C4B5FD"),
            alignment=TA_CENTER,
            spaceAfter=0,
        ),
        "section_header": ParagraphStyle(
            "section_header",
            fontName="Helvetica-Bold",
            fontSize=10,
            textColor=WHITE,
            alignment=TA_CENTER,
            spaceAfter=0,
            leading=14,
        ),
        "migraine_col": ParagraphStyle(
            "migraine_col",
            fontName="Helvetica-Bold",
            fontSize=10,
            textColor=MIGRAINE_DARK,
            alignment=TA_CENTER,
        ),
        "tension_col": ParagraphStyle(
            "tension_col",
            fontName="Helvetica-Bold",
            fontSize=10,
            textColor=TENSION_DARK,
            alignment=TA_CENTER,
        ),
        "feature_label": ParagraphStyle(
            "feature_label",
            fontName="Helvetica-Bold",
            fontSize=8.5,
            textColor=HexColor("#1E293B"),
            alignment=TA_LEFT,
        ),
        "cell_text": ParagraphStyle(
            "cell_text",
            fontName="Helvetica",
            fontSize=8,
            textColor=HexColor("#1E293B"),
            alignment=TA_LEFT,
            leading=11,
        ),
        "cell_text_c": ParagraphStyle(
            "cell_text_c",
            fontName="Helvetica",
            fontSize=8,
            textColor=HexColor("#1E293B"),
            alignment=TA_CENTER,
            leading=11,
        ),
        "warn_title": ParagraphStyle(
            "warn_title",
            fontName="Helvetica-Bold",
            fontSize=9,
            textColor=ACCENT_RED,
            alignment=TA_LEFT,
        ),
        "warn_body": ParagraphStyle(
            "warn_body",
            fontName="Helvetica",
            fontSize=8,
            textColor=HexColor("#7F1D1D"),
            alignment=TA_LEFT,
            leading=12,
        ),
        "box_title": ParagraphStyle(
            "box_title",
            fontName="Helvetica-Bold",
            fontSize=9,
            textColor=HEADER_BG,
            alignment=TA_LEFT,
            spaceAfter=2,
        ),
        "box_body": ParagraphStyle(
            "box_body",
            fontName="Helvetica",
            fontSize=8,
            textColor=HexColor("#1E293B"),
            alignment=TA_LEFT,
            leading=12,
        ),
        "footer": ParagraphStyle(
            "footer",
            fontName="Helvetica",
            fontSize=7,
            textColor=GREY_DARK,
            alignment=TA_CENTER,
        ),
        "green_title": ParagraphStyle(
            "green_title",
            fontName="Helvetica-Bold",
            fontSize=9,
            textColor=GREEN_DARK,
            alignment=TA_LEFT,
            spaceAfter=2,
        ),
        "green_body": ParagraphStyle(
            "green_body",
            fontName="Helvetica",
            fontSize=8,
            textColor=HexColor("#14532D"),
            alignment=TA_LEFT,
            leading=12,
        ),
        "orange_title": ParagraphStyle(
            "orange_title",
            fontName="Helvetica-Bold",
            fontSize=9,
            textColor=ACCENT_ORANGE,
            alignment=TA_LEFT,
            spaceAfter=2,
        ),
        "orange_body": ParagraphStyle(
            "orange_body",
            fontName="Helvetica",
            fontSize=8,
            textColor=HexColor("#431407"),
            alignment=TA_LEFT,
            leading=12,
        ),
        "pin_title": ParagraphStyle(
            "pin_title",
            fontName="Helvetica-Bold",
            fontSize=9,
            textColor=MIGRAINE_DARK,
            alignment=TA_CENTER,
        ),
        "pin_big": ParagraphStyle(
            "pin_big",
            fontName="Helvetica-Bold",
            fontSize=20,
            textColor=MIGRAINE_MID,
            alignment=TA_CENTER,
            leading=24,
        ),
        "pin_body": ParagraphStyle(
            "pin_body",
            fontName="Helvetica",
            fontSize=8,
            textColor=MIGRAINE_DARK,
            alignment=TA_CENTER,
            leading=12,
        ),
    }
    return styles

# ── Helper: draw page border & header background via canvas ─────────────────
def draw_page_background(canvas, doc):
    canvas.saveState()
    # Header background band
    canvas.setFillColor(HEADER_BG)
    canvas.rect(0, PAGE_H - 42*mm, PAGE_W, 42*mm, fill=1, stroke=0)
    # Decorative accent line under header
    canvas.setStrokeColor(MIGRAINE_MID)
    canvas.setLineWidth(3)
    canvas.line(MARGIN, PAGE_H - 42*mm, PAGE_W - MARGIN, PAGE_H - 42*mm)
    # Footer
    canvas.setFillColor(GREY_LIGHT)
    canvas.rect(0, 0, PAGE_W, 12*mm, fill=1, stroke=0)
    canvas.setStrokeColor(GREY_MID)
    canvas.setLineWidth(0.5)
    canvas.line(MARGIN, 12*mm, PAGE_W - MARGIN, 12*mm)
    canvas.setFont("Helvetica", 7)
    canvas.setFillColor(GREY_DARK)
    canvas.drawCentredString(
        PAGE_W/2, 4.5*mm,
        "Quick Reference Guide | Migraine vs Tension-Type Headache  |  "
        "Sources: Harrison's 22E, Neuroanatomy Through Clinical Cases 3rd Ed., ICHD-3"
    )
    canvas.restoreState()

def make_pdf(output_path):
    S = build_styles()

    doc = BaseDocTemplate(
        output_path,
        pagesize=A4,
        leftMargin=MARGIN, rightMargin=MARGIN,
        topMargin=44*mm, bottomMargin=14*mm,
    )
    frame = Frame(MARGIN, 14*mm, PAGE_W - 2*MARGIN, PAGE_H - 58*mm, id="main")
    template = PageTemplate(id="main_page", frames=[frame], onPage=draw_page_background)
    doc.addPageTemplates([template])

    story = []
    usable_w = PAGE_W - 2*MARGIN

    # ── TITLE (drawn on canvas, so we just add a spacer to shift content down) ──
    # The header band is drawn by draw_page_background; put title text there via canvas
    # We'll overlay it using a transparent table at the top of the frame
    header_table = Table(
        [[
            Paragraph("MIGRAINE vs TENSION-TYPE HEADACHE", S["title"]),
        ]],
        colWidths=[usable_w],
        rowHeights=[12*mm],
    )
    header_table.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), colors.transparent),
        ("BOX", (0,0), (-1,-1), 0, colors.transparent),
        ("TOPPADDING", (0,0), (-1,-1), 0),
        ("BOTTOMPADDING", (0,0), (-1,-1), 0),
    ]))

    subtitle_table = Table(
        [[Paragraph("Clinical Quick Reference Guide  |  Differential Diagnosis & Management", S["subtitle"])]],
        colWidths=[usable_w],
        rowHeights=[7*mm],
    )
    subtitle_table.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), colors.transparent),
        ("TOPPADDING", (0,0), (-1,-1), 0),
        ("BOTTOMPADDING", (0,0), (-1,-1), 2),
    ]))

    story.append(header_table)
    story.append(subtitle_table)
    story.append(Spacer(1, 3*mm))

    # ── Section: OVERVIEW COMPARISON TABLE ──────────────────────────────────
    col_feat = 38*mm
    col_mig  = (usable_w - col_feat) / 2
    col_ten  = col_mig

    # Column headers
    headers = [
        Paragraph("FEATURE", S["section_header"]),
        Paragraph("MIGRAINE", S["section_header"]),
        Paragraph("TENSION-TYPE", S["section_header"]),
    ]
    header_row = Table(
        [headers],
        colWidths=[col_feat, col_mig, col_ten],
        rowHeights=[8*mm],
    )
    header_row.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (0,0), GREY_DARK),
        ("BACKGROUND", (1,0), (1,0), MIGRAINE_DARK),
        ("BACKGROUND", (2,0), (2,0), TENSION_DARK),
        ("TEXTCOLOR", (0,0), (-1,-1), WHITE),
        ("VALIGN", (0,0), (-1,-1), "MIDDLE"),
        ("ALIGN", (0,0), (-1,-1), "CENTER"),
        ("FONTNAME", (0,0), (-1,-1), "Helvetica-Bold"),
        ("FONTSIZE", (0,0), (-1,-1), 9),
        ("TOPPADDING", (0,0), (-1,-1), 2),
        ("BOTTOMPADDING", (0,0), (-1,-1), 2),
    ]))
    story.append(header_row)

    # Comparison rows: (feature, migraine text, tension text, mig_bg, ten_bg)
    rows = [
        ("Prevalence",
         "~16% of all headaches",
         "~69% of all headaches (most common)",
         MIGRAINE_LIGHT, TENSION_LIGHT),
        ("Sex ratio",
         "Female : Male = 3:1",
         "Roughly equal (F slightly > M)",
         WHITE, WHITE),
        ("Location",
         "Unilateral (60–70%)\nCan be bilateral",
         "Bilateral — always\n'Band around head'",
         MIGRAINE_LIGHT, TENSION_LIGHT),
        ("Quality / Character",
         "Throbbing, pulsating\nPounding",
         "Pressing, tightening\nNon-pulsating, dull ache",
         WHITE, WHITE),
        ("Severity",
         "Moderate to severe\nOften incapacitating",
         "Mild to moderate\nRarely stops daily activity",
         MIGRAINE_LIGHT, TENSION_LIGHT),
        ("Duration",
         "4 – 72 hours\n(untreated / inadequately treated)",
         "30 min – several days",
         WHITE, WHITE),
        ("Nausea / Vomiting",
         "YES — characteristic\n(nausea in ~80%, vomiting in ~30%)",
         "NO (or very mild nausea in chronic type)",
         MIGRAINE_LIGHT, TENSION_LIGHT),
        ("Photophobia",
         "YES — prominent feature",
         "Mild, if present at all",
         WHITE, WHITE),
        ("Phonophobia",
         "YES — prominent feature",
         "Mild, if present at all",
         MIGRAINE_LIGHT, TENSION_LIGHT),
        ("Aura",
         "Present in ~20% (classic migraine)\nVisual most common; lasts 5–60 min",
         "ABSENT",
         WHITE, WHITE),
        ("Effect of activity",
         "WORSENED by routine\nphysical activity (e.g. walking)",
         "NOT worsened by activity",
         MIGRAINE_LIGHT, TENSION_LIGHT),
        ("Prodrome",
         "YES — yawning, mood changes,\nneck stiffness, food cravings (hrs before)",
         "Uncommon",
         WHITE, WHITE),
        ("Autonomic features",
         "Sometimes: photophobia,\nphonophobia, osmophobia",
         "None",
         MIGRAINE_LIGHT, TENSION_LIGHT),
        ("Associated factors",
         "Hormonal (menstrual), sleep changes,\nstress, certain foods, weather, odours",
         "Stress, poor posture,\nfatigue, eye strain, hunger",
         WHITE, WHITE),
        ("Pathophysiology",
         "Brain disorder — trigeminovascular\nactivation, cortical spreading depression",
         "Pericranial muscle tenderness,\ncentral sensitisation",
         MIGRAINE_LIGHT, TENSION_LIGHT),
    ]

    comp_data = []
    comp_styles_list = [
        ("GRID", (0,0), (-1,-1), 0.3, GREY_MID),
        ("VALIGN", (0,0), (-1,-1), "MIDDLE"),
        ("TOPPADDING", (0,0), (-1,-1), 3),
        ("BOTTOMPADDING", (0,0), (-1,-1), 3),
        ("LEFTPADDING", (0,0), (-1,-1), 4),
        ("RIGHTPADDING", (0,0), (-1,-1), 4),
    ]

    for i, (feat, mig, ten, mig_bg, ten_bg) in enumerate(rows):
        feat_bg = HexColor("#F1F5F9") if i % 2 == 0 else WHITE
        comp_data.append([
            Paragraph(feat, S["feature_label"]),
            Paragraph(mig.replace("\n", "<br/>"), S["cell_text"]),
            Paragraph(ten.replace("\n", "<br/>"), S["cell_text"]),
        ])
        comp_styles_list.append(("BACKGROUND", (0,i), (0,i), feat_bg))
        comp_styles_list.append(("BACKGROUND", (1,i), (1,i), mig_bg))
        comp_styles_list.append(("BACKGROUND", (2,i), (2,i), ten_bg))

    comp_table = Table(comp_data, colWidths=[col_feat, col_mig, col_ten])
    comp_table.setStyle(TableStyle(comp_styles_list))
    story.append(comp_table)
    story.append(Spacer(1, 4*mm))

    # ── Three bottom boxes: PIN mnemonic | Red Flags | Treatment ─────────────
    box_w = (usable_w - 4*mm) / 3

    # -- PIN Mnemonic box
    pin_content = [
        Paragraph("PIN MNEMONIC", S["pin_title"]),
        Spacer(1, 1*mm),
        Paragraph("P · I · N", S["pin_big"]),
        Spacer(1, 1*mm),
        Paragraph(
            "<b>P</b>hotosensitivity<br/>"
            "<b>I</b>ncapacitation<br/>"
            "<b>N</b>ausea",
            S["pin_body"]
        ),
        Spacer(1, 1*mm),
        Paragraph(
            "2 of 3 features = 93% PPV for Migraine",
            S["pin_body"]
        ),
        Spacer(1, 1*mm),
        Paragraph(
            "<i>(Neuroanatomy Through Clinical Cases, 3rd Ed.)</i>",
            S["pin_body"]
        ),
    ]
    pin_table = Table(
        [[pin_content]],
        colWidths=[box_w],
    )
    pin_table.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), MIGRAINE_LIGHT),
        ("BOX", (0,0), (-1,-1), 1.5, MIGRAINE_MID),
        ("TOPPADDING", (0,0), (-1,-1), 5),
        ("BOTTOMPADDING", (0,0), (-1,-1), 5),
        ("LEFTPADDING", (0,0), (-1,-1), 6),
        ("RIGHTPADDING", (0,0), (-1,-1), 6),
        ("VALIGN", (0,0), (-1,-1), "TOP"),
    ]))

    # -- Red Flags box
    red_flags = [
        Paragraph("⚠  RED FLAGS — Investigate Urgently", S["warn_title"]),
        Spacer(1, 2*mm),
        Paragraph(
            "• Sudden-onset / 'thunderclap' headache<br/>"
            "• Worst headache of life<br/>"
            "• Fever + stiff neck (meningism)<br/>"
            "• New headache after age 50<br/>"
            "• Progressive worsening over days/weeks<br/>"
            "• Vomiting before headache begins<br/>"
            "• Pain worsened by bending / coughing<br/>"
            "• Wakes patient from sleep<br/>"
            "• Neurological deficit / papilloedema<br/>"
            "• Temporal artery tenderness (elderly)<br/>"
            "• New headache in cancer / HIV patient",
            S["warn_body"]
        ),
    ]
    red_table = Table(
        [[red_flags]],
        colWidths=[box_w],
    )
    red_table.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), HexColor("#FEF2F2")),
        ("BOX", (0,0), (-1,-1), 1.5, ACCENT_RED),
        ("TOPPADDING", (0,0), (-1,-1), 5),
        ("BOTTOMPADDING", (0,0), (-1,-1), 5),
        ("LEFTPADDING", (0,0), (-1,-1), 6),
        ("RIGHTPADDING", (0,0), (-1,-1), 6),
        ("VALIGN", (0,0), (-1,-1), "TOP"),
    ]))

    # -- Treatment box
    treat_content = [
        Paragraph("TREATMENT SUMMARY", S["box_title"]),
        Spacer(1, 1*mm),
        Paragraph("<b><font color='#6B21A8'>MIGRAINE — Acute</font></b>", S["box_body"]),
        Paragraph(
            "Mild-mod: NSAIDs + caffeine combinations<br/>"
            "Mod-severe: Triptans (sumatriptan, rizatriptan)<br/>"
            "With nausea: add metoclopramide IV/IM<br/>"
            "Newer: Gepants (ubrogepant, rimegepant)<br/>"
            "Ditans: Lasmiditan (5-HT1F agonist)",
            S["box_body"]
        ),
        Spacer(1, 1.5*mm),
        Paragraph("<b><font color='#6B21A8'>MIGRAINE — Prevention</font></b>", S["box_body"]),
        Paragraph(
            "Beta-blockers (propranolol, metoprolol)<br/>"
            "TCAs (amitriptyline 10–25 mg nightly)<br/>"
            "Antiepilpetics (topiramate, valproate)<br/>"
            "CGRP mAbs (erenumab, fremanezumab)<br/>"
            "Ca-channel blockers (flunarizine)",
            S["box_body"]
        ),
        Spacer(1, 1.5*mm),
        Paragraph("<b><font color='#0369A1'>TENSION — Acute</font></b>", S["box_body"]),
        Paragraph(
            "Acetaminophen or NSAIDs (first-line)<br/>"
            "Moist heat, massage, relaxation",
            S["box_body"]
        ),
        Spacer(1, 1.5*mm),
        Paragraph("<b><font color='#0369A1'>TENSION — Prevention</font></b>", S["box_body"]),
        Paragraph(
            "Amitriptyline / nortriptyline<br/>"
            "Biofeedback, CBT, exercise<br/>"
            "Avoid medication overuse (&gt;15 days/mo)",
            S["box_body"]
        ),
    ]
    treat_table = Table(
        [[treat_content]],
        colWidths=[box_w],
    )
    treat_table.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), GREY_LIGHT),
        ("BOX", (0,0), (-1,-1), 1.5, GREY_MID),
        ("TOPPADDING", (0,0), (-1,-1), 5),
        ("BOTTOMPADDING", (0,0), (-1,-1), 5),
        ("LEFTPADDING", (0,0), (-1,-1), 6),
        ("RIGHTPADDING", (0,0), (-1,-1), 6),
        ("VALIGN", (0,0), (-1,-1), "TOP"),
    ]))

    # Assemble three boxes side by side
    bottom_row = Table(
        [[pin_table, treat_table, red_table]],
        colWidths=[box_w, box_w, box_w],
        spaceBefore=0,
    )
    bottom_row.setStyle(TableStyle([
        ("LEFTPADDING",  (0,0), (-1,-1), 0),
        ("RIGHTPADDING", (0,0), (-1,-1), 0),
        ("TOPPADDING",   (0,0), (-1,-1), 0),
        ("BOTTOMPADDING",(0,0), (-1,-1), 0),
        ("ALIGN",        (0,0), (-1,-1), "CENTER"),
        ("VALIGN",       (0,0), (-1,-1), "TOP"),
        ("COLPADDING",   (0,0), (-1,-1), 2),
    ]))

    # Use a wrapper to add spacing between columns
    three_cols_data = [[pin_table, Spacer(2*mm, 1), treat_table, Spacer(2*mm, 1), red_table]]
    three_cols = Table(
        three_cols_data,
        colWidths=[box_w, 2*mm, box_w, 2*mm, box_w],
    )
    three_cols.setStyle(TableStyle([
        ("LEFTPADDING",  (0,0), (-1,-1), 0),
        ("RIGHTPADDING", (0,0), (-1,-1), 0),
        ("TOPPADDING",   (0,0), (-1,-1), 0),
        ("BOTTOMPADDING",(0,0), (-1,-1), 0),
        ("VALIGN",       (0,0), (-1,-1), "TOP"),
    ]))

    story.append(KeepTogether(three_cols))

    doc.build(story)
    print(f"PDF created: {output_path}")

if __name__ == "__main__":
    out = "/home/daytona/workspace/headache-guide/Migraine_vs_Tension_Headache_QuickRef.pdf"
    make_pdf(out)

Running Command

cd /home/daytona/workspace/headache-guide && python create_headache_guide.py 2>&1

Running Command

ls -lh /home/daytona/workspace/headache-guide/

The PDF generated successfully. Here's your download link:

Migraine vs Tension Headache QuickRef

PDF Document · PDF

Here's what's packed into this single A4 quick reference guide:

Layout - 3 zones:

Header band (dark indigo) - Title and subtitle in white/lavender
Main comparison table (15 rows) - Color-coded columns:
- Purple = Migraine column
- Blue = Tension-type column
- Covers: Prevalence, Sex, Location, Quality, Severity, Duration, Nausea, Photophobia, Phonophobia, Aura, Effect of activity, Prodrome, Autonomic features, Triggers, Pathophysiology
Three side-by-side boxes at the bottom:
- PIN Mnemonic (lavender) - Photosensitivity + Incapacitation + Nausea = 93% PPV for migraine
- Treatment Summary - Acute and preventive options for both headache types, including gepants and CGRP monoclonal antibodies
- Red Flags (red) - 11 warning signs requiring urgent investigation (SAH, meningitis, tumor, etc.)

Sources cited in the footer: Harrison's Principles of Internal Medicine 22E, Neuroanatomy Through Clinical Cases 3rd Ed., ICHD-3.

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