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Health
About Headaches

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.
The brain tissue itself is not sensitive to pain as it lacks pain receptors. Rather, the pain is caused by disturbance of the pain-sensitive structures around the brain. 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. 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.

Headache

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A headache is pain or discomfort in the head, scalp, or neck. Serious causes of headaches are rare. Most people with headaches can feel much better by making lifestyle changes, learning ways to relax, and sometimes by taking medications.

Primary vs. secondary headaches

Headaches are broadly classified as "primary" or "secondary".Primary headaches are benign, recurrent headaches not caused by underlying disease or structural problems. For example, migraine is a type of primary headache.

Secondary headaches

Headaches may be caused by problems elsewhere in the head or neck. Some of these are not harmful, such as cervicogenic headache (pain arising from the neck muscles). Medication overuse headache may occur in those using excessive painkillers for headaches, paradoxically causing worsening headaches.

Pathophysiology

The brain itself is not sensitive to pain, because it lacks pain receptors, also called nociceptors. However, several areas of the head and neck do have nociceptors, and can thus sense pain. These include the extracranial arteries, large veins, venous sinuses, cranial and spinal nerves, head and neck muscles, the meninges, parts of the brainstem, eyes, ears, teeth and lining of the mouth.

Headache often results from traction to or irritation of the meninges and blood vessels. The nociceptors may be stimulated by head trauma or tumors and cause headaches. Blood vessel spasms, dilated blood vessels, inflammation and/or infection of meninges and muscular tension can also stimulate nociceptors and cause pain.Once stimulated, a nociceptor sends a message up the length of the nerve fiber to the nerve cells in the brain, signaling that a part of the body hurts.

Primary headaches are more difficult to understand than secondary headaches. The exact mechanisms which cause migraines, tension headaches and cluster headaches are not known.

Red flags

It can be challenging to differentiate between low-risk, benign headaches and high-risk, dangerous headaches since symptoms are often similar.Headaches that are possibly dangerous require further lab tests and imaging to diagnose.

The American College for Emergency Physicians published criteria for low-risk headaches. They are as follows:

age younger than 30 years
features typical of primary headache
history of similar headache
no abnormal findings on neurologic exam
no concerning change in normal headache pattern
no high-risk comorbid conditions (for example, HIV)
no new concerning history or physical examination findings

Epidemiology

Approximately 64–77% of people have a headache at some point in their lives. During each year, on average, 46–53% of people have headaches. Most of these headaches are not dangerous. Only approximately 1–5% of people with headaches who go to the emergency room have a serious underlying cause.

More than 90% of headaches are primary headaches

History

An 1819 caricature by George Cruikshank depicting a headache.
The first recorded classification system that resembles the modern ones was published by Thomas Willis, in De Cephalalgia in 1672. In 1787 Christian Baur generally divided headaches into idiopathic (primary headaches) and symptomatic (secondary ones), and defined 84 categories.

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