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Headache
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In medicine a headache or cephalalgia is a symptom of a number of different conditions of the head and sometimes neck. Some of the causes are benign while others are medical emergencies. It ranks among the most common pain complaints.
There are a number of different classification systems for headaches. The most well recognized is that of the International Headache Society.
Treatment of a headache depends on the underlying etiology or cause, but commonly involves analgesics.
Classification
The classification of headaches has a rich history.
Discussion
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Encyclopedia
In medicine a headache or cephalalgia is a symptom of a number of different conditions of the head and sometimes neck. Some of the causes are benign while others are medical emergencies. It ranks among the most common pain complaints.
There are a number of different classification systems for headaches. The most well recognized is that of the International Headache Society.
Treatment of a headache depends on the underlying etiology or cause, but commonly involves analgesics.
Classification
The classification of headaches has a rich history. The first recorded system that resembles the modern ones was published by Thomas Willis, in De Cephalagia in 1672. In 1787 Christian Baur generally divided headaches into idiopathic (primary headaches) and symptomatic (secondary ones), and defined 84 categories.
Today headaches are most thoroughly classified by the International Headache Society's, International Classification of Headache Disorders (ICHD), which published the second edition in 2004. This classification is accepted by the WHO.
Other classification systems exist. One of the first published attempts was in 1951. NIH developed a classification system in 1962.
ICHD-2
The International Classification of Headache Disorders (ICHD) is an in-depth hierarchical classification of headaches published by the International Headache Society. It contains explicit (operational) diagnostic criteria for headache disorders. The first version of the classification, ICHD-1, was published in 1988. The current revision, ICHD-2, was published in 2004.
The classification uses numeric codes. The top, one-digit diagnostic level includes 14 headache groups. The first four of these are classified as primary headaches, groups 5-12 as secondary headaches, cranial neuralgia, central and primary facial pain and other headaches for the last two groups.
Primary headaches
Migraine
Tension-type headache (TTH)
Cluster headache and other trigeminal autonomic cephalalgias (TAC)
Other primary headaches including
Secondary headaches
Headache attributed to head and/or neck trauma
Headache attributed to cranial or cervical vascular disorder including:
Headache attributed to non-vascular intracranial disorder including:
Headache attributed to a substance or its withdrawal including:
Headache attributed to infection including:
Headache attributed to disorder of homoeostasis
Headache or facial pain attributed to disorder of cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cranial structures
Headache attributed to psychiatric disorder
Neuralgias and other headaches
Cranial neuralgias, central and primary facial pain and other headaches
Other headache, cranial neuralgia, central or primary facial pain including:
NIH
The NIH classification consists of brief, relatively vague glossary-type definitions of a limited number of headaches.
Symptoms and signs
Headache associated with specific symptoms may warrant urgent medical attention, particularly sudden, severe headache or sudden headache associated with a stiff neck; headaches associated with fever, convulsions or accompanied by confusion or loss of consciousness; headaches following a blow to the head, or associated with pain in the eye or ear; persistent headache in a person with no previous history of headaches; and recurring headache in children.
Pathophysiology
The brain in itself is not sensitive to pain, because it lacks nociceptors. Several areas of the head neck however can sense pain. These include: extracranial arteries, large veins, cranial and spinal nerves, head and neck muscles, the meninges, raised intracranial pressure, disturbance of the intracerebral serotonergic levels.
Diagnosis
In 2008 the American College of Emergency Physicians updated their guidelines on the evaluation and management of adult patients who have a nontraumatic headache of acute onset.
While, statistically, headaches are most likely to be primary ( harmless and self-limiting ), some specific secondary headache syndromes may demand specific treatment or may be warning signals of more serious disorders. Differentiating between primary and secondary headaches can be difficult.
As it is often difficult for patients to recall the precise details regarding each headache, it is often useful for the sufferer to fill-out a "headache diary" detailing the characteristics of the headache.
Imaging
When the headache does not clearly fit into one of the recognized primary headache syndromes or when atypical symptoms or signs are present then further investigations are justified. Neuroimaging ( noncontrast head CT ) is recommended if there are new neurological problems such as decreased level of consciousness, one sided weakness, pupil size difference, etc or if the pain is of sudden onset and severe, or if the person is known HIV positive. People over the age of 50 years may also warrant a CT scan.
Treatment
Not all headaches require medical attention, and most respond with simple analgesia (painkillers) such as paracetamol/acetaminophen or members of the NSAID class (such as aspirin/acetylsalicylic acid or ibuprofen).
In recurrent unexplained headaches, healthcare professionals may recommend keeping a "headache diary" with entries on type of headache, associated symptoms, precipitating and aggravating factors. This may reveal specific patterns, such as an association with medication, menstruation or absenteeism or with certain foods.
It was reported in March 2007 by two separate teams of researchers that stimulating the brain with implanted electrodes appears to help ease the pain of cluster headaches.
Further reading
External links
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