Overview, Causes, & Risk Factors
A headache is a painful sensation in the muscles, the skin, or one of the
organs in the head or near the brain.
What is going on in the body?
Causes of headaches commonly fall into four categories:
vascular headaches, which are caused by conditions affecting the blood vessels. A
migraine is a common form of vascular
headache.
tension headaches, usually brought
on by muscle tension
inflammatory headaches, which are causd by infections or lesions such as
tumors
headaches associated with abnormalities of cranial nerves, or cranial
neuralgias. The cranial nerves supply the face, head, and neck.
There are no nerve endings in the brain itself. Therefore, a headache is a
painful sensation in the muscles, the skin, or one of the organs in the
head or near the brain. The pain can be confined to a small area or it can
cover the entire head.
Some headaches are preceded by auras, which are sensations that things are not
quite right. These auras can involve unusual sounds, smells or visions.
Most headaches are benign, which means they are self-limited and not likely to
be serious. However, some headaches are serious and require extensive
evaluation.
What are the causes and risks of the condition?
Headaches have a wide variety of causes.
Vascular headaches include:
migraine headaches of all
types
classical migraines, which are
throbbing headaches that usually begin with an aura
ophthalmoplegic migraines, which
are severe headaches usually felt around the eye
cluster headaches, which are
severe, one-sided headaches that occur in groups
headaches associated with hangovers from excessive alcohol intake, or exposure to other drugs and toxins Tension headaches are caused by stress or by abnormalities in the neck,
muscles, or bones. They can also be caused by
conversion disorders, which are psychological problems that cause symptoms
similar to those accompanying an actual physical condition.
Inflammatory headaches are caused by:
lesions such as brain tumors
meningitis, which is an infection
or inflammation of tissue covering the brain and spinal cord
bleeding into or around the brain, which occurs with a subdural hematoma, epidural hematoma, or
subarachnoid hemorrhage
autoimmune disorders, or diseases
in which the body produces chemicals that attack its own tissues
arteritis, which is an inflammation of the wall of an artery
Cranial neuralgias involve severe pains in or about the face or scalp, and are
caused by abnormalities of the trigeminal or glossopharyngeal nerves. The
trigeminal nerve controls sensation in the face, cheek, and jaw. The
glossopharyngeal nerve controls the throat and vocal cords.
Symptoms & Signs
What are the signs and symptoms of the condition?
A headache may involve:
pain in the head
visual impairment, such as blurred
vision
nausea and vomiting
hearing impairment
irritability
confusion
malaise, or a general feeling of
discomfort
Diagnosis & Tests
How is the condition diagnosed?
The first step in diagnosing the cause of headaches is a complete history and
physical examination. The healthcare provider may then order tests, including:
a cranial CT scan, or examination
of the head with a special three-dimensional X-ray
a cranial MRI, which is a special
three-dimensional image made using a magnetic field
an electroencephalogram or
EEG, which is a recording of brain waves
skull X-rays
a spinal tap, which involves
removing a small amount of cerebrospinal fluid with a thin needle
an electromyogram or EMG. This
test is a recording of the electrical activity of selected muscle groups.
biopsy of the arteries in the
head. This test involves collecting a piece of the artery and examining it
under the microscope.
testing of levels of certain drugs or toxins in the blood
Prevention & Expectations
What can be done to prevent the condition?
Many causes of headaches are not preventable. An individual may develop
headaches after exposure to alcohol,
caffeine, chocolate, or stress. Avoiding those triggers can help
prevent headaches.
Medications that can help prevent migraine headaches include:
beta-blockers, such as propranolol, and nadolol
calcium channel blockers, such as verapamil
tricyclic antidepressants, such as amitriptyline, and nortriptyline
cyproheptadine
anticonvulsants, such as valproic
acid and gabapentin
lithium
methysergide maleate
What are the long-term effects of the condition?
Most people do not have any significant long-term effects because their
headaches are benign and recur infrequently. However, vascular headaches
can result in significant loss of quality of life. An individual with a brain
tumor, bleeding, or meningitis
is at risk for severe illness and death.
What are the risks to others?
Headaches are not contagious and pose no risk to others. If the underlying
cause of the headache is an infection such as
meningitis, the infection may be highly contagious. Some headaches,
such as migraines, tend to run in
families.
Treatment & Monitoring
What are the treatments for the condition?
Over-the-counter pain medications such
as ibuprofen, acetaminophen, or aspirin will relieve most headaches.
Medications for acute migraine attacks include:
nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen
isometheptene/dichloralphenazone/acetaminophen
butalbital/acetaminophen/caffeine
other pain medications, such as
hydrocodone/acetaminophen
triptans, such as sumatriptan or zolmitriptan
dihydroergotamine
What are the side effects of the treatments?
Over-the-counter pain medications may
cause stomach upset and allergic
reactions. Other side effects depend on the medication used. Calcium
channel blockers, for example, are associated with a significantly increased
risk of heart attack or congestive heart failure in individuals with
high blood pressure.
What happens after treatment for the condition?
Complications of headaches are usually limited. However, some causes of
headaches such as brain tumors,
bleeding, or meningitis may cause
significant complications.
How is the condition monitored?
A person with frequent or severe headaches may be asked to keep a headache
diary. Any new or worsening symptoms should be reported to the healthcare
provider.