Pain felt in the forehead, eyes, jaws, temples, scalp, skull, occiput, or neck. Headache is exceptionally common; it affects almost everyone at some time. From a clinical perspective, benign HA must be distinguished from a potentially life-threatening HA. Types of benign HA include tension, migraine, cluster, sinus, and environmentally induced (e.g., “ice cream” HA or “caffeine-withdrawal” HA). Life-threatening HA may be caused by rupture of an intracranial aneurysm, subarachnoid hemorrhage, hemorrhagic stroke, cranial trauma, encephalitis, meningitis, brain tumors, or brain abscesses. Synonym: cephalalgia
Typically, benign HAs have a recurrent or chronic history with which the patient is familiar. The tension HA sufferer, for example, develops bandlike pressure around the head at the end of a difficult or stressful day. The onset of the HA is gradual and progressively worsens but is usually not severe or intense.
The migraine HA sufferer also typically has a history of recurrent HA, often dating back to childhood. Migraine HA is often of rapid onset, unilateral, throbbing, or beating in character. It may be preceded by scotoma and be associated with nausea, vomiting, or even transient neurological deficits, such as hemibody weakness. The HA may be triggered by eating chocolate, monosodium glutamate, or some cheeses, drinking alcohol, or taking certain medications, such as the hormone estrogen. By contrast, an HA that is life-threatening may have some of the following hallmarks: (1) first, or the worst, HA a patient has ever suffered (i.e., subarachnoid hemorrhage should be suspected); (2) first occurrence in a patient with a history of cancer (metastatic tumor); (3) accompanying fever, stiff neck, or photophobia (meningitis, intracranial hemorrhage); (4) associated loss of consciousness or severely altered mental status (intracerebral hemorrhage, brain embolism, encephalitis, meningitis); (5) associated neurological deficits that do not quickly resolve (intracerebral hemorrhage, brain embolism, brain abscesses); (6) occurrence in a patient with recent head trauma (hemorrhage, carotid artery dissection) or a history of recent foreign travel (neurocysticercosis; falciparum malaria); and (7) occurrence in a patient with acquired immunodeficiency syndrome (cryptococcal meningitis, Toxoplasma gondii, central nervous system lymphoma).
Only a few examples are given here. Almost any disturbance of body function may cause HA, including sunstroke, motion sickness, insomnia, altitude sickness, spinal puncture, alcohol withdrawal, prolonged fasting, exposure to loud noise, menstruation, psychological stressors, or new medications (e.g., nitrates).
Mild HA often responds to rest, massage, acetaminophen, or listening to relaxing music. Moderate HA typically requires nonsteroidal anti-inflammatory drug (NSAID) therapy. Caffeine helps ameliorate many mild to moderate HAs. Antiemetics (e.g., prochlorperazine, metoclopramide) help relieve moderate to severe HAs, esp. those accompanied by nausea; ergotamines and the triptan drugs are particularly suited to treating migraines. Cluster HAs often resolve after treatment with corticosteroids or high-flow oxygen. The HA of temporal arteritis also responds to high-dose steroids, but these agents must be continued for months or years until the syndrome remits. Narcotic analgesics relieve HA pain, but habitual use may diminish their effectiveness or result in dependence.
A description of the headache is obtained and documented, including the character, severity, location, radiation, prodromes, or associated symptoms, as well as any palliative measures that have brought relief. Temporal factors and any relationship of recurring headaches to other activities are also documented. The patient is taught to avoid precipitating or exacerbating factors. Noninvasive comfort measures (lying down in a quiet, darkened room with an ice pack on the forehead or cool compresses on the eyes) and prescribed drug therapy are instituted, and the patient is taught about these and evaluated for desired responses and any adverse reactions. If nausea and vomiting precede or accompany HA, the patient is taught to use antiemetics, and to drink fluids for rehydration once the medication has taken effect.
A headache that occurs when a patient who has chronic or recurring headaches and overuses medications to control them stops using pain relievers. Analgesic rebound is a common cause of daily headache pain; it may respond to treatment with antidepressant medications and withdrawal of the offending analgesics. Synonym: medication overuse headache
caffeine withdrawal headache
Headache, usually mild to moderate, that begins after someone stops drinking coffee, tea, or other caffeinated drinks. This type of headache usually occurs only in those who habitually consume more than 4 cups of caffeine daily and is often accompanied by fatigue and malaise.
A headache that begins in the superior segments of the cervical spine and radiates to one side of the neck, forehead, and/or shoulder. It typically is worsened by movements or postures of the head or neck, or by pressure applied directly to the neck. It may be relieved by massage, manipulation, or occipital nerve blocks.
A series of headaches, typically occurring in men, that are intense, recurring, felt near one eye, and often associated with nasal congestion, rhinorrhea, and watering of the affected eye. They typically occur 1 or 2 hr after the patient has fallen asleep, last for about 45 min, and recur daily for several weeks before spontaneous resolution. The cause of the headaches is unknown, but their recurrence during certain seasons of the year and certain times of day may suggest a circadian or chronobiological mechanism.
Medications that alleviate cluster headaches include corticosteroids, ergotamines, gabapentin, lithium, melatonin, NSAIDs, sumatriptan and other “-triptan” drugs, and high-flow oxygen. Surgery is sometimes used to cut affected nerves.
coin-shaped headacheNummular headache.
A headache that begins suddenly during coitus or immediately after orgasm. These are uncommon, occur more frequently in men than in women, and may last for minutes or hours.
An acute headache of short duration that appears after strenuous physical activity. Usually benign, it is relieved by aspirin and prevented by changing to a less strenuous exercise.
A headache resulting from ingestion of histamine (found in some wines), injection of histamine, or excessive histamine in circulating blood. This type of headache is due to dilatation of branches of the carotid artery. See: cluster headache
A headache that awakens a patient from sleep. Hypnic headaches are typically bilateral, and are experienced more often by the elderly than by other patients. Unlike cluster headaches, which also occur during rest or sleep, the hypnic headache is not felt on one side of the face, and not associated with tearing of the eye or painful congestion of the sinuses.
idiopathic stabbing headacheStabbing headache.
medication overuse headacheAnalgesic-rebound headache.
Headache that may have features of some combination of migraine headache, tension headache, and analgesic withdrawal.
A rare form of headache that is confined to a small circular or elliptical region of the head, usually the size of a nickel or silver dollar. It does not migrate to other areas of the head or neck. Sometimes it is caused by focal infection, trauma, or tumor. Synonym: coin-shaped headache
postdural puncture headachePostlumbar puncture headache.
postlumbar puncture headache
Synonym: postdural puncture headache
A headache occurring after a spinal tap, felt mostly in the front and the back of the head. It is markedly worse when the patient sits up and better when the patient lies down. The headache is sometimes associated with double vision.
It is caused by the leakage of spinal fluid through a hole that fails to close when the spinal needle is removed from the dura mater. It is less likely to occur when pencil-point needles are used for lumbar puncture and when the spinal needle has a small diameter (e.g., 25 gauge).
Bedrest in a completely flat and prone position (without a pillow), forced oral and intravenous fluids, and administration of cortical steroids are useful in treating the headache. If the headache persists in spite of therapy, it may be possible to stop the leakage of spinal fluid by injecting 10 ml of the patient's blood in the epidural space at the site of the lumbar puncture. The blood may “patch” the hole in the dura.
primary stabbing headacheStabbing headache.
A headache of very brief duration, consisting of jabbing or stabbing pain that lasts only a few seconds and then recurs. It often improves when treated with indomethacin. Synonym: idiopathic stabbing headache; primary stabbing headache
An abbreviation for short-lasting unilateral neuralgiform headache with cranial autonomic features, a form of intense headache affecting one side of the face and often associated with tearing, reddening of the conjunctiva, and swelling of the eyelid on the affected side. A SUNA headache is similar to a SUNCT headache; some headache specialists consider SUNCT headache to be a subtype of SUNA and both to be related to disturbances of the trigeminal nerve.
An abbreviation for short-lasting unilateral neuralgiform headaches occurring with conjunctival injection and tearing, consisting of brief but repetitive intense attacks affecting one side of the face and the eye on the same side. Transient nasal congestion often accompanies the headache. The syndrome is most often reported in men over 50, although it has been documented in other groups of patients.
1. A headache associated with chronic contraction of the muscles of the neck and scalp.
2. A headache associated with emotional or physical strain.
A sudden, severe headache that reaches maximal intensity within seconds. Common causes include subarachnoid hemorrhage, cerebral aneurysm, arterial dissection, and cerebral venous sinus thrombosis. Its absence does not rule out intracranial hemorrhage.
A form of exertional headache that occurs after straining during workouts with free weights or weight-training machines.
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