A Headache is defined as a pain in the head or upper neck. It is one of the most common locations of pain in the body and has many causes.


How are headaches classified?


Headaches have numerous causes, and in 2007 the International Headache Society agreed upon an updated classification system for headache. Because so many people suffer from headaches and because treatment sometimes is difficult, it is hoped that the new classification system will allow health care practitioners come to a specific diagnosis as to the type of headache and to provide better and more effective treatment.


There are three major categories of headaches:


  • primary headaches, 
  • secondary headaches,
  • cranial neuralgias, facial pain, and other headaches.


What are primary headaches?


Primary headaches include migraine, tension, and cluster headaches, as well as a variety of other less common types of headache.


Tension headaches are the most common type of primary headache. Up to 90% of adults have had or will have tension headaches. Tension headaches occur more commonly among women than men.


Migraine headaches are the second most common type of primary headache. An estimated 28 million people in the United States (about 12% of the population) will experience a migraine headache. Migraine headaches affect children as well as adults.


Before puberty, boys and girls are affected equally by migraine headaches, but after puberty, more women than men are affected. It is estimated that 6% of men and up to 18% of women will experience a migraine headache in their lifetime. 


Cluster headaches are a rare type of primary headache affecting 0.1% of the population (1 in a 1,000 people). It more commonly affects men in their late 20s though women and children can also suffer these types of headache.


Primary headaches can affect the quality of life. Some people have occasional headaches that resolve quickly while others are debilitated. While these headaches are not life-threatening, they may be associated with symptoms that can mimic strokes or intracerebral bleeding.


What are secondary headaches?


Secondary headaches are those that are due to an underlying structural problem in the head or neck. There are numerous causes of this type of headache ranging from bleeding in the brain, tumor, or meningitis and encephalitis.


The pain symptoms of a tension headache are:


  • The pain begins in the back of the head and upper neck and is described as a band-like tightness or pressure. 
  • Often is described as pressure encircling the head with the most intense pressure over the eyebrows. 
  • The pain usually is mild (not disabling) and bilateral (affecting both sides of the head). 
  • The pain is not associated with an aura (see below), nausea, vomiting, or sensitivity to light and sound. 
  • The pain occurs sporadically (infrequently and without a pattern) but can occur frequently and even daily in some people. 
  • The pain allows most people to function normally, despite the headache.


While tension headaches are the most frequently occurring type of headache, their cause is not known. The most likely cause is contraction of the muscles that cover the skull. When the muscles covering the skull are stressed, they may spasm and cause pain.


Common sites include the base of the skull where the trapezius muscles of the neck inserts, the temple where muscles that move the jaw are located, and the forehead.


There is little research to confirm the exact cause of tension headaches. Tension headaches occur because of physical or emotional stress placed on the body. These stressors can cause the muscles surrounding the skull to clench the teeth and go into spasm.


Physical stressors include difficult and prolonged manual labor, or sitting at a desk or computer for long periods of time concentrating. Emotional stress may also cause tension headaches by causing the muscles surrounding the skull to contract.


Headaches may be very difficult to treat, and it make take trial and error to find the specific treatment regimen that will work for each patient. Since the headache recurs daily, there are two treatment needs. The pain of the first episode needs to be controlled, and additional headaches need to be prevented.


Self-Care at Home


Most affected individuals usually may take an over-the-counter (OTC) headache medication, such as acetaminophen (Tylenol) to reduce the headache pain; taking ibuprofen (Advil) or other nonsteroidal anti-inflammatory drugs (NSAIDs) is not advised because if the headache is due to bleeding in the brain, the medication may make it worse.


If the headache is truly the worst headache of your life you should go to an emergency department immediately. 


  • Some tension headaches are relieved if the person removes themselves from the situation causing stress. 
  • A cool, wet towel over the forehead may reduce symptoms. 
  • A person with chronic migraine headaches should discuss a treatment plan with their health care practitioner.


If the affected individual continues to visit the emergency department, repeated CT scans may be performed, resulting in unnecessary radiation exposure, and no follow-up plan for the patient for a potentially treatable condition.


Medical Treatment


Treatment of the headache depends on the specific diagnosis. It is important for the patient to keep their primary care doctor updated on visits to the emergency department, so that the doctor is aware of any changes that may need to be made to the patient's treatment plan, especially if they are managing chronic migraine headaches.


  • Headaches that are not life-threatening, such as tension, mild, cluster, or migraine headaches may be treated with a variety of pain medications. 
  • More serious headaches will require specific treatments prescribed by the doctor, possibly with the involvement of a specialist.
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