Headaches are a pain or discomfort that can be generalized or local affecting any part of the cephalum (head). There are many causes of HA, some originating from the head region itself, others are referred from the neck and upper back, as well as ophthalmologic origins.
Most causes of HAs are benign and have no underlying significant pathology, however, it is important to have a physician or pain specialist rule out more severe causes before beginning headache treatment for the benign causes. Headaches themselves are one of the most common complaints from people visiting a physician.A headache specialist will then classify the HA as Primary or Secondary. Primary HAs are not caused by an underlying pathology or disease. Meaning, they are benign HAs which can further be subdivided as Cluster, Tension, and Migraine headaches. Secondary HAs are associated with a pre-existing pathology causing the pain, which may be benign or malignant of origin.There are many causes of secondary headaches that should be excluded by a headache specialist before assuming a HA is of primary origin.Some of the more severe causes that require immediate treatment are intracranial hemorrhages/ hematomas, meningeal infections (viral, bacterial, fungal), strokes, and malignant hypertension.Other pathologies that are more subacute, or have an insidious onset may be malignant tumors (primary or malignant) or ophthalmologic (glaucoma, cataract).There are other diseases associated with HA and these all should be evaluated by your physician before treating your HA.Your physician may wish to order radiological studies (MRI, CT scan), neurological exam, blood work, or an eye/vision assessment to help rule out some of the causes of secondary HA Primary headaches are much more common and can be broken down into three categories; Cluster, Tension, and Migraine headaches.Headache TypesCluster HeadachesIn Cluster HA, men are more commonly affected than women with a peak age of onset around 25 years. Patients will present with a severe, unilateral, pulsatile, periorbital pain that typically lasts anywhere from 20 minutes to 3 hours. Patients describe the pain associated with Cluster HA to be far more severe than is experienced in Tension or Migraine HAs. Risk factors for Cluster HA are vasodilating medications as well as recent alcohol or illicit drug use. A specific trait to Cluster HAs are that they occur in clusters, hence the name, meaning they affect the same location of the head, around the same time of day, during the same time of year. Patients may also experience tearing from the eye on the same side of the head as the pain as well as nasal discharge or stuffiness, or neurological complications (Horners syndrome, ptosis). In contrast with the other two types of primary HA, emotion and food are NOT triggers in Cluster HA.sTension HeadachesTensions HAs are considered the most common HA diagnosed in adults. The pain is described as a restrictive, band like pain that is being wrapped around the patients head. Patients describe it as an insidious (slow) onset and can be exacerbated by bright lights, noise, and especially stress. A patient experiencing Tension headaches may also have an associated Depression, sleep disturbance, or poor concentration. These typically occur towards the end of the day and are located in the upper neck and occipital (back of head) region. Unlike Cluster and Migraines, Tension HA are not associated with any neurological disturbances and are usually a diagnosis of exclusion.