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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 (also called muscle contraction headaches, usually brought on by muscle tension or spasm
• inflammatory headaches, which are caused by infections or lesions such as tumors
• headaches associated with abnormalities of cranial nerves, called 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 (especially migraine headaches) can be preceded by auras, which are unusual sensations involving sounds, smells or visions that are not really present.

Most headaches are benign, meaning that they are self-limited and not likely to be serious. However, some headaches are serious and require extensive evaluation.

What are the signs and symptoms of the condition?

• pain in the head
• visual impairment, such as blurred vision
• nausea and vomiting
• hearing impairment
• irritability
• confusion
• malaise, or a general feeling of discomfort

What are the causes and risks of the condition?

• migraine headaches of all types
• classical migraines, throbbing headaches that are usually preceeded by an aura, a strange series of visual, smell, or feeling perception
• 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 by far the most common type of headaches. They may be caused by stress or by abnormalities in the neck, muscles, or bones. Sometimes they are part of a psychological condition called a conversion disorder, which is characterized by symptoms similar to those accompanying an actual physical condition.

• 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.

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 (i.e., Inderal, InnoPran), and nadolol (i.e., Corgard)
• calcium channel blockers, such as verapamil (i.e., Calan, Isoptin, Verelan)
• tricyclic antidepressants, such as amitriptyline (i.e., Elavil), and nortriptyline (i.e., Aventyl, Pamelor)
• cyproheptadine
• anticonvulsants, such as valproic acid (i.e., Depakene) and gabapentin (i.e., Neurontin)
• lithium (i.e., Eskalith, Lithobid)

How is the condition diagnosed?

The first step in diagnosing the cause of headaches is a complete history and physical examination. The healthcare professional 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 powerful electromagnetic field
• an electroencephalogram (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
• 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

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.

What are the treatments for the condition?

Over-the-counter pain medications such as ibuprofen (i.e., Advil, Motrin), acetaminophen (i.e., Tylenol), or aspirin will relieve most headaches.

Medications for acute migraine attacks include:

• nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (i.e., Advil, Motrin) and naproxen (i.e., Aleve, Anaprox, Naprosyn)
• isometheptene/dichloralphenazone/acetaminophen (i.e., Midrin)
• butalbital/acetaminophen/caffeine
• other pain medications, such as hydrocodone/acetaminophen
• triptans, such as sumatriptan (i.e., Imitrex) or zolmitriptan (i.e., Zomig)
• dihydroergotamine (i.e., DHE 45, Migranol)

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 to help the healthcare professional figure out a pattern for the headaches that may help diagnose their cause. Any new or worsening symptoms should be reported.