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Overview

Though headache represents one of the most debilitating conditions in all of medicine, it remains one of the most neglected. Studies have shown that both physicians and patients commonly ignore and subsequently under-treat headache. Although many headache disorders can be chronic and disabling, accurate diagnosis and proper treatment can result in sustained pain relief and restoration of a functional quality of life.
 
Symptoms
 
Headache symptoms vary depending on what is causing the pain. Primary headache syndromes include migraine, tension-type headache, and the trigeminal autonomic cephalalgias (such as cluster headache). Contributing factors may include certain foods, medications, dehydration, or changing levels of hormones. Secondary headaches are symptoms of another medical problem, such as an aneurysm or brain tumor.  The following is a description of some of the common primary headache disorders:
 

  • Migraine presents as throbbing pain on one or both sides of the head of moderate to severe intensity, which can feel worse upon exertion. Migraine headaches may also be accompanied by nausea/vomiting and sensitivity to light, sounds, smells, and movement.
     
  • Tension-type headache manifests as dull pain or a feeling of tightness on both sides of the head. Pain may be mild to moderate, but is usually not severe, and not associated with sensitivity to sensory stimuli.
     
  • Trigeminal autonomic cephalalgias (TACs) are characterized by recurrent episodes of moderate-severe pain on one side of the head or face, with associated symptoms of eye tearing, swelling or drooping of the eye, redness of the eye, and/or nasal congestion or drainage on the same side of the pain.  Cluster headache is the most common headache disorder within this group, with pain typically localized behind one eye and usually occurring in a series that may last weeks or months in a row, with a seasonal or annual recurrence.

Frequent use of pain medications (over-the-counter or prescription drugs) can also lead to headaches, called medication overuse or rebound headache.  Seeking specialized medical attention at the initial presentation of a headache disorder is important to prevent medication overuse headache, which can be difficult to treat.
 
Headaches that are extremely severe ("worst headache ever") or cause vision changes, weakness of the arms or legs, or seizures may be caused by a serious medical condition, such as an aneurysm, and require emergency attention.