Headache
From Wikipedia, the free encyclopedia
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| ICD-10 | R51. |
|---|---|
| ICD-9 | 784.0 |
| DiseasesDB | 19825 |
| MedlinePlus | 003024 |
| eMedicine | neuro/517 neuro/70 |
| MeSH | D006261 |
In medicine a headache or cephalalgia is a symptom of a number of different conditions of the head and sometimes neck. Some of the causes are benign while others are medical emergencies. It ranks among the most common pain complaints.[citation needed]
There are a number of different classification systems for headaches. The most well-recognized is that of the International Headache Society.
Treatment of a headache depends on the underlying etiology or cause, but commonly involves analgesics.
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[edit] Classification
The classification of headaches has a rich history. The first recorded system that resembles the modern ones was published by Thomas Willis, in De Cephalagia in 1672. In 1787 Christian Baur generally divided headaches into idiopathic (primary headaches) and symptomatic (secondary ones), and defined 84 categories.[1]
Today headaches are most thoroughly classified by the International Headache Society's, International Classification of Headache Disorders (ICHD), which published the second edition in 2004.[2] This classification is accepted by the WHO.[3]
Other classification systems exist. One of the first published attempts was in 1951.[4] NIH developed a classification system in 1962.
Headaches can also be classified by severity and acuity of onset. Headaches that are both severe and acute are known as thunderclap headaches.
[edit] ICHD-2
The International Classification of Headache Disorders (ICHD) is an in-depth hierarchical classification of headaches published by the International Headache Society. It contains explicit (operational) diagnostic criteria for headache disorders. The first version of the classification, ICHD-1, was published in 1988. The current revision, ICHD-2, was published in 2004.[5]
The classification uses numeric codes. The top, one-digit diagnostic level includes 14 headache groups. The first four of these are classified as primary headaches, groups 5-12 as secondary headaches, cranial neuralgia, central and primary facial pain and other headaches for the last two groups.[6]
[edit] Primary headaches
Tension-type headache (TTH)
Cluster headache and other trigeminal autonomic cephalalgias (TAC)
Other primary headaches including
[edit] Secondary headaches
Headache attributed to head and/or neck trauma
Headache attributed to cranial or cervical vascular disorder including:
Headache attributed to non-vascular intracranial disorder including:
Headache attributed to a substance or its withdrawal including:
Headache attributed to infection including:
Headache attributed to disorder of homoeostasis
Headache or facial pain attributed to disorder of cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cranial structures
Headache attributed to psychiatric disorder
[edit] Neuralgias and other headaches
Cranial neuralgias, central and primary facial pain and other headaches
Other headache, cranial neuralgia, central or primary facial pain including:
[edit] NIH
The NIH classification consists of brief, relatively vague glossary-type definitions of a limited number of headaches.[7]
[edit] Symptoms and signs
Headache associated with specific symptoms may warrant urgent medical attention, particularly sudden, severe headache or sudden headache associated with a stiff neck; headaches associated with fever, convulsions or accompanied by confusion or loss of consciousness; headaches following a blow to the head, or associated with pain in the eye or ear; persistent headache in a person with no previous history of headaches; and recurring headache in children.[citation needed]
[edit] Pathophysiology
The brain in itself is not sensitive to pain, because it lacks nociceptors. However, several areas of the head and neck do have nociceptors, and can thus sense pain. These include the extracranial arteries, large veins, cranial and spinal nerves, head and neck muscles, the meninges, raised intracranial pressure, disturbance of the intracerebral serotonergic levels.[8]
[edit] Diagnosis
In 2008, the American College of Emergency Physicians updated their guidelines on the evaluation and management of adult patients who have a nontraumatic headache of acute onset.[8]
While, statistically, headaches are most likely to be primary (harmless and self-limiting), some specific secondary headache syndromes may demand specific treatment or may be warning signals of more serious disorders.[citation needed] Differentiating between primary and secondary headaches can be difficult.
As it is often difficult for patients to recall the precise details regarding each headache, it is often useful for the sufferer to fill-out a "headache diary" detailing the characteristics of the headache.
[edit] Imaging
When the headache does not clearly fit into one of the recognized primary headache syndromes or when atypical symptoms or signs are present then further investigations are justified.[9] Neuroimaging (noncontrast head CT) is recommended if there are new neurological problems such as decreased level of consciousness, one sided weakness, pupil size difference, etc or if the pain is of sudden onset and severe, or if the person is known HIV positive.[8] People over the age of 50 years may also warrant a CT scan.[8]
[edit] Treatment
Not all headaches require medical attention, and most respond with simple analgesia (painkillers) such as paracetamol/acetaminophen or members of the NSAID class (such as aspirin/acetylsalicylic acid, diclofenac or ibuprofen).[citation needed] Although over the counter medications, such as acetaminophen, are generally safe at recommended doses, a recent FDA Consumer Corner Bulletin pointed out that an overdose can cause serious, even fatal liver damage. In fact, acetaminophen poisoning is a leading cause of liver failure in the United States.[10]
In recurrent unexplained headaches, health care professionals may recommend keeping a "headache diary" with entries on type of headache, associated symptoms, precipitating and aggravating factors. This may reveal specific patterns, such as an association with medication, menstruation or absenteeism or with certain foods. It was reported in March 2007 by two separate teams of researchers that stimulating the brain with implanted electrodes appears to help ease the pain of cluster headaches.[11]
Acupuncture has been found to be beneficial in chronic headaches.[12]
[edit] Epidemiology
During a given year, 90% of people suffer with headaches. Of the ones who are seen in the ER, only about 1% have a serious underlying problem.[13]
[edit] References
- ^ Levine et al., p 60
- ^ "216.25.100.131" (PDF). the Headache Classification Subcommittee of the International Headache Society. http://216.25.100.131/ihscommon/guidelines/pdfs/ihc_II_main_no_print.pdf.
- ^ Olsen et al., p. 9–11
- ^ BROWN MR (September 1951). "The classification and treatment of headache". Med. Clin. North Am. 35 (5): 1485–93. PMID 14862569.
- ^ Jes Olesen, Peter J. Goadsby, Nabih M. Ramadan, Peer Tfelt-Hansen, K. Michael A. Welch (2005). The Headaches (3 ed.). Lippincott Williams & Wilkins. ISBN 0781754003.
- ^ Morris Levin, Steven M. Baskin, Marcelo E. Bigal (2008). Comprehensive Review of Headache Medicine. Oxford University Press US. ISBN 0195366735.
- ^ Levine et al., p 60
- ^ a b c d Edlow JA, Panagos PD, Godwin SA, Thomas TL, Decker WW (October 2008). "Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with acute headache". Ann Emerg Med 52 (4): 407–36. doi:. PMID 18809105.
- ^ Detsky ME, McDonald DR, Baerlocher MO, Tomlinson GA, McCrory DC, Booth CM. Does this patient with headache have a migraine or need neuroimaging? JAMA 2006;296:1274–83
- ^ Acetaminophen Overdose Linked to Liver Failure.
- ^ Brain Stimulation May Ease Headaches. Reuters, March 9, 2007.
- ^ Sun Y, Gan TJ (December 2008). "Acupuncture for the management of chronic headache: a systematic review". Anesth. Analg. 107 (6): 2038–47. doi:. PMID 19020156.
- ^ Amal Mattu; Deepi Goyal; Barrett, Jeffrey W.; Joshua Broder; DeAngelis, Michael; Peter Deblieux; Gus M. Garmel; Richard Harrigan; David Karras; Anita L'Italien; David Manthey (2007). Emergency medicine: avoiding the pitfalls and improving the outcomes. Malden, Mass: Blackwell Pub./BMJ Books. pp. 39. ISBN 1-4051-4166-2.
[edit] Further reading
- Jes Olesen, Peter J. Goadsby, Nabih M. Ramadan, Peer Tfelt-Hansen, K. Michael A. Welch (2005). The Headaches (3 ed.). Lippincott Williams & Wilkins. ISBN 0781754003.
- Morris Levin, Steven M. Baskin, Marcelo E. Bigal (2008). Comprehensive Review of Headache Medicine. Oxford University Press US. ISBN 0195366735.
- William Estlin Waters (1986). Headache. Taylor & Francis. ISBN 0709936249.
[edit] External links
- National Headache Foundation
- IHS - The International Headache Classification (ICHD-2)
- American Headache Society
- Withdrawal related headache information
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