Editing Headache (section)

== Causes ==
There are more than 200 types of headaches. Some are harmless and some are [[life-threatening]]. The description of the headache and findings on [[neurological examination]], determine whether additional tests are needed and what treatment is best.<ref name=SIGN>{{cite book |author= Scottish Intercollegiate Network |title= Diagnosis and management of headache in adults |location= Edinburgh |date= November 2008 |isbn= 978-1-905813-39-1 |url= http://www.sign.ac.uk/guidelines/fulltext/107/ |publisher= [[NHS Scotland|NHS Quality Improvement Scotland]] |url-status= dead |archive-url= https://web.archive.org/web/20110419031343/http://www.sign.ac.uk/guidelines/fulltext/107/ |archive-date= 19 April 2011 |access-date= 14 July 2010 }}</ref>

Headaches are broadly classified as "primary" or "secondary".<ref>{{cite web|url=http://www.hopkinsmedicine.org/neurology_neurosurgery/specialty_areas/headache/conditions/primary_vs_secondary_headaches.html|title=The Johns Hopkins Headache Center - Primary Exertion Headache| vauthors = Young CB |date=3 January 2012|work=hopkinsmedicine.org|url-status=dead|archive-url= https://web.archive.org/web/20140503222313/http://www.hopkinsmedicine.org/neurology_neurosurgery/specialty_areas/headache/conditions/primary_vs_secondary_headaches.html|archive-date=3 May 2014}}</ref> Primary headaches are benign, recurrent headaches not caused by underlying disease or structural problems. For example, [[migraine]] is a type of primary headache. While primary headaches may cause significant daily pain and disability, they are not dangerous from a physiological point of view. Secondary headaches are caused by an underlying disease, like an [[Systemic infection|infection]], [[head injury]], [[vascular disorders]], [[Subarachnoid hemorrhage|brain bleed]], stomach irritation, or [[brain tumor|tumors]]. Secondary headaches can be dangerous. Certain "red flags" or warning signs indicate a secondary headache may be dangerous.<ref name="Goadsby">{{cite book | vauthors = Goadsby PJ, Raskin NH | chapter = Chapter 14. Headache | veditors = Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J | title = Harrison's Principles of Internal Medicine | edition = 18th | location = New York, NY | publisher = McGraw-Hill | date = 2012 | isbn = 978-0-07-174890-2 }}</ref>

===Primary===
Ninety percent of all headaches are primary headaches.<ref>{{Cite journal| vauthors = Damayanti Y, Marhaendraputro EA, Santoso WM, Rahmawati D |date=2021-03-02|title= Profile of Primary Patients in Neurological Polyclinic |url= https://jphv.ub.ac.id/index.php/jphv/article/view/19 |journal=Journal of Pain, Headache and Vertigo |volume=2|issue=1|pages=1–4|doi=10.21776/ub.jphv.2021.002.01.1|s2cid=233777394|issn=2723-3960|doi-access=free}}</ref> Primary headaches usually first start when people are between 20 and 40 years old.<ref>{{cite journal | vauthors = Straube A, Andreou A | title = Primary headaches during lifespan | journal = The Journal of Headache and Pain | volume = 20 | issue = 1 | pages = 35 | date = April 2019 | pmid = 30961531 | pmc = 6734460 | doi = 10.1186/s10194-019-0985-0 | doi-access = free }}</ref><ref name="Clinch">{{cite book|title=Clinch C. Chapter 28. Evaluation & Management of Headache - CURRENT Diagnosis & Treatment in Family Medicine | edition = Third | series = Lange Current Series | vauthors = South-Paul JE, Matheny SC, Lewis EL |isbn=978-0-07-162436-7 |publisher=McGraw-Hill|year=2011}}</ref> The most common types of primary headaches are migraines and tension-type headaches.<ref name="Clinch" /> They have different characteristics. Migraines typically present with pulsing head pain, nausea, photophobia (sensitivity to light) and phonophobia (sensitivity to sound).<ref>{{Cite web|title=Migraine - Symptoms and causes|url=https://www.mayoclinic.org/diseases-conditions/migraine-headache/symptoms-causes/syc-20360201|access-date=2021-12-15|website=Mayo Clinic|language=en}}</ref> Tension-type headaches usually present with non-pulsing "bandlike" pressure on both sides of the head, not accompanied by other symptoms.<ref>{{Cite web|title=Tension Headaches|url=https://www.hopkinsmedicine.org/health/conditions-and-diseases/headache/tension-headaches|access-date=2021-12-15|website=www.hopkinsmedicine.org|date=8 August 2021 |language=en}}</ref><ref name="Detsky">{{cite journal | vauthors = Detsky ME, McDonald DR, Baerlocher MO, Tomlinson GA, McCrory DC, Booth CM | title = Does this patient with headache have a migraine or need neuroimaging? | journal = JAMA | volume = 296 | issue = 10 | pages = 1274–1283 | date = September 2006 | pmid = 16968852 | doi = 10.1001/jama.296.10.1274 }}</ref> Such kind of headaches may be further classified into-[[Tension headache|episodic]] and chronic tension type headaches<ref>{{Cite web|title=Tension headache - Symptoms and causes|url=https://www.mayoclinic.org/diseases-conditions/tension-headache/symptoms-causes/syc-20353977|access-date=2021-12-15|website=Mayo Clinic|language=en}}</ref> Other very rare types of primary headaches include:<ref name="Goadsby" />
* [[cluster headache]]s: short episodes (15–180 minutes) of severe pain, usually around one eye, with autonomic symptoms (tearing, red eye, nasal congestion) which occur at the same time every day. Cluster headaches can be treated with triptans and prevented with prednisone, ergotamine or lithium.
* [[trigeminal neuralgia]] or [[occipital neuralgia]]: shooting face pain
* [[hemicrania continua]]: continuous unilateral pain with episodes of severe pain. Hemicrania continua can be relieved by the medication [[Indometacin|indomethacin]].
* [[Ophthalmodynia periodica|primary stabbing headache]]: recurrent episodes of stabbing "ice pick pain" or "jabs and jolts" for 1 second to several minutes without autonomic symptoms (tearing, red eye, nasal congestion). These headaches can be treated with indomethacin.
* primary cough headache: starts suddenly and lasts for several minutes after coughing, sneezing or straining (anything that may increase pressure in the head). Serious causes (see secondary headaches red flag section) must be ruled out before a diagnosis of "benign" primary cough headache can be made.
* primary exertional headache: throbbing, pulsatile pain which starts during or after exercising, lasting for 5 minutes to 24 hours. The mechanism behind these headaches is unclear, possibly due to straining causing veins in the head to dilate, causing pain. These headaches can be prevented by not exercising too strenuously and can be treated with medications such as indomethacin.
* [[Sexual headache|primary sex headache]]: dull, bilateral headache that starts during sexual activity and becomes much worse during orgasm. These headaches are thought to be due to lower pressure in the head during sex. It is important to realize that headaches that begin during orgasm may be due to a subarachnoid hemorrhage, so serious causes must be ruled out first. These headaches are treated by advising the person to stop sex if they develop a headache. Medications such as [[propranolol]] and [[diltiazem]] can also be helpful.
* [[hypnic headache]]: a moderate-severe headache that starts a few hours after falling asleep and lasts 15–30 minutes. The headache may recur several times during the night. Hypnic headaches are usually in older women. They may be treated with [[lithium (medication)|lithium]].

=== Secondary ===
{{More citations needed section|date=February 2021}}
Headaches may be caused by problems elsewhere in the head or neck. Some of these are not harmful, such as [[cervicogenic headache]] (pain arising from the neck muscles). The excessive use of painkillers can paradoxically cause worsening [[painkiller headache]]s.<ref name=SIGN /><ref name="NHS">{{cite web |title=Headaches |url=https://www.nhs.uk/conditions/headaches/ |website=nhs.uk |language=en |date=8 January 2018}}</ref>

More serious causes of secondary headaches include the following:<ref name="Goadsby" />
* [[meningitis]]: [[inflammation]] of the meninges which presents with fever and meningismus, or stiff neck
* [[Stroke|ischemic stroke]] or a previous stage of the same
* [[Stroke|hemorragic stroke]] or a previous stage of the same
* [[intracranial hemorrhage]] (bleeding inside the brain) because of any origin
* [[subarachnoid hemorrhage]] (with acute, severe headache, stiff neck without fever) because of any origin
* [[intraparenchymal hemorrhage]] (with headache only) because of any origin
* [[ruptured aneurysm]] or [[aneurysm]]
* [[brain tumor]] (a form of cancer): dull headache, worse with exertion and change in position, accompanied by nausea and vomiting. Often, the person will have nausea and vomiting for weeks before the headache starts.
* [[temporal arteritis]]: inflammatory disease of arteries common in the elderly (average age 70) with fever, headache, weight loss, jaw claudication, tender vessels by the temples, polymyalgia rheumatica
* [[Glaucoma|acute closed-angle glaucoma]] (increased pressure in the eyeball): a headache that starts with eye pain, blurry vision, associated with nausea and vomiting. On physical exam, the person will have red eyes and a fixed, mid-dilated pupil.
* [[arteriovenous malformation]]
* post-ictal headaches: Headaches that happen after a convulsion or other type of seizure, as part of the period after the seizure (the [[post-ictal]] state)
* [[traumatic brain injury]]

[[Gastrointestinal disease|Gastrointestinal disorders]] may cause headaches, including [[Helicobacter pylori]] infection, [[celiac disease]], [[non-celiac gluten sensitivity]], [[irritable bowel syndrome]], [[inflammatory bowel disease]], [[gastroparesis]], and [[List of hepato-biliary diseases|hepatobiliary disorders]].<ref name=LionettiFrancavilla2010>{{cite journal | vauthors = Lionetti E, Francavilla R, Pavone P, Pavone L, Francavilla T, Pulvirenti A, Giugno R, Ruggieri M | title = The neurology of coeliac disease in childhood: what is the evidence? A systematic review and meta-analysis | journal = Developmental Medicine and Child Neurology | volume = 52 | issue = 8 | pages = 700–707 | date = August 2010 | pmid = 20345955 | doi = 10.1111/j.1469-8749.2010.03647.x | type = Systematic review and meta-analysis | s2cid = 205611320 | doi-access = free }}{{open access}}</ref><ref name=AzizHadjivassiliou2015>{{cite journal | vauthors = Aziz I, Hadjivassiliou M, Sanders DS | title = The spectrum of noncoeliac gluten sensitivity | journal = Nature Reviews. Gastroenterology & Hepatology | volume = 12 | issue = 9 | pages = 516–526 | date = September 2015 | pmid = 26122473 | doi = 10.1038/nrgastro.2015.107 | type = Review | s2cid = 2867448 }}</ref><ref name=CamaraLemarroyRodriguezGutierrez2016>{{cite journal | vauthors = Cámara-Lemarroy CR, Rodriguez-Gutierrez R, Monreal-Robles R, Marfil-Rivera A | title = Gastrointestinal disorders associated with migraine: A comprehensive review | journal = World Journal of Gastroenterology | volume = 22 | issue = 36 | pages = 8149–8160 | date = September 2016 | pmid = 27688656 | pmc = 5037083 | doi = 10.3748/wjg.v22.i36.8149 | type = Review | doi-access = free }}</ref> The treatment of the gastrointestinal disorders may lead to a remission or improvement of headaches.<ref name=CamaraLemarroyRodriguezGutierrez2016 />

Migraine headaches are also associated with [[Cyclic Vomiting Syndrome]] (CVS). CVS is characterized by episodes of severe vomiting, and often occur alongside symptoms similar to those of migraine headaches (photophobia, abdominal pain, etc.).<ref>{{cite journal | vauthors = Hasler WL, Levinthal DJ, Tarbell SE, Adams KA, Li BU, Issenman RM, Sarosiek I, Jaradeh SS, Sharaf RN, Sultan S, Venkatesan T | title = Cyclic vomiting syndrome: Pathophysiology, comorbidities, and future research directions | journal = Neurogastroenterology and Motility | volume = 31 | issue = Suppl 2 | pages = e13607 | date = June 2019 | pmid = 31241816 | pmc = 6899706 | doi = 10.1111/nmo.13607 }}</ref>