Headache is a pain in the head. Almost all people experience a headache at some time in their lives. Although most headaches do not indicate serious illness, they are a major cause of suffering and missed work.
Headaches rank as one of the most common reasons that people consult a doctor. However, most headaches do not cause any abnormalities that a doctor can detect in an office examination. Doctors evaluate headaches by considering such symptoms as how severe pain is, where it occurs, and how long it lasts. When diagnosing headaches, most doctors first decide whether a headache is (1) primary or (2) secondary.
Primary headache
is a condition in which head pain is usually the basic medical problem. Doctors perform a thorough physical examination to rule out underlying causes of head pain, which are discussed in the next section under Secondary headache. Treatment of primary headaches is aimed at relieving pain or preventing future headaches. The most common type of primary headache is tension-type headache. Doctors once thought that tension (tightness) in muscles of the head and neck caused these headaches. Most scientific studies have not found tension in these muscles. But many patients report that these muscles feel tight, even though such tension cannot be scientifically confirmed. Although symptoms vary, most patients with tension-type headache experience steady, dull pain. The pain usually occurs in the front of the head, the temples, the back of the neck, or in a combination of these regions.
Treatment of tension-type headaches depends on how often they happen. For occasional headaches, doctors usually recommend rest, pain medications, or, sometimes, muscle relaxants.
For frequent tension-type headaches, doctors usually avoid prescribing pain medication. Repeated use of pain preparations can lead to changes in the way the brain interprets pain signals. These changes can cause rebound headaches, in which pain returns repeatedly when the effects of pain medicine wear off. Pain medicine may thus help create a cycle of continuing headaches and dependence on drugs. Doctors generally treat frequent tension headaches and other chronic pain with drugs called antidepressants (see Antidepressant).
Another type of primary headache is a migraine. For more information about such headaches, see Migraine.
Secondary headache
is a symptom of some other underlying illness. Treating such headaches often requires correcting the underlying condition as well as relieving head pain. One of the most common secondary headaches is sinus headache. Sinus headache results from congestion of the sinuses, small air-filled spaces in the skull near the nose. The location of headache pain from sinus congestion varies, depending on which sinus is involved. Sinus headaches are usually treated with rest, medicines that relieve nasal congestion, and pain medication. Doctors may also prescribe antibiotics to treat sinus headaches caused by bacterial infections.
Secondary headaches may also result from serious illnesses such as meningitis, an infection of the membranes covering the brain and spinal cord. Stroke, a blood clot or bleeding in the brain, is another major cause of secondary headaches.
