Headache and Migraine

Complaints of headache are common making evaluation difficult. Essential to diagnosis and management is working with the patient to determine medical and family medical history in addition to symptoms. Treatment must be based on the cause of the headache. Patients assist in the diagnosis by providing information to describe the pain in relation to intensity (how much it hurts), quality (stabbing, throbbing, ice pick, etc.) site of pain (neck, forehead, localized, on both sides, etc.), associated symptoms (vision disturbances, vertigo, nausea and vomiting, etc.), and duration and frequency of pain.

Sudden onset headache and major complaint of headache without trauma necessitates determining cause and provide immediate treatment for any underlying causes for which the headache may be a secondary symptom. The underlying cause may be vascular, infection, intracranial masses, preeclampsia, carbon monoxide poisoning. In addition to taking vital signs and checking eyes/vision, performing neurological, motor and sensory testing, the physician may also order further tests. Additional tests include blood testing, electrocardiogram, electroencephalogram, computed tomography (CT) scan or magnetic resonance imaging (MRI) will exclude intracranial mass lesion, MR angiography or venography can detect suspected aneurysms and weak areas of vessels. Lumbar puncture will exclude infections.

After determining medical history, physical examination and testing the diagnosis is determined and treatment options considered. The two possible diagnoses for headache are secondary (a symptom of an underlying cause) or primary (tension headache or migraine). Secondary headache pain is a symptom of other illnesses, due to injury, infection, brain malformation, depression, tumors, spinal headache, sinus congestion, aneurysm, giant cell arteritis (inflammation of blood vessels in the head most often seen in elderly patients), cough, hypertension, exertion (exercise including sex), mountain sickness (hypoxia at altitudes 6,560 feet above sea level.

When the diagnosis is primary headache, the headache itself is the illness. The most common and least debilitating primary headache is the ice-cream headache. Other headache triggers include stress, weather or season changes, certain foods and alcohol, and flickering light.