The Nature of Headaches

Headaches are a common reason for visiting a Neurologist, a primary care provider or an emergency department. Most headaches that cause a medical visit are benign in nature in that the pain is self limited and mortality and or irreversible morbidity is unlikely. These benign headaches may be one of primary headache disorders such as migraine or tension type headache, cluster headache or secondary cause of headache such as viral sinusitis or cervicogenic headache.

For most patients management should consist of identifying the headache disorder and providing patients with a specific diagnosis identifying causative or contributing factors as this assists the clinician in making the right diagnosis and have the most appropriate treatment leading to a favourable outcome for the patient. At times, headaches are symptomatic of an underlying process that requires prompt diagnosis and urgent treatment to reduce threats to life or limb. Suspicion of these disorders mandates emergent diagnostic testing to exclude the disease.

The diagnosis of headache can be challenging as it shares many properties similar to migraine. According to the Headache Classification Committee of the International Headache Society a migraine is predominantly a unilateral severe form of a headache that infrequently shifts sides. Headaches share similar properties to migraines so initially a diagnosis between the two can be challenging.