Allergy Headache

Symptoms: Generalized headache; nasal congestion; watery eyes

Precipitating Factors: Seasonal allergens, such as pollen, molds. Allergies to food are not usually a factor.

Treatment: Antihistamine medication; topical, nasal cortisone-related sprays; or desensitization injections

Prevention: None

Aneurysm/Subarachnoid Hemorrhage

Symptoms: A sudden (less than 5 minutes), unbearable headache, double vision, rigid neck. Individual may rapidly become unconscious.

Precipitating Factors: Caused by weakness or bulge in blood vessel at the base of the brain. May rupture (stroke) or allow blood to leak. If aneurysm is discovered early, treat with surgery if needed.

Treatment and Prevention: If aneurysm is discovered early, treat with surgery if needed.

Caffeine-Withdrawal Headache

Symptoms: Bilateral, pulsating occurring within ≤ 24 hours of caffeine withdrawal.

Precipitating Factors: Caffeine consumption

Treatment and Prevention: Prevent by avoiding excess use of caffeine and sudden withdrawal.

Cervicogenic Headache

Symptoms: Pain on one side of the head or face, stiff neck, pain around the eyes, neck, shoulder, and arms, nausea, blurred vision, sensitivity to light and sound.

Precipitating Factors: Injury to the neck, malformations of the cervical vertebrae, arthritis of the upper spine

Treatment: Treatment varies depending on the severity of symptoms, non-steroidal anti-inflammatories (aspirin or ibuprofen), nerve blocks, physical therapy, transcutaneous electrical nerve stimulation (TENS), neuromodulation surgery

Prevention: Without treatment, a cervicogenic headache can become debilitating.

Chronic Daily Headache

Symptoms: Refers to a broad range of headache disorders occurring more than 15 days a month; two categories are determined by the duration of the headache (less than four hours and more than four hours).

Precipitating Factors: Typically evolve from transformed migraine. Although not related to chronic tension-type headache, they can evolve from episodic tension-type headache. Can be associated with medication overuse.

Treatment: Depending on the type of CDH, different treatment options exist. It is important to limit analgesic use.

Prevention: Based on the diagnosis of headache, how long they last, and the number experienced per month.

Chronic Migraine

Symptoms: Headache occurring more than 15 days a month, for more than 3 months, which has the features of migraine headache on at least 8 days per month.

Precipitating Factors: Medication Overuse Headache (MOH) and poorly controlled episodic migraine. Can occur without MOH and be associated with major life events, obesity, ineffective migraine control with acute medications.

Treatment and Prevention: After drug withdrawal, headaches will either revert to episodic or remain chronic. OnabotulinumtoxinA and CGRP monoclonal antibodies have been approved for prevention of use in chronic migraine.

Acute attacks can be treated with triptans, gepants, NSAIDS, and combination analgesics. Limit use of acute treatment to less than 2 days per week to reduce risk of MOH. Avoid opioids and butalbital whenever possible.

Cluster Headache

Symptoms: Rapid onset, excruciating pain in vicinity of eye. Tearing and redness of eye; runny, congested nose; flushing of face. Pain may last for 15
minutes to 3 hours if untreated. Repeated daily attacks for weeks, may disappear for months or years. More common among men (3:4.1 ratio), and frequently appears between ages 20-50.

Precipitating Factors: May be inherited in 5% of cases. During cluster, attacks may be provoked by alcohol.

Treatment and Prevention: Prevent with use of verapamil, often with divalproex, corticosteroids are very effective at high doses but only used short term. Galcanezumab approved for prevention. Attacks should be treated with oxygen inhalation or subcutaneous sumatriptan.

Depression and Headache

Symptoms: People with painful diseases tend to become depressed.

Precipitating Factors: Causes can originate from a wide variety of complaints that can be categorized as physical, emotional, and psychic.

Treatment: The presence of depression is often subtle and the diagnosis is frequently missed. Depression is a widespread affliction that can be treated, but first, it must be unmasked.

Prevention: Physicians can prescribe tricyclic antidepressants, selective serotonin reuptake inhibitors, or monoamine oxidize inhibitors in the treatment of headaches associated with depression.

Eyestrain Headache

Symptoms: Recurrent, mild headache. Frontal, bilateral pain, directly related to eye strain.

Precipitating Factors: Uncorrected or miscorrected vision, astigmatism, or difficulty with convergence.

Treatment and Prevention: Prevent and treat through vision correction or conversion exercises.

Exertional Headache

Symptoms: Often, abrupt onset of headache. Generalized head pain of short duration (minutes to 1 hour); may last up to 48 hours.

Precipitating Factors: Triggered by strenuous physical exertion (running, jumping, orgasm), or passive exertion (coughing, sneezing, or straining for a bowel

Treatment and Prevention:
Should always receive a neurological evaluation and brain imaging. Most commonly treated with indomethacin or propranolol. Pretreatment with triptans or ergotamines may be effective.

Fasting Headache

Symptoms: Frontal location, with diffuse, non-pulsating pain of mild-to-moderate intensity.

Precipitating Factors: Caused by fasting > 16 hours.

Treatment and Prevention: Headache should resolve ≤ 72 hours after resumption of food intake.

Eat multiple small meals daily.

Fever Headache

Symptoms: Generalized head pain that develops with fever and is caused by the swelling of the blood vessels of the head.

Precipitating Factors: Caused by infection

Treatment: Aspirin; acetaminophen; NSAIDs; antibiotics

Prevention: None

Giant Cell Arteritis

Symptoms: A burning or soreness of the scalp, commonly associated with tenderness of temporal arteries. Often, jaw pain with sustained chewing. Sudden and irreversible visual loss can occur. Patients generally ≥ 50 years.

Precipitating Factors: Vascular disease characterized by inflammation of the blood vessels.

Treatment and Prevention: Treat as soon as diagnosis suspected with oral corticosteroids while awaiting biopsy. after diagnosis. Detected by erythrocyte sedimentation rate (ESR) and C-reactive protein test. Confirmed by biopsy of temporal artery.

Hangover Headache

Symptoms: Migraine-like symptoms of throbbing pain and nausea, but it is not localized to one side.

Precipitating Factors: Alcohol, which causes dilation and irritation of the blood vessels of the brain and surrounding tissue.

Treatment: Liquids (including broth); consumption of fructose (honey, tomato juice are a good source)

Prevention: Drink alcohol only in moderation

Headache Attributed to Infection

Symptoms: Diffuse, moderate-to-severe pain caused by acute infection, accompanied by fever.

Precipitating Factors: Caused by infections

Treatment and Prevention: Treat with aspirin, acetaminophen, NSAIDs, antibiotics as needed.

Hemiplegic Migraine

Symptoms: Stroke-like symptoms- Severe throbbing pain, often on one side of the head, numbness, weakness or paralysis on one side of the body, nausea, vomiting, dizziness, loss of balance, speech difficulties, visual disturbances, auras, sensitivity to light, sound, and smell.

Precipitating Factors: Hemiplegic migraine has a strong genetic component

Treatment: Once confirmed, treatment should consist of dietary modification to avoid triggers, regular exercise and sleep, and dietary supplementation, such as magnesium. Topiramate, valproic acid, and calcium channel blockers have shown the best pharmacologic results. Triptans must be avoided to prevent severe complications. Such care is best provided under the supervision of a multidisciplinary headache clinic or a specialized neurologist.

Prevention: Preventive medications, dietary modification to avoid triggers, regular exercise and sleep

Hunger Headache

Symptoms: Pain strikes just before mealtime. It is caused by muscle tension, low blood sugar, and rebound dilation of the blood vessels, oversleeping, or missing a meal.

Precipitating Factors: Strenuous dieting or skipping meals

Treatment: Regular, nourishing meals containing adequate protein and complex carbohydrates

Prevention: Regular, nourishing meals containing adequate protein and complex carbohydrates

Hypertension Headache

Symptoms: Most severe in the morning and diminishes throughout the day.

Precipitating Factors: Severe hypertension ≥ 200mm Hg systolic and ≥ 110 diastolic. Modest increases in blood pressure do not cause headache.

Treatment and Prevention: To prevent, keep blood pressure under control. Treat with appropriate blood pressure medication.

Menstrual Headache

Symptoms: Migraine-type pain that occurs shortly before, during, or immediately after menstruation or at mid-cycle (at time of ovulation).

Precipitating Factors: Hormonal fluctuations.

Treatment and Prevention: Preemptively manage migraine attacks with mini-prophylaxis or pulse therapy with triptans, Remegepant may be effective to treat and/ or prevent. NSAIDs, or ergotamines immediately before and during menstrual period. Treat as for migraine. Hysterectomy does not cure menstrual headaches.


Migraine with Aura

Symptoms: Similar to migraine without aura, attacks often preceded by changes in vision, tingling and numbness lasting less than an hour.

Precipitating Factors: Same as migraine without aura.

Treatment and Prevention: Prevent as with migraine without aura. Once pain has begun, treat as with migraine without aura.

Migraine without Aura

Symptoms: Moderate to severe pain; commonly associated with sensitivity to light and sound; nausea common. Worse with activity; attacks last 4 to 72 hours. One-sided throbbing pain.

Precipitating Factors: Certain foods, hormones in women, excessive hunger, changes in altitude, weather, bright lights, odors, and emotional stress. Hereditary component.

Treatment and Prevention: Prevent with biofeedback, some beta-blockers ex. propranolol, timolol, some antiepileptic drugs ex topiramate, divalproex sodium, or some antidepressants amitriptyline, nortriptyline. CGRP monoclonal antibodies recently available for prevention. 

Acute treatment includes triptans, NSAIDs ex Cambia, naproxen, aspirin, can also include: ice packs, combination products containing caffeine, ergotamine, DHE, triptans, or analgesics and neuromodulation devices. 

Supportive care with icepacks and bedrest. For prolonged attacks steroids and occipital nerve blocks may be helpful.

New Daily Persistent Headache

Symptoms: This headache can best be described as the rapid development (less than three days) of unrelenting headache, and typically presents in a person with no past history of headache.

Precipitating Factors: Typically NDPH does not evolve from migraine or episodic tension-type headache. NDPH begins as a new headache. It may be the result of a viral infection but cause generally unknown.

Treatment and Prevention: In some cases NPDH can resolve on its own within several months. Other cases persist and are more refractory. NPDH does not respond to traditional options. Migraine preventive agents can be tried.

Post-Traumatic Headaches

Symptoms: Localized or generalized pain following trauma. May be accompanied by dizziness, difficulty concentrating, nervousness, personality changes, and insomnia. Can mimic migraine or tension-type headache symptoms.

Precipitating Factors: Pain can occur after relatively minor traumas.

Treatment and Prevention: Possible treatment with anti-inflammatory drugs, propranolol, or biofeedback.

Sinus Headache

Symptoms: Commonly associated with fever and colored nasal drainage. Most self-diagnosed cases are actually migraine.

Precipitating Factors: Infection, nasal polyps, anatomical deformities, such as a deviated septum, that block the sinus ducts. Most cases are actually migraine rather than sinus headache.

Treatment and Prevention: Treat with antibiotics if due to bacteria, nasal rinses, decongestants, surgical drainage if necessary.

Temporo-Mandibular Joint Dysfunction (TMD) Headache

Symptoms: Pain in temples often associated with a click over the temporomandibular joints.

Precipitating Factors: Pathology can be in the joint or in the muscles of chewing.

Treatment and Prevention: Relaxation, biofeedback, use of bite plate. In extreme cases, correction of malocclusion, nerve blocks.

Tension-Type Headache

Symptoms: Dull, non-throbbing pain, frequently bilateral, associated with tightness of scalp or neck. Degree of severity remains constant and should not be disabling

Precipitating Factors: Stress, depression. When associated with migraine, most are actually mild migraines.

Treatment and Prevention: Prevent with avoidance of stress, biofeedback, relaxation techniques, and antidepressants. Treat with aspirin, acetaminophen, ibuprofen, and naproxen sodium. Combination with caffeine may enhance the action of the analgesics.

Trigeminal Neuralgia (Tic Douloureux)

Symptoms: Sharp, lancinating pain in the face. No pain between jabs. More common in women after age 55.

Precipitating Factors: Often triggered by touching the face. Often caused by abnormal artery loop compressing the trigeminal nerve.

Treatment and Prevention: Treat with some anticonvulsants. Neurosurgery, if appropriate, to release the artery loop. Blocking trigeminal nerve by various means can be helpful.

Thunderclap Headache

Symptoms: Sudden and severe pain that may be accompanied by nausea, vomiting, fever, seizure speech problems, weakness, confusion, visual disturbances.

Precipitating Factors: Thunderclap Headache may be due to a benign syndrome or a potentially life-threatening condition.

Treatment: Since the nature of the headache by itself cannot allow the distinction between benign and serious causes, it is essential to seek out an emergency medical evaluation if the onset of a headache is sudden and severe.

Prevention: None

Tumor Headache

Symptoms: Progressive, localized pain that is worse in the morning and aggravated by coughing or bending forward. Pain may be diffuse, associated with nausea and/or vomiting, and occur in attack-like episodes.

Precipitating Factors: Cause of tumor is usually unknown.

Treatment and Prevention: Treat tumor with surgery or chemotherapy, and associated symptoms with corticosteroids. Hysterectomy does not cure menstrual headaches.

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