- Clinical science
Headache is a commonly presenting complaint in everyday clinical practice, and, according to the WHO, one of the ten most common causes of functional disability. It may be primary (e.g., tension-type headaches, migraine) or secondary (e.g., following head trauma or infections) in nature. Headache may occur as acute episodes or persist chronically. Chronic headaches, which are associated with a decline in quality of life, have a significant socioeconomic impact. Therefore, chronic headaches should be diagnosed and treated early. Although most episodes of headache are fleeting and harmless, one must always consider potentially life-threatening causes (e.g., subarachnoid hemorrhage, meningitis). Identifying the cause of headaches is often difficult, and requires a detailed clinical history as well as a thorough physical examination. Additional investigation, such as cranial imaging, is only indicated if headache persists despite treatment or when specific clinical features are present that are signs of an underlying disease. This learning card gives an overview of the most common types of headache and serves as a guide to diagnosing different headache disorders.
- Distribution: Headache is a global health problem that affects people of all ages, ethnicities, and regions.
- Worldwide prevalence: 60%
Most common forms of headache
- Tension-type headache: 60–80% of cases
- Migraine: 12–14% of cases
Epidemiological data refers to the US, unless otherwise specified.
|Type of headache||Common causes|
|Head and/or cervical trauma|| |
|Vascular disorders in the head and neck region|
|Non-vascular intracranial disorders|
|Introduction or withdrawal of a substance|
|Disorders of homeostasis|| |
|Disorders of the eyes, teeth, nasal cavity, neck, and/or paranasal sinuses|
|Psychiatric disorders|| |
|Cranial nerve neuralgias and facial pain|| |
|Headaches that do not fit any of the patterns above or have an unknown cause are referred to as “unclassified headache disorders.”|
|Nature of headache|| |
|Triggers and exacerbating factors|
|Concomitant symptoms|| |
|Other relevant aspects|
A thorough physical examination is important to identify the cause of secondary headache!
|Additional diagnostic tests should be undertaken if any of the following red flags are present:|
| || |
Diagnostic tests are usually not indicated in most cases (especially primary headaches). They are used primarily to evaluate secondary headaches and severe, acute headaches, which may be life-threatening (e.g., subarachnoid hemorrhage, trauma)!
The investigation of choice is determined by the clinical presentation!
|Tension headache||Migraine||Cluster headache|
|Sex|| || || |
|Duration|| || || |
|Frequency|| || || |
|Localization|| || || |
|Character|| || || |
|Intensity|| || || |
|Additional symptoms||No additional autonomic symptoms|| || |
|Triggers/exacerbating factors|| || |
The following table deals with secondary causes of headaches, some of which are life-threatening but treatable and should therefore be diagnosed as early as possible.
|Causes||Diagnosis||Type of headache||Additional clinical features|
|Vascular causes||Intracranial hemorrhage|| |
|Cerebral venous sinus thrombosis|| |
|hypertensive emergency/|| |
|Stroke|| || |
|Tumors||Intracranial space-occupying lesion (e.g., )|| || |
|Trauma||Traumatic brain injury|| || |
|Other causes||Glaucoma|| |
|Medication-overuse headache|| || |
Consider secondary life-threatening causes if red flags are present!
The differential diagnoses listed here are not exhaustive.