Headache

Abstract Headache can be described as a throbbing, pulsating or dull ache, at times worsened by movement and varying in intensity. Headache can be a disorder unto itself, such as migraine, or a symptom of another disorder ranging from a head injury to a brain tumour. Migraine is a primary episodic headache disorder characterised by various combinations of neurological, gastrointestinal and autonomic changes. Tension‐type headache (TTH) is usually bilateral. The approach to the treatment of episodic headache, whether TTH or migraine, is similar, and consists of psychophysiological therapy, physical therapy and pharmacotherapy. Cluster headache is a rare, distinct, primary headache characterised by devastating pain. Key Concepts: Headache can be a disorder unto itself, such as migraine, or a symptom of another disorder. Migraine has an enormous impact on society. In evaluating a patient with headache, secondary causes of headache, such as a mass lesion, subarachnoid haemorrhage or subdural haematoma, need to be identified or excluded. TTH varies in frequency as well as in severity, from rare, brief episodes to frequent, often continuous, disabling headaches. What we call migraine may be the upper end of a normal distribution of painful episodic headaches. Prophylactic treatment, designed to reduce the frequency and severity of headache attacks, should be considered if the frequency (more than two per week), duration (>3–4 h) and severity might lead to the overuse of abortive medication or significant disability. The migraine attack can be divided into four phases: the prodrome, which occurs hours or days before the headache; the aura, which immediately precedes the headache; the headache itself and the headache resolution phase. The pharmacological treatment of migraine may be acute (abortive) or preventive (prophylactic), and patients who are experiencing frequent severe headaches often require both the approaches. Cluster headache is a rare, distinct, primary headache characterised by devastating pain. Cluster headache attacks are stereotypical. They are generally shorter than those of migraine, invariably unilateral and very severe.