Headache
Basics
Description
Description
- Pain in the cranium, orbits, or upper neck
- Pain within the skull is projected to the surface:
- Intracranial:
- Arteries, veins, dura, meninges
- Extracranial:
- Skin, scalp, fascia, muscles
- Mucosal linings of the sinuses
- Arteries
- Temporomandibular joints, teeth
- Intracranial:
- Pain is transmitted via the V cranial nerve
- May be caused by a number of mechanisms:
- Nerve irritation
- Traction on pain-sensitive vessels
- Vasodilatation of pain-sensitive vessels
- Hypoxia, hypercapnia, fever, histamine injection, nitroglycerin ingestion
- Complaint in 2–4% of all ED visits:
- 95% have a benign etiology (lower in patients >50 yr)
- Life-threatening etiologies are rare and can be difficult to diagnose
Etiology
Etiology
- Migraine:
- Intra/extracranial vasodilatation and constriction of pain-sensitive blood vessels
- May also involve cortical depression
- Throbbing headache
- Tension:
- Requires ≥10 attacks of a similar nature
- Unknown etiology (possibly serotonin imbalance, decreased endorphins, spasm)
- Most common type of recurring headache
- Triggered by poor posture, stress, anxiety, depression, cervical osteoarthritis
- Bilateral, nonpulsatile, band-like
- Mild to moderate intensity
- 4–13 hr duration
- Cluster headaches:
- Triggered by alcohol, certain foods, altered sleep habits, strong emotions
- May involve vasospasm near cranial nerves
- Intracranial (traction, pressure):
- Mass lesions
- Idiopathic intracranial hypertension
- Extracranial (compression):
- Pathology causing pain in a peripheral nerve of the head and neck
- Inflammation:
- Temporal arteritis
- Cerebral vasculitis
- Thrombosis:
- Cerebral venous sinus thrombosis (CVST)
- Impaired vascular autoregulation/endothelial dysfunction:
- Posterior reversible leukoencephalopathy syndrome (PRES)
- Reversible cerebral vasoconstriction syndrome (RCVS)
Pediatric Considerations
Serious causes of headache in children are rare but those who come to the ED for this complaint should all have follow-up with a pediatrician
Geriatric Considerations
Older patients with new headache have a higher likelihood of a serious etiology and should have more thorough evaluation with a low threshold for imaging
Pregnancy Considerations
In addition to all other causes of headache, pregnant women (and recently postpartum women) are at increased risk for CVST, eclampsia, PRES, and RCVS
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Citation
Schaider, Jeffrey J., et al., editors. "Headache." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307297/all/Headache.
Headache. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307297/all/Headache. Accessed December 3, 2024.
Headache. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307297/all/Headache
Headache [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 December 03]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307297/all/Headache.
* Article titles in AMA citation format should be in sentence-case
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BT - 5-Minute Emergency Consult
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PB - Lippincott Williams & Wilkins
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