The document provides an overview of headaches, categorizing them into primary and secondary types, and detailing various headache types along with their symptoms, potential triggers, treatments, and prevention strategies. It emphasizes that individuals can experience multiple headache types and highlights the importance of identifying personal triggers through tracking. Various headache categories such as migraines, tension-type headaches, and cluster headaches are discussed, along with their specific causes and recommended treatments.

1. HEADACHE
By
SYED MASOOD AHMED QUADRI
PHARM.D { Doctor of Pharmacy }
MESCO COLLEGE OF PHARMACY

2. IN BRIEF
Information

3. AND IT IS ?
How many types of headache are there?
 According to the National Headache Foundation,
headaches are divided into two basic categories:
primary/benign (tension-type, migraine, cluster)
and secondary (organically caused). All
headaches fall into one of these two categories
depending on their causes and symptoms.

4. AND IT IS ?
 Is it possible for one person to have several
types of headaches?
 It’s not uncommon for an individual to suffer from more
than one type of headache. According to
Dr. Seymour Diamond, Executive Chairman of the
National Headache Foundation, people with mixed
headache problems — such as migraine with tension-
type headache — are not unusual.

5. AND IT IS ?
 There are three major categories of
headache based upon the source of the
pain
 Primary headaches;
 Secondary headaches; and
 Cranial neuralgias, facial pain, and other
headaches.

6. AND IT IS ?
 What is a trigger?
 Certain physical or environmental factors, such
as foods, hormonal changes, weather, and
stress, can lead to or “trigger” a headache .
 However, it’s important to remember that triggers
are different for everyone. That’s why, to help
prevent attacks, you need to figure out which
triggers affect you and which ones don’t.
Keeping a headache diary is an effective way to
track triggers, and it will help you talk to your
healthcare professional about your condition.

8. IDENTIFYING THE TRIGGERS
 Tension-type headaches are triggered by emotional stress related to family, school or
schoolmates, or friends.
 Problems and tension at home
 New brother or sister
 Parents who are either too strict or demanding, too permissive or inattentive
 Self-image, such as being overweight
 Being made fun of by other children
 No close friends
 Insufficient or irregular sleep
 Going to a new school
 Learning difficulties
 Competing in activities or sports
 Pressure to be an “A” student
 Too many extracurricular activities
 Tests and exams
 Death or separation from a loved one, e.g., a sibling going away to college or the death
of a grandparent)

9. HEADACHES AND THEIR TYPES

10. ICD 10 - CLASSIFICATION OF HEADACHES

11. ALLERGY HEADACHES
 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

13. ANEURYSM
o Symptoms: May mimic frequent migraine or cluster
headaches, caused by balloon-like weakness or bulge in
blood-vessel wall. May rupture (stroke) or allow blood to
leak slowly resulting in a sudden, unbearable headache,
double vision, rigid neck. The individual rapidly becomes
unconscious.
 Precipitating Factors: Congenital tendency; extreme
hypertension
 Treatment: If aneurysm is discovered early, treat with
surgery.
 Prevention: Keep blood pressure under control to
prevent.

14. ARTHRITIS HEADACHES
 Symptoms: Pain at the back of head or neck which
intensifies on movement. It is caused by
inflammation of the blood vessels of the head or
bony changes in the structures of the neck.
 Precipitating Factors: Cause of pain is unknown
 Treatment: Anti-inflammatory drugs, muscle
relaxants
 Prevention: None

15. CAFFEINE-WITHDRAWAL HEADACHES
 Symptoms: Throbbing headache caused by
rebound dilation of the blood vessels, occurring
multiple days after consumption of large quantities
of caffeine.
 Precipitating Factors: Caffeine
 Treatment: Treat by terminating caffeine
consumption in extreme cases.
 Prevention: Avoiding excess use of caffeine.

17. CHRONIC DAILY HEADACHES
 Symptoms: Refers to a broad range of headache disorders
occurring more than 15 days a month; two categories are
determined by 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 CHD, different
treatment options exist. It is important to limit analgesic use.
 Prevention: Based on diagnosis of headache, how long they
last, and the number experienced per month.

19. CLUSTER HEADACHES
 Symptoms: Excruciating pain in the vicinity of the eye;
tearing of the eye; nose congestion; and flushing of the
face. Pain frequently develops during sleep and may
last for several hours. Attacks occur every day for
weeks, or even months, then disappears for up to a
year. Eighty percent of cluster patients are male, most
between the ages of 20 and 50.
 Precipitating Factors: Alcoholic beverages; excessive
smoking
 Treatment: Oxygen; ergotamine; sumatriptan; or
intranasal application of local anesthetic agent
 Prevention: Use of steroids; ergotamine; calcium
channel blockers; and lithium

22. DEPRESSION AND HEADACHES
 Symptoms: People with painful organic diseased 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
wide spread affliction that can be treated, but first it must
be unmasked.
 Prevention: Physicians can prescribe tricyclic
antidepressants, selective serotonin re-uptake inhibitors,
or monoamine oxidize inhibitors in the treatment of
headaches associated with depression.

23. EYESTRAIN HEADACHES
 Symptoms: Usually frontal, bilateral pain directly
related to eyestrain. It is a rare cause of headache.
 Precipitating Factors: Muscle imbalance;
uncorrected vision; astigmatism
 Treatment: Correction of vision
 Prevention: Correction of vision

25. EXERTIONAL HEADACHES
 Symptoms: Generalized head pain of short duration (minutes to
an hour) during or following physical exertion (running, jumping,
or sexual intercourse), or passive exertion (sneezing, coughing,
moving one’s bowels, etc.)
 Precipitating Factors: Ten percent caused by organic diseases
(aneurysms, tumors, or blood vessel malformation). Ninety
percent are related to migraine or cluster headaches.
 Treatment: Cause must be accurately determined. Most
commonly treated with aspiring, indomethacin, or propranolol.
Extensive testing is necessary to determine the headache cause.
Surgery is occasionally indicated to correct the organic disease.
 Prevention: Alternative forms of exercise; avoid jarring exercises

27. FEVER HEADACHES
 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

28. GIANT CELL ARTERITIS
 Symptoms: A boring, burning, or jabbing pain
caused by inflammation of the temporal arteries;
pain, often around the ear, when chewing; weight
loss; eyesight problems. This rarely affects people
under 50.
 Precipitating Factors: Cause is unknown. May be
due to immune disorder.
 Treatment: Steroids after diagnosis; confirmed by
biopsy
 Prevention: None

30. HANGOVER HEADACHES
 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

31. HUNGER HEADACHES
 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

32. HYPERTENSION HEADACHES
 Symptoms: Generalized or “hairband” type pain
that is most severe in the morning. It diminishes
throughout the day.
 Precipitating Factors: Severe hypertension: over
200 systolic and 110 diastolic
 Treatment: Treat with appropriate blood pressure
medication
 Prevention: Keep blood pressure under control

33. MENSTRUAL HEADACHES
 Symptoms: Migraine-type pain that occurs shortly
before, during, or immediately after menstruation or at
mid-cycle (at time of ovulation).
 Precipitating Factors: Variances in estrogen levels
 Treatment: At earliest onset of symptoms, treat using
biodfeedback, ergotamine, dihydroergotamine, or a 5-
HT agonist. Once pain has begun, treatment is identical
to migraine without aura.
 Prevention: Biofeedback; betablockers (propranolol,
timolol); anti-convulsant (divalproex sodium); calcium
blockers; and NSAIDs

34. MIGRAINE ?

35. WHAT IS THAT FOR ?
 What is migraine? What causes it, and how can I
treat it?
 Generally, migraine begins as a dull ache and then develops
into a constant throbbing and pulsating pain that you may feel
at the temples, as well as the front or back of one or both
sides of the head.
 The pain is usually accompanied by a combination of nausea,
vomiting, and sensitivity to light and noise. Some people
(about 15% of migraine sufferers) experience an aura before
an attack.
 The cause of migraine is believed to be chemical reactions in
the brain.
 Treatment for migraine may include over-the-counter or
prescription medications, as well as self-help techniques such
as relaxation training and biofeedback.

36. WHAT IS THAT FOR ?
 What is an Aura?
 About 15-20% of people with migraine get an “aura,”
which is a manifestation of neurological symptoms that
occurs before a migraine headache.
 You may see wavy or jagged lines, dots, or flashing
lights; or you might experience tunnel vision or blind
spots in one or both eyes.
 The aura can include visual or auditory hallucinations
and disruptions in smell (such as strange odors), taste,
or touch.
 Other symptoms include numbness, a “pins and
needles” sensation, or difficulty in recalling or speaking
the correct word.
 These neurological events may last as long as sixty
minutes and will fade as the headache begins.

37. MIGRAINE WITH AURA
 Symptoms: Warning signs develop, which may include visual
disturbances or numbness in arm or leg. Warning symptoms subside
within 30 minutes followed by severe pain.
 Precipitating Factors: There is a hereditary component. Other factors
include: Certain foods; the Pill or menopausal hormones; excessive
hunger; changes in altitude; weather; lights; excessive smoking; and
emotional stress.
 Treatment: At earliest onset of symptoms, treat using biofeedback,
ergotamine, dihydroergotamine, or a 5-HT agonist. Once pain has
begun, treat with: ice packs; isometheptene; mucate; combination
products containing caffeine; ergotamine; DHE injectable and nasal
spray; 5-HT agonists; analgesics or medications, which constrict the
blood vessels. Steroids may be helpful for prolonged attacks.
 Prevention: Biofeedback; betablockers (propranolol, timolol); anti-
convulsant (divalproex sodium); calcium blockers; and NSAIDs

38. HOW PATIENT WITH MIGRAINE FEELS WHILE
READING

39. MIGRAINE WITHOUT AURA
 Symptoms: Severe, one-sided throbbing pain, often
accompanied by nausea, vomiting, cold hands, sensitivity to
sound and light
 Precipitating Factors: There is a hereditary component.
Other factors include: Certain foods; the Pill or menopausal
hormones; excessive hunger; changes in altitude; weather;
lights; excessive smoking; and emotional stress.
 Treatment: Ice packs; isometheptene; mucate; combination
products containing caffeine; ergotamine; DHE injectable and
nasal spray; 5-HT agonists; analgesics or medications, which
constrict the blood vessels. Steroids may be helpful for
prolonged attacks.
 Prevention: Biofeedback; betablockers (propranolol, timolol);
anti-convulsant (divalproex sodium); calcium blockers; and
NSAIDs

46. NEW DAILY PERSISTENT HEADACHE
 Symptoms: Best described as the rapid development
(less than three days) of unrelenting headache. Typically
presents in a person with no past history of headache.
 Precipitating Factors: Does not evolve from migraine
or episodic tension-type headache. It begins as a new
headache and may be the result of a viral infection.
 Treatment: Can resolve on its own within several
months. Other cases persist and are more refractory.
 Prevention: Does not respond to traditional options, but
anti-seizure medications, Topamax, or Neurontine can
be used.

47. POST-TRAUMATIC HEADACHES
 Symptoms: Localized or generalized pain, can mimic
migraine or tension-type headache symptoms.
Headaches usually occur on daily basis and are
frequently resistant to treatment.
 Precipitating Factors: Pain can occur after relatively
minor traumas, but the cause of the pain often difficult to
diagnose.
 Treatment: Possible treatment by use of anti-
inflammatory drugs, propranolol, or biofeedback
 Prevention: Standard precautions against trauma

49. SINUS HEADACHES
 Symptoms:
 Gnawing pain over nasal area, often increasing in severity throughout
day.
 Pain is caused by acute infection, usually with fever, producing blockage
of sinus ducts and preventing normal drainage.
 Sinus headaches are rare.
 Migraine and cluster headaches are often misdiagnosed as sinus in
origin.
 Precipitating Factors: Infection, nasal polyps, anatomical
deformities, such as deviated septum that blocks the sinus ducts
 Treatment: Treat with antibiotics, decongestants, surgical
drainage, if necessary
 Prevention: None

51. TEMPOROMANDIBULAR JOINT (TMJ)
HEADACHES
 Symptoms: A muscle-contraction type of pain,
sometimes accompanied by a painful “clicking” sound
on opening of the jaw. It is an infrequent cause of
headache.
 Precipitating Factors: Caused by malocclusion (poor
bite), stress, and jaw clenching
 Treatment: Relaxation, biofeedback, and the use of a
bite plate are the most common treatments. In extreme
cases, the correction of malocclusion may be necessary
 Prevention: Same as treatment

54. TENSION-TYPE HEADACHES
 Symptoms: Dull, non-throbbing pain, frequently
bilateral, associated with tightness of scalp or neck.
Degree of severity remains constant.
 Precipitating Factors: Emotional stress, hidden
depression
 Treatment: Rest; aspirin; acetaminophen; ibuprofen;
naproxen sodium; combinations of analgesics with
caffeine; ice packs; muscle relaxants; antidepressants, if
appropriate; biofeedback; psychotherapy; temporary use
of stronger prescription analgesics, if necessary.
 Prevention: Avoidance of stress; use of biofeedback;
relaxation techniques; or antidepressant medication

55. MUSCLES INVOLVED IN TENSION TYPE
HEADACHE

56. ICE PICK HEADACHES
 Symptoms
 sharp, stabbing pains occurring as a single stab or as a series of stabs,
occurring mostly in the eye and orbit, temple, or parietal regions.
 Stabs last a few seconds, and may recur throughout the day, usually at
irregular intervals.
 This headache type is not well understood, even though it occurs more
commonly in migraine sufferers.
 Although this is often referred to as ice pick headache, the official term
according to the International Headache Society is Primary Stabbing
Headache. It has also been referred to as "jabs and jolts.“
 Precipitating Factors
 not well understood
 Treatment
 the pain comes and goes too quickly to take anything.
 ice pick headaches report that the stabbing headaches improve with better
control of their migraines.
 Prevention
 not well understood

58. TIC DOULOUREUX HEADACHES
 Symptoms: Short, jab like pain in trigger areas found in
the face around the mouth or jaw; frequency and
longevity of pain varies. It is a relatively rare disease of
the neural impulses and is more common in women
after age 55.
 Precipitating Factors: Cause unknown, pain from
chewing, cold air, touching face. If under age 55, may
result from neurological disease,
 Treatment: Anticonvulsants and muscle relaxants,
neurosurgery
 Prevention: None

60. TUMOR HEADACHE
 Symptoms: Pain progressively worsens; projectile
vomiting; possible visual disturbances speech or
personality changes; problems with equilibrium;
gait, or coordination; seizures. It is an extremely
rare condition.
 Precipitating Factors: The cause of tumor is
usually unknown.
 Treatment: If discovered early, treat with surgery or
newer radiological methods.
 Prevention: None

61. VACUUM HEADACHE
 Symptoms of Vacuum Headache
 Vacuum headache itself is a symptom of the aforementioned problems.
 Other Accompanying Symptoms Of Vacuum Headaches Are:
 Pain in the sinuses.
 Pressure sensation around the region of the eyes.
 Sensation of a weight or feeling of pressure on the forehead.
 Throbbing pain in sinus cavities (frontal sinuses in particular) and temples.
 Treatment for Vacuum Headache
 The common line of treatment for vacuum headaches is use of decongestants like
Sudafed.
 For severe vacuum headaches, a cortisone injection is given to help open the sinus
cavities and blocked nose.
 Headache subsides after the congestion is relieved and the nose and sinuses get open
leading to release in the pressure.
 Prevention of Vacuum Headache
 Taking appropriate precautions, in order to keep the nose clear, when doing altitude-
changing activities, like scuba diving or flying, is important.
 Medications should be taken before embarking on these activities. Another thing is to
avoid dehydration by ensuring you have adequate fluid intake and have plenty of fluids
with you.

62. MEDICATION AND PAINKILLER HEADACHES
 Some headaches are a side effect of taking a
particular medication. Frequent headaches can also
be caused by taking too many painkillers. This is
known as a painkiller or medication-overuse
headache.
 A medication-overuse headache will usually get
better within a few weeks once you stop taking the
painkillers that are causing it, although your pain
may get worse for a few days before it starts to
improve.

66. HORMONE HEADACHES
 Headaches in women are often caused by
hormones, and many women notice a link with
their periods. The combined contraceptive pill,
the menopause and pregnancy are also potential
triggers.
 Reducing your stress levels, having a regular
sleeping pattern, and ensuring you don't miss
meals may help reduce headaches associated with
your menstrual cycle.

67. CHILDREN’S HEADACHE DISORDERS
 Symptoms
 throbbing head pain affect both sides, affect both sides
 Treatment without Medication
 Sometimes children, especially young children, do not need any
medication to treat a headache. Often there are non-medication
treatments that, used with medication, can provide added benefit.
 Medications
 Once a migraine has begun, several types of medication can alleviate the
symptoms.
 Analgesics, such as acetaminophen or ibuprofen, are first-line pain
relievers for treatment of headaches in children and adolescents. Triptans
can be helpful in those children who don’t find simple analgesics helpful.
There are several different triptans available and three triptans
(almotriptan [Axert], zolmitriptan [Zomig] and rizatriptan [Maxalt]) and one
combination triptan and non-steroidal antinflammatory
sumatriptan/naproxen [Treximet] are FDA-approved for children. In
addition, your doctor may also prescribe antiemetics to stop the nausea
and vomiting or a sedative to help a child rest.

68.  Other causes of headaches
 Headaches can also have a number of other causes,
including:
 drinking too much alcohol
 a head injury or concussion
 a cold or flu
 temporomandibular disorders – problems affecting
the "chewing" muscles and the joints between the lower jaw
and the base of the skull
 sinusitis – inflammation of the lining of the sinuses; read more
about sinus headaches
 carbon monoxide poisoning
 sleep apnoea – a condition where the walls of the throat relax
and narrow during sleep, interrupting normal breathing

69. VARIANTS ?
 Migraine Variants
 Hemiplegic Migraine
 Ophthalmoplegic Migraine
 Basilar Migraine
 Paroxysmal Vertigo
 Paroxysmal Torticollis
 Confusional Migraine
 Tension-Type Headaches

70. ORGANIC HEADACHES
 Organic Headaches
 Fortunately, less than 5 percent of children’s headaches
are the result of serious disease or physical problems,
such as an abscess, head trauma, tumor, blood clots,
intracranial bleeding, or bacterial or viral meningitis.

73. REBOUND HEADACHE
 What is a rebound headache? What causes it, and
how to treat it?
 A pattern of taking acute headache medications too often
(more than two days per week) or in excessive amounts
(more than the label or a doctor advises) can lead to a
condition known as “rebound headache.” With rebound
headache, your medications not only stop relieving pain, they
actually begin to cause headaches. Doctors treat rebound
headache by tapering the medication that is being overused,
sometimes by gradually substituting a different type of
treatment or medication. Stopping may be a challenge, but
regularly overusing a medication increases the potential for
serious side effects. Consult a physician if you regularly use
headache medications more than two days per week or more
than the label advises.

74.  Signs You’re Having Rebound Headaches
 Your headache is present upon awakening.
 Your headache has become exquisitely sensitive to
movement, or physical activity.
 Your headache pain is more spread out than usual, and
oftentimes seems to concentrate in the back of your
head, towards the base of the skull.
 The medicine you usually take for headache relief has
stopped working.
 You’ve taken headache relief medicine more than two
days in a row.
 Your headache medication works for maybe a couple of
hours, but then the pain returns, oftentimes stronger than
before OR the headache INTENSIFIES shortly after taking
medication.
 Your headache has become extremely sensitive to
heightened emotion.

75. HEADACHE TESTS

76.  See your physician immediately if
 You are having your worst headache ever
 You are having your worst migraine attack ever
 Your headache is accompanied by the following
symptoms:
 Unresolved loss of vision
 Loss of consciousness
 Uncontrollable vomiting
 The pain of your headache lasts more than 72 hours with less
than a solid four-hour, pain-free period while awake
 You experience a headache or a migraine attack that
presents unusual symptoms that are abnormal for you and
frightening

77. HEADACHE TESTS
 Headache Impact Test
 HIT stands for Headache Impact Test. This tool
helps patients communicate the severity of their
headache pain to their healthcare provider. It helps
to:
 Determine the impact headaches have on the
patient’s life
 Better communicate the information to the
healthcare provider
 Track the patient’s headache history and the
effectiveness of therapy over time

78. HEADACHE TESTS
 MIDAS
 MIDAS stands for Migraine Disability Assessment
Questionnaire. This tool was developed to measure
headache-related disability in three areas:
 Paid work and education (school/college)
 Household work
 Family, social and leisure activities
 By measuring the number of days missed in these
activity areas due to migraine, the MIDAS tool can
“improve migraine care by getting treatment right the
first time a patient consults” with his or her healthcare
provider.
 The MIDAS score provides insight into the medical
needs of patients and helps the healthcare provider to
determine the appropriate treatment at the first
consultation.

79. HEADACHE TESTS
 ID Migraine
 Has a headache limited your activities for a day or
more in the last three months?
 Are you nauseated or sick to your stomach when
you have a headache?
 Does light bother you when you have a headache?

81. IMPORTANCE OF A DIAGNOSIS
 Determining the cause and type of headache can be challenging even to an experienced
physician.
 In order to develop an accurate diagnosis, the evaluation process should include a very
detailed history from the child and parents (who should partner with their doctors
throughout the diagnostic and treatment process), a thorough physical examination, and
a complete neurological examination.
 When taking a history, your family doctor or pediatrician will become a detective looking
for clues.
 What does the headache feel like?
 Where is the location of the pain?
 What is its severity?
 Does it appear without warning, or are there signs of it coming?
 Is there weakness, nausea, sensitivity to light or noise, lethargy, dizziness?
 Are there auras (bright lights, blind spots, changes in vision)?
 How long does the headache last? Do headaches occur after eating certain foods or
beverages (soft drinks with caffeine, pizza or chocolate)?
 Do certain situations, events or physical activity produce a headache?
 Are the child’s headache symptoms similar to those experienced by other family
members?

84. REFERENCES
 Books
 Headache and Your Child
by Seymour Diamond and Amy Diamond
 Conquering Your Child’s Chronic Pain: A Pediatrician’s Guide
for Reclaiming a Normal Childhood
by Lonnie K Zeltzer and Christina Blackett Schlank
 Websites
 seattlechildrens.org/clinics-programs/biofeedback/resources
 http://www.headaches.org/
 https://patient.info/doctor/headache-pro
 www.sign.ac.uk/pdf/qrg107.pdf
 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3266527/
 http://www.icd10data.com/ICD10CM/Codes/G00-G99/G40-
G47/G44-