Headache General Principles

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Headache is a common symptom arising from psychological, otological, ophthalmological, neurological or systemic disease. In clinical practice psychological 'tension' headache is encountered most frequently.

Definition: Pain or discomfort between the orbits and occiput, arising from pain-sensitive structures.

Intracranial pain-sensitive structures are:

venous sinuses, cortical veins, basal arteries, dura of anterior, middle and posterior fossae.

Posterior fossa:

innervated by IX, X cranial nerves and the upper ^ cervical nerves

Pain referred to:

suboccipital upper cervical

Posterior fossa:

innervated by IX, X cranial nerves and the upper ^ cervical nerves

Anterior fossa

Middle fossa

Anterior fossa

Middle fossa innervated by 1st and 2nd branches of the V cranial nerve regions -bilateral or ipsilateral

Pain referred to:

forehead temporal regions -bilateral or ipsilateral

Extracranial pain-sensitive structures are:

Scalp vessels and muscles, orbital contents, mucous membranes of nasal and paranasal spaces, external and middle ear, teeth and gums.

International classification of headache type (19SS)

% Frequency in General Practice

Type Percentage

Tension type headache

45

Migraine

30

With diseases of the eye/sinuses

<8

With systemic infection

7

With head trauma

3

Examination

With drugs

2

Full general examination, including:

With cerebrovascular disease

<1

Ocular - acuity, tenderness, strabismus

With other intracranial disease

<1

Teeth and scalp

With metabolic disease

<1

Percussion over frontal and maxillary

Cluster headache

< 1

sinuses.

Neuralgias

< 1

Full neurological examination.

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