A headache is one of the common reasons for seeking medical attention. The term "headache" generally encompasses all aches and pains located in the head. It is plausible to ask: why so many pain symptoms are centered in the head? A reasonable explanation is that the face and scalp are richly supplied with pain receptors, more so than many other parts of the body (Zagami 1994). It is a well-designed mechanism that protects the precious contents of the skull (Fig. 27.1). When pain-sensitive structures, which reside in the skull, are attacked by disease or trauma, each structure has its own way of inducing pain (Headache Classification Committee of the International Headache Society 1998). This chapter is designed to give an introduction and overview to various types of headaches, their origin, presentation, pathophysiology, and treatment modalities.

In order to understand various types of headaches, it is essential to know the underlying pathophysiology of headaches. However, the pathogenesis of headaches is often unclear and multi-factorial. The most common underlying causes of headaches are:

• Vascular theory, which states that headache is the result of abnormal synthesis of vasoac-tive amines, such as nor-epinephrine, dopamine, and serotonin, which cause cerebral vasoconstriction followed by compensatory vasodilatation.

• Inflammatory theory, which states that substance P, a vasodilator released from trigeminal ganglia, causes neuro-inflammatory changes that stimulate pain-sensitive cranial arteries and subsequently cause pain.

• Genetics plays an important role in predisposing certain individuals to headaches.

• Physical abnormalities of the brain such as tumors, stroke, aneurysms.

• Psychological abnormalities such as anxiety, stress, and mood disorders, and

Table 27.1 shows at least eight different types of headaches, general pathology, and presentation, and discusses each type in detail.

N. Vadivelu et al. (eds.), Essentials of Pain Management,

DOI 10.1007/978-0-387-87579-8_27, © Springer Science+Business Media, LLC 2011

Arachnoid membrane

Arachnoid membrane

Figure 27.1 Major structures of the skull.
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