DEFINITION
A headache is defined as the pain felt in the area of the head, which may develop during a short or longer period of time and last for some hours or even days. Because the area of the head includes the mouth and nose and other structures, keep in mind that a person experiences a headache when they feel pain of the head, above the line formed by the lower part of the eyes and ears, namely on the forehead, “behind” the eyes, on the top part of the head and the back upper part of the head.

PREVALENCE AND CAUSES
A headache is the most frequently experienced type of pain. It is believed that in an annual basis, approximately 90-05% of people worldwide will experience at least one episode of a headache.

The staggering majority of the people who complain of headaches have no underlying disease that causes the pain; this type of a headache is referred to as a primary headache. The term “primary” in medicine, usually means that a symptom is a result of no other serious pathology- it just exists by itself and its presence harbors no other risk.

A minority of headache incidents are caused by another condition, known or yet unknown to the individual who experiences the symptom of pain in the head.

The list of possible, more serious causes of a headache are summarized below:
• Head trauma
• Cervicobrachial syndrome
• Subarachnoid hematoma
• Brain artery thrombosis
• Meningitis
• Brain tumors
• Primary or secondary vasculitis of the central nervous system
• Alcohol, cocaine or other substance abuse
• Brain abscess. This is a sac of pus that is formed within a closed cavity, due to infection.
• HIV/AIDS
• Pheochromocytoma (PCC), a malignant tumor usually stemming from the adrenal glands
• Acute glaucoma, namely ac acute phase of elevated pressure within the eye (intraocular pressure)
• Conditions of the eyes
• Conditions of the ears
• Stress
• Psychotic disorders

PRESENTATION
A headache is defined as the pain felt in the head, over the line that crosses the bottom part of the eyes and ears. However, there are various sub-types of a primary headache, classified based on their particular clinical characteristics.

Migraine
Persistent pain in the right or left side of the head, with a pounding character. Migraines usually cause a lot of pain and may or may not be preceded by an aura. An aura is a feeling that comes before the actual pain, and, after some instances of a headache an individual can recognize its coming by the aura. An aura exists in up to 20% of the migraine cases, and causes diplopia (seeing things double), flashes of light in one’s visual field, weakness, numbness in one side of the head or even ataxia, which is an inability to walk straight or carry out coordinated movement.

Tension headache
A tension headache is, perhaps, the most common type of a headache and is many times dependent on psychological factors, such as stress. The pain is located at the back of the head or the temporal and frontal part of the head; the temporal part os the region between the end of your eyebrows and ears. Tension headaches can be also experienced as widespread pain, all over the head. It can last anywhere between a few hours and a couple of days and is not preceded by an aura.

Cluster headache
This type of a headache tends to develop in members of the same family, due to which fact, a genetic background has been proposed. The pain starts abruptly and is mainly localized in the area of the eyes. Patients may describe it as being felt “behind the eyes”. It also leads to a feeling that one’s head pounds and is felt on one side of the head (mainly). The eye and nose may also be watery. Cluster headaches usually last for a couple of hours, leaving the patient feeling weak and tired.

WHEN TO SEEK TREATMENT
Some of the particular characteristics of a headache that should raise suspicion include:
• A headache that you have not experienced before, with different characteristics, that appears suddenly.
• A headache that is felt as soon as you wake up, or one that wakes you up during sleep.
• A headache experienced after a trauma on the head.
• A headache that is accompanied by neurological symptoms, such as inability to carry out coordinated movement, seeing things double, or even loss of mobility.
• A headache that persists for more than 72 hours.
• A headache that is accompanied by fever or inability to bend the neck.

WORKUP
Your doctor will take your vitals (blood pressure, oxygen, pulse rate and temperature) and perform a detailed physical examination. A neurologic assessment is performed: the doctor will ask you to do movements and exercises to see whether there is an indication of neurological damage. The tests are non-invasive and are actually quite fun! They may examine your arteries on the head by palpation, check whether you can bend your neck, and check your reflexes and many other factors. If it is required, they may suggest a brain computerized tomography scan (CT scan), a magnetic resonance imaging scan (MRI) or a lumbar puncture.

TREATMENT
You can experience symptom relief from a headache, using basic over-the-counter medications, such as Tylenol or non-steroidal anti-inflammatory drugs (NSAIDs). Do not take any of these medications, if you have not done so before unless you consult your doctor. If you are allergic to any of them, do not ingest it. Have in mind the maximum dosage of each medication and never exceed it. A doctor may prescribe other medications for migraines and different types of headaches if you experience them frequently.

POPULAR MISCONCEPTIONS
• I usually ingest Tylenol pills if I have a headache. This time it is not working. I believe something serious is going on. If your usual dosage of basic medication does not work, it is not necessarily the sign of a critical underlying condition. Some headaches may simply be more intense than others. Consider taking another Tylenol pill, always cautious of the maximum dosage. If the pain cannot be stopped, contact your doctor. If the characteristics of the pain alter, also contact your doctor.

• I drink coffee every day. When I have a headache in the morning, coffee usually stops it. I am considering drinking coffee as medication. Coffee cannot be considered a headache medication an, if you suffer from frequent headaches, you should actually consume less coffee. Having a headache in the morning that is cured with coffee is the result of caffeine withdrawal: caffeine causes body addiction, and if you stop drinking it suddenly, this can result in a headache; drinking coffee again reverses the withdrawal symptoms. This is why a cup of coffee can only cured headaches caused by caffeine withdrawal.