From the Guidelines
The most common etiologies of cephalalgia (headache) in adults are tension-type headaches, migraines, and cluster headaches, with tension-type headaches being the most prevalent form. According to the most recent and highest quality study 1, migraine is a highly disabling primary headache disorder with a 1-year prevalence of ~15% in the general population. The study also highlights that migraine manifests clinically as recurrent attacks of headache with a range of accompanying symptoms, and that the pathogenesis of migraine is widely believed to involve peripheral and central activation of the trigeminovascular system.
Key Characteristics of Common Headache Types
- Tension-type headaches: typically result from muscle tension in the neck, scalp, and shoulders, often triggered by stress, poor posture, or eye strain
- Migraines: characterized by throbbing pain, often on one side of the head, frequently accompanied by nausea, vomiting, and sensitivity to light and sound
- Cluster headaches: cause severe pain around one eye and occur in cyclical patterns
Diagnosis and Management
The diagnosis of headaches should be based on a detailed history and physical examination, as outlined in the International Headache Society Classification of Headaches 2. The management of headaches depends on the type and severity of the headache, and may include over-the-counter medications such as acetaminophen or ibuprofen for occasional tension headaches, and prescription medications such as triptans or preventive therapies for migraines. Lifestyle modifications, including regular sleep patterns, stress management, proper hydration, and avoiding known triggers, can also significantly reduce headache frequency.
Importance of Accurate Diagnosis and Management
Accurate diagnosis and management of headaches are crucial to improve patient outcomes and reduce disability. As highlighted in the study 1, misdiagnosis and under-treatment of migraine are substantial public health challenges, and a comprehensive approach is needed to facilitate accurate diagnosis and evidence-based management. Therefore, it is essential to prioritize a thorough diagnosis and management plan for patients with headaches, taking into account the latest evidence and guidelines.
From the Research
Etiologies of Cephalalgia in Adults
The most common etiologies of cephalalgia (headache) in adults can be categorized into primary and secondary causes.
- Primary causes include: + Tension-type headache, which is the most common primary headache disorder seen in adults, with a worldwide lifetime prevalence of 46% to 78% 3 + Migraine and variants, and cluster headaches, which are also common primary headache disorders 4
- Secondary causes include: + Giant cell arteritis 5 + Intracranial lesions 5 + Other underlying and usually treatable causes, such as head trauma, vascular disorders, infection, or disorders of facial or cranial structures 6
Prevalence of Primary Headache Disorders
- Tension-type headache is the most common primary headache disorder, and its prevalence peaks in the fourth and fifth decades of life 7
- Migraine and probable migraine headaches are also common, accounting for 57.1% and 30.7% of primary headaches, respectively, in one study 6
- Tension-type headache causes greater disability and accounts for more missed work days than migraine 3
Diagnosis and Management
- A clear understanding of the types and possible causes of headache pain is essential to adequately assess and manage the patient with headaches 4
- A focused diagnostic evaluation is recommended, ranging from blood tests to neuroimaging, depending on the headache characteristics 5
- Treatment options may be limited in older patients and may need to be tailored to the presence of comorbid medical conditions 5