1. Classification of Headache

2. Pain Sensitive parts of cranium
Our understanding of headache has been augmented by observations made during operations on the brain (Ray and Wolff).
skin, subcutaneous tissue, muscles, extracranial arteries, and periosteum of the skull;
delicate structures of the eye, ear, nasal cavities, and paranasal sinuses;
intracranial venous sinuses and their large tributaries, especially pericavernous structures;
parts of the dura at the base of the brain and the arteries within the dura, particularly the proximal parts of the anterior and middle cerebral arteries and the intracranial segment of the internal carotid artery;
the middle meningeal and superficial temporal arteries; and
the optic, oculomotor, trigeminal, glossopharyngeal, vagus, and first three cervical nerves.

4. Interestingly, pain is practically the only sensation produced by stimulation of these structures;
the pain arises in the walls of blood vessels containing pain fibers
Much of the pia-arachnoid and dura over the convexity of the brain, the parenchyma of the brain, and the ependyma and choroid plexuses lack sensitivity

5. pain from supratentorial structures is referred to the anterior two-thirds of the head, i.e., to the territory of sensory supply of the first and second divisions of the trigeminal nerve;
pain from infratentorial structures is referred to the vertex and back of the head and neck by the upper cervical roots

7. Mechanisms of Cranial Pain
intracranial mass lesions cause headache only if they deform, displace, or exert traction on vessels and dural structures at the base of the brain
Dilatation of intracranial or extracranial arteries (and possibly sensitization of these vessels), of whatever cause, is likely to produce headache. The headaches that follow seizures, infusion of histamine, and ingestion of alcohol are probably all caused by cerebral vasodilatation. Nitroglycerin, nitrites in cured meats ("hot-dog headache"), and monosodium glutamate in Chinese food may cause headache by the same mechanism.

8. Common Types of headaches

9. one eye or Ear Becomes dull ache and Generalize Scalp sensitive Upon
type
site
Age and sex
Clinical
characteristics
Diurnal
pattern
Life
profile
Provoking
factors
Associated
features
Migraine
without aura
(common
migraine)
Frontotemporal
Uni- or
bilateral
Adolescents,
young to
middle-aged
adults,
sometimes
children,
more
common in
women
Throbbing
(pulsatile);
worse behind
one eye or Ear Becomes dull
ache and
Generalize
Scalp sensitive
Upon
awakening
or later in
Day
Duration: 4–
24 h in most
cases,
Longer
Irregular
intervals,
weeks to
Months
Tends to
decrease
in middle
age and
during
Pregnancy
Bright
light,
noise,
tension,
Alcohol
Relieved by
darkness
and sleep
Nausea and
vomiting in
some cases

10. type
site
Age and sex
Clinical
characteristics
Diurnal
pattern
Life
profile
Provoking
factors
Associated
features
Migraine with
aura
(neurologic
migraine)
Same as above
Scintillating
lights, visual
loss, and
Scotomas
Unilateral
paresthesias,
weakness,
dysphasia,
vertigo, rarely
confusion

11. type site Age and sex Clinical characteristics Diurnal pattern Life
profile
Provoking
factors
Associated
features
Cluster
(histamine
headache,
migrainous
neuralgia)
Orbitotemporal
Unilateral
Adolescent
and adult
males
(90%)
Intense,
nonthrobbing
Usually
nocturnal,
1–2 h after
falling
Asleep
Occasionally
diurnal
Nightly or
daily for
several
weeks to
Months
Recurrence
after many
months or
years
Alcohol in
some
Lacrimation
Stuffed nostril
Rhinorrhea
Injected
Conjunctivum
Ptosis

12. type
site
Age and sex
Clinical
characteristics
Diurnal
pattern
Life
profile
Provoking
factors
Associated
features
Tension
headaches
Generalized
Mainly
adults, both
sexes, more
common in
women
Pressure
(nonthrobbing),
tightness,
aching
Continuous
variable
intensity, for
days, weeks,
or months
One or
more
periods of
months to
years
Fatigue
and
nervous
strain
Depression,
worry,
anxiety

13. type
site
Age and sex
Clinical characteristics
Diurnal pattern
Life profile
Provoking factors
Associated features
Meningeal irritation (meningitis, subarachnoid hemorrhage)
Generalizedor
bioccipital, or
bifrontal
Any age,
both sexes
Intense, steady
deep pain, may
be worse in
neck
Rapid
evolution—
minutes to
hours
Single
episode
None
Neck stiff on
forward
Bending
Kernig and
Brudzinski
signs