MAPS | Medical Pain Clinics

Headaches are one of the most common complaints in society today and the fifth most common reason for outpatient medical care. Headache pain may be extremely intense, but most headaches are unrelated to structural neurologic disease. While some are related to life-threatening disorders, the vast majority of headaches are chronic and not related to neurologic dysfunction. More than 300 conditions can produce headaches, and for that reason precisely determining the cause of this pain can be a daunting task.

Patient History and Exam
The key to making any diagnosis about the cause of headache pain is first to obtain a thorough history from the patient. Details about the pain—such as when it started, where the pain is located, the quality of the symptoms, what makes it better or worse—are all pertinent. Other health conditions as well as life style choices may also be important headache contributing factors. The next step is to carefully examine the patient. Depending on the source of the pain, it may be able to be replicated on exam, leading to the discovery of its cause. Diagnostic tests or trials of therapeutic treatments often lead to discovery of causative factors of headache pain.

Headache Classifications
The International Headache Society has developed a headache classification system comprised of thirteen diagnostic groups. Divided into two major divisions of primary headache disorders and secondary headaches, types of headaches in both divisions are listed below. Individuals may experience multiple types of headaches. The headache pattern and intensity may also change over time.

Treatment Pathways
The type of headache and associated disabling symptoms determine the choice of treatment. Optimally, the treatment goal is to become headache free. However, when that is unlikely, the goal is to decrease the intensity as well as the frequency of the headaches. The most common types of headaches seen by healthcare providers include migraine headaches (with or without aura), tension headaches, and headaches of cervical muscular origin.

Migraine headaches affect twenty percent of the population. The headaches are treated in two ways. If the migraine is infrequent, treating single episodes with medication and non-medication therapies is preferable. If the migraines occur on a frequent or regular basis, prophylactic (preventive) management is needed. Treatment may include life style recommendations, daily medications and/or physical therapy. Daily tension headaches are often treated
effectively with stress reduction therapies and anti-depressant medication. Cervical muscular headaches often occur after a neck injury. The cause may be from any of the pain generating structures in the neck—torn muscles or ligaments, damage to joints, or from damage to the discs in the neck. These are often the components of pain that are referred to as “whiplash” injury. If cervical headaches don’t resolve within several weeks following the original trauma, aggressive intervention may be needed. MAPS offers a comprehensive pain management team including expert diagnosticians and physical therapists to help define and resolve these complex problems.

Headache Classifications
Primary headache disorders include:

• Migraine headache
• Tension headache cluster headache

Secondary headaches include headache associated with:

• Head injury
• Miscellaneous headaches not associated with a structural lesion
• Vascular disorders and nonvascular disorders (such as neoplasms)
• Substances or their withdrawal
• Noncephalic infection
• Metabolic disorders
• Disorders of other structures of the head such as the eyes, ears, and neck
• Cranial neuralgias
• All other causes

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