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Causes of Headaches
A few years ago the International Headache Society (IHS) rewrote the classifications and causes of headaches. Those of us in the profession were aware of the coming changes and fortunately they were minimal. Mostly they involved terminology and some slight reclassification of headaches. Headaches can be divided into two basic categories: Primary and Secondary Headaches
Primary Headaches
Primary headaches are those where the headache itself is the cause of the pain not some underlying medical condition. The majority (90%) of all headaches that come into a doctor's office are from primary causes such as migraine, cluster and tension headaches. Tension headache may be episodic or chronic. Usually, these headaches are not associated with structural brain problems although numbness, tingling, and dizziness may occur with these headaches. Imaging studies and blood work are usually also normal. When I examine a patient with one of these types of headaches, the exam is also ususally normal. Tension headache patients may, however, have cervical spasming, which can also cause
cervicogenic headaches.
Secondary HeadachesThese are headaches that are caused by an underlying medical condition such as diabetes (hypoglycemic headache), hypertension, or lupus. With secondary headaches, the head pain is not the main problem, but presents as part of a constellation of symptoms. Lab work and other studies do show an abnormality here and the physical exam may also be abnormal. It is vital for practitioners to listen to you the patient when headaches are part of the complaint. Treatment of the underlying condition will not only relieve the headaches, but in some cases may also save your life.
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