All About HEADACHES

By a layman ... for a layman

Headaches. (cephalgia)
Practically everyone knows the pain of a headache. 7 out of 10 Americans have experienced at least one headache per year and between 45 to 100 million Americans have chronic headaches. Over 90% of population will experience headache of some kind at some time in their lives. There are over 32 million Migraineurs alone in the USA. Headaches may cost you time, affect your quality of life, or even point to a more serious condition. Headaches are one of the most common adult health problems. Most are not serious but may occur again and again.

Defining Headaches.

A headache is a pain in the head with the pain or discomfort in the scalp, above the eyes or the ears, or upper neck region being behind the head (occipital). Headache, like chest pain or back ache, has many causes. People usually suffer from many types of headaches. Headaches may be due to tension, migraine or both. Most people often worry that their frequent headaches may be a symptom of tumour or a possible stroke. This is very rare and headaches may mean several other things. Headaches are often subjective experiences, characterized by pain felt in the head. However, headaches do not occur from the bones or brain tissues itself, both of which lack pain-receptors. Instead, headaches occur from the nerves located in the facial organs (eyes, tongue, etc.) that run through the scalp of the head. The nerve receptors that sense pain, called nociceptors, can be triggered by tension, stress, hormones, dilated blood vessels, etc. All headaches are considered primary headaches or secondary headaches. Primary headaches are not associated with other diseases. Examples of primary headaches are migraine headaches, tension headaches, and cluster headaches. Secondary headaches are caused by other minor or major diseases ranging from life threatening ones such as brain tumours, strokes, meningitis, and subarachnoid haemorrhages to less serious but common conditions such as withdrawal from caffeine and discontinuation of analgesics (pain killing medication). Many people suffer from "mixed" headache disorders in which tension headaches or secondary headaches may trigger migraine. Frequent pain in the back of the head without any valid reason can mean a headache due to migraine. Headaches come in many different shapes and sizes. Some last for just a few minutes, others can last for more than 72 hours. They may occur on just one side of the head, or both. One headache may pulsate, another one sharp, and yet another gives a dull pain. There are four main categories and distinct types of headaches, vascular, muscle contraction (tension), traction, and inflammatory.

Headaches may occur from activities as varied as exercise, coughing or sex, for example. Other headaches are caused by caffeine withdrawal, or low blood sugar. The headache experience by one person varies from another and headaches occur for different reasons. The most likely cause is pain coming from the upper part of your neck called Cervicogenic headache. Cervicogenic headache can be extremely painful and persistent, but is the most common severe headache that can be treated, without resorting to medication - you need to see a qualified physiotherapist. Some causes of common headaches can be due to: Muscle strain in the neck, upper back or shoulder muscles Emotional stress Certain drugs Eating or drinking cold foods and liquids Coughing or sneezing Eye strain Alcohol, caffeine or other drug use, abuse or withdrawal Exposure to smoke or fumes from chemicals, including carbon monoxide Medical procedures, such as the after effects of a spinal tap Dental problems or procedures, such as pain from grinding the teeth or from a root canal Changes in the levels of chemicals in the body (neutrotransmitters) Although rare, headaches in adults or children may be a sign of a serious illness. Other symptoms, such as vomiting, dizziness or changes in vision, may also be present. Some serious illnesses or injuries that can cause headaches include: A head injury that damages the brain, fractures the skull or causes bleeding in or around the brain Brain tumour (growth in the brain that creates pressure in the skull) Problems with pregnancy Stroke Aneurysm (bulging in a blood vessel of the brain) Other health conditions, such as high blood sugar (hyperglycemia), low blood sugar (hypoglycemia), low blood calcium levels (hypocalcemia), kidney failure (uremia), glaucoma (nerve damage at the back of the eye), Lyme disease (bacterial infection spread by ticks) or inflammatory problems (lupus or temporal arteritis)
Rarely, a headache may be a sign of a more serious cause, such as:

Causes of Headaches.

Brain infection like meningitis or encephalitis, or abscess Brain tumour Hydrocephalus Problems with the blood vessels and bleeding in the brain, such as arteriovenous malformation (AVM),brain aneurysm, or stroke Pseudomotor cerebri Very high blood pressure

Dealing with Headaches

Keep a headache diary to help find the source or trigger of your symptoms. Then change your environment or habits to avoid future headaches. When a headache occurs, write down: The date and time the headache began What you ate for the past 24 hours How long you slept the night before What you were doing and thinking about just before the headache started Any stress in your life How long the headache lasted What you did to make it stop Some headaches may be a sign of a more serious illness. Anyone who has these danger signs should seek medical help immediately: This is the first headache you have ever had in your life and it interferes with your daily activities Your headache comes on suddenly and is explosive or violent You would describe your headache as "your worst ever," even if you regularly get headaches You also have slurred speech, a change in vision, problems moving your arms or legs, loss of balance, confusion, or memory loss with your headache Your headache gets worse over a 24-hour period You also have a fever, stiff neck, nausea, and vomiting with your headache Your headache occurs with a head injury Your headache is severe and just in one eye, with redness in that eye You are over age 50 and your headaches just began, especially if you also have vision problems and pain while chewing You have cancer and develop a new headache

The time for concern is if a "back of head pain" hit you suddenly (time from onset to maximum pain within seconds) thunderclap headache which has a 10% risk of a serious cause being found, and requires immediate medical attention. While most headaches do not require immediate attention, emergency attention is need in the following cases: Fever, stiff neck, rash, confusion, seizure, double vision, weakness, numbness or difficulty speaking Onset after a head injury, fall or bump Pain worsens despite rest and over-the-counter pain medication Sudden onset of severe headache If your life quality is being interrupted by headaches, you may want to see your doctor. Doctors can help diagnose and treat pains caused by headaches. To learn more about the diagnosis process for different headache types, read the next section called Diagnosis of headaches.

When To Seek Help.

Diagnosis of Headaches.

Proper diagnosis is essential to overall health and to obtain the best possible treatment for head pain, whatever type it is. The best prescription is knowledge. The more you learn about your head pain, the more effective you can be as the leader of your healthcare team. An educated patient is a better patient. If your doctor resists or resents questions and does not react well to your being an active member of your healthcare team, talk to him or her about it. If that doesn't resolve the issue, it may be time for a new doctor. Keep a headache diary, work with your doctor to diagnose your head pain and develop your treatment plan and talking with others who truly understand is invaluable. The first step toward diagnosing a headache is to see your family physician. Your family physician will want to better understand the circumstances of your headaches (around light? noise? during exercise? stress?), and how frequently they occur. Also, he will want to better understand your family history, as some types of headaches may be due to genetics (e.g. migraines). Additionally, if you've ever suffered any head injury, had dental surgery or problems, have eyestrain, etc., this information will be relevant as well. If your doctor feels it necessary, he may refer you to a neurologist or internist. This referral may be necessary if conventional treatments are not effective. Or, you may see a specialist if you have a serious type of headache. For example, if you experience a status migrainosus headache, in which a severe headache lasts for 72 hours or longer and requires hospitalization, you may see a neurologist. Your health care provider will take a medical history and will perform an examination of your head, eyes, ears, nose, throat, neck, and nervous system. The diagnosis is usually based on your history of symptoms. A "headache diary" may be helpful for recording information about headaches over a period of time. Your health care provider may ask questions such as: Is the headache located in your forehead, around your eyes, in the back of your head, near your temples, behind your eyeball, or all over? Is the headache on one side only? Is this a new type of headache for you? Would you describe the headache as throbbing? Is there a pressure or band-like sensation? When does the headache occur? How long have you had headaches? How long does each headache last? Does the headache wake you up from sleep? Are the headaches worse during the day and better at night? Did other symptoms begin shortly after the headaches began? Do you have repeat headaches? Does the headache reach maximum intensity over 1 to 2 hours? Are the headaches worse when you are lying down? Standing up? Are the headaches worse when you cough or strain? Do they occur at a specific time related to your menstrual period? What home treatment have you tried? How well did it work?

Head pain can be a symptom of various diseases or physical anomalies such as tumours or aneurysms. A CAT Scan of the sinus cavities is helpful, as is an MRI to rule out tumours and other problems. Keep in mind that your doctor may not order such tests immediately. It's quite normal procedure to try treatment first, and do such tests if the treatments fail. Your keeping a headache diary will also be helpful to your doctor for diagnosis purposes. Headaches can seriously affect your quality of life. But how do doctors locate the source of a potential problem and what doctors should you see? In addition to your medical history, your doctor may run several tests in order to determine if the headache is a result of an infection, a tumour or abscess, aneurism, misfiring of the brain's neurons, etc. Headaches may occur due to specific physical conditions, so one or more tests may allow your doctor to determine the underlying cause. These tests in combination with your medical history and a physical/neurological examination should allow your doctor to pinpoint the cause. Tests and exams necessary to confirm a diagnosis for problem headaches are:
1. Blood tests or Lumber Puncture (spinal tap)

Medical Tests of Headaches.

Testing for infection. Suspicion of meningitis caused headaches may require a spinal tap. Testing for sinus infection possibly using nasal endoscopy.

2. Sinus X-Rays

3. EEG (electroencephalogram).

Measures brain activity by recording the firing of neurons in the brain. While it cannot diagnose the cause of a headache, it can tell a doctor if there is a malfunction in the brain's firing of neurons. If you have any danger signs or you've been having headaches for a while, provides a 3-D image of the head/brain, thus allowing doctors to look for physical problems (such as tumours).

4. CT scan (computed tomography) / CAT scan(computed axial tomography).

5. MRI (magnetic resonance imaging).

An MRI scan provides of the internal features of the body, but in greater contrast than CTs. This may be useful for identifying brain tumours or blood vessel issues. (Like a CT scan)

Relief for Headaches.

There may be things you can do to relieve the symptoms of a headache. Try to treat the symptoms right away. When migraine symptoms begin: Drink water to avoid getting dehydrated, especially if you have vomited Rest in a quiet, dark room Place a cool cloth on your head Use any relaxation techniques you have learned If your doctor has already told you what type of headaches you have, there are many things you can do to manage migraines or tension headaches at home. Your doctor may have already prescribed medicines to treat your type of headache. Try acetaminophen, aspirin, or ibuprofen for tension headaches. Do NOT give aspirin to children because of the risk of Reye syndrome. Talk to your doctor if you are taking pain medicines 3 or more days a week. 5

Treatment of Headaches.

There are different kinds of head pain, requiring differing treatments. The treatment of the headache depends on the type and severity of the headache and on other factors such as the age of the patient. Treatment methods and medications for different types of head pain vary. For example, the triptan drugs used to treat migraine (e.g. Imitrex) do nothing for sinus/allergy headaches Most headaches are treated with prescription or over-the-counter medicines. Patients have also experienced relief using stress management techniques, massage therapy and alternative medicine. Your doctor will be able to make a treatment recommendation upon examining your medical history in conjunction with your test results. But how can you medically treat a headache? And can you realistically expect for headaches to go away completely? Upon diagnosis of a specific headache condition, your doctor will be in a better position to help you manage your headache. Early diagnosis can help you seek treatment immediately and start to feel better sooner. Goals of treatment may be to reduce the intensity and frequency of headaches, or, in the case of infection-related headaches, to treat the underlying cause. Headaches may be common, but there is a wide variety of techniques to treat them. Living a healthy life is just one strategy for recovering from headaches, and never is a bad thing. However, if necessary, prescription and non-prescription medication is available. With these arrays of options, you may be able to have a more fulfilling life. Different methods of treatment: 1. Alternative Practices. Acupuncture, vitamin and mineral supplements, chiropractic care, and herbs may have some affect on your headaches. However, always check with your doctor about alternative practices and the safety of using them. Many alternative practices may not be sufficiently backed by scientific 2. Diet Changes. Some headaches are brought on by low blood sugar. For example, some migraine sufferers note that when they do not eat or eat regularly, they experience a headache. This may be corrected by eating smaller meals more frequently throughout the day. Other headaches may be caused by certain foods. Avoidance or elimination of these foods from your diet may accompany treatment. 3. Lifestyle. Because a disruption in the normal sleep pattern, smoking, or other lifestyle habit may trigger headaches, focusing on these may provide relief. Some migraine sufferers experience migraines as a result of oversleeping. Thus, not oversleeping may be a partial solution to your headache pain. Cluster headache sufferers may experience headaches as a result of smoking and eliminating smoking may prove beneficial. If headaches are caused by exercise, a change in the duration, intensity, or how you begin your exercise program may be helpful. 4. Pain medication. Pain medication to treat headaches can be of prescription strength or non-prescription strength. Medications are typically used during the onset of a headache, in an effort to shorten the duration of the headache, or to lessen the intensity of the headache. Because rebound headaches may occur if medication is taken excessively, finding the correct dosage is important if you have headaches that occur frequently. In general, medications are used only as needed when the headache is occurring or about to occur. 6

5. Preventative Medication. Preventative medication may be used to decrease the likelihood of experiencing a headache. Preventative medication is usually taken every day, regardless of whether or not a person is experiencing a headache. A period of time may be necessary before effects are seen, maybe between 4-6 weeks. Because this medication is intended to be taken every day, you should always consult with your doctor before you stop or reduce the dosage of medication that you are prescribed. Possible prescriptions include: anti-depressants anti-seizure medications botulinum toxin type A (Botox) cardiovascular drugs cyproheptadine 6. Relaxation Techniques. Some headaches can be brought on by stress and your doctor may recommend that you practice relaxation techniques or exercise more frequently in order to help you relax. Meditation may allow you to focus on your breathing, hence allowing your neck and shoulder muscles to relax. Or, you may choose to practice biofeedback techniques. These techniques may utilize visual images, breathing techniques, and oral mantras. By using these techniques you may be able to reduce anxiety, thereby reducing the chances of an oncoming headache.

Primary / Common Types of Headaches.

These are common causes of an ache in back of the head. Pain can also be due to common cold, flu, fever or premenstrual syndrome.

Children and teenagers often have headaches along with sore throats, colds, sinus problems or other infections. They also may have tension headaches from stress and emotional strain. Approximately one-third of people who have migraine headaches first began having them as teenagers. Approximately 75% of all headaches are tension headaches the most common type of primary headache. As many as 90% of adults have tension headaches and are more common among women than men on a ratio of 3 to 2 and may affect children mild to moderate cluster. Most adults experience them from time to time and often develop after a difficult day at work or school or during times of physical or emotional stress . While some people rarely have tension headaches, others may have them daily (chronic), or others a low level ache lasting from an hour to an entire week. When you are under tension or stress or have poor posture it can cause the muscles in the neck and scalp to tense up and create a tension headache. This may be due to lack of enough sleep, overworking, missing your meals, alcohol or drug abuse. Many times the food that we eat triggers pain in back of the head. These foods include chocolate, cheese and food enhancer like mono-sodium glutamate (MGM). If you use a computer, microscope or are in the same position for a long time, even sleeping in an abnormal position or a cold climate can lead to pain, especially in the back of the head. Do not clench your jaw or grind your teeth as this also causes head pain. Noise and stuffy environments aggravate these types of headaches. 7

Children's Headaches.

Tension Headaches - Muscle contraction .

Tension headaches are sometimes, but not always, in the muscles of the head and neck. The neck, upper back and shoulder muscles may feel tense and tight due to contraction or spasm, and the scalp may feel sensitive or painful. Tension headaches usually cause a pain around your head, like a tight band, starting at the back of the head and spread to the front of the head usually both sides and are sometimes described as a feeling of having one's head in a vice or having a tight band around it. The headache pain may be dull and aching, with the area around the head, shoulders, neck, and scalp being tender and you may experience the pain in the shoulders, neck and jaw as well. Mild tension-type headaches are not incapacitating and usually get better with home treatment or go away on their own. Most people do not need to see a doctor for help unless the headaches become frequent or severe. If the headache is severe, the person may be nauseous or have no appetite. Severe or frequent tension-type headaches often require a combination of home treatment and prescription medication.

Migraine Headaches.

Migraine headaches are the second most common type of primary headache. An estimated 28 million people in the US have migraine headaches. Migraine headaches affect children mild to severe as well as adults. Before puberty, boys and girls are affected equally by migraine headaches, but after puberty more women than men have them at a ratio of 3 women to 1 man. Migraines are most common in girls and women between the ages of 15 and 44. A migraine typically lasts 4 to 24 hours but can last up to 3 days. Some people have several headaches per month, while others have them much less often. Migraine headaches occur repeatedly. These recurrent headaches are the most common cause. Migraine often goes undiagnosed or is misdiagnosed as tension or sinus headaches. Migraine is not a common diagnosis of people suffering a back of the head headache with only from 6% to 39% of people with migraine reporting pain in the back of head or neck. A back of head headache might be migraine if it is severe enough to make you want to lie down, and you feel nauseated with it. About 20% of people have symptoms, called an aura, such as visual disturbances and noise intolerance 15 to 30 minutes before a headache starts. You may experience these headaches with or without an aura called common migraine. Migraine headaches are usually accompanied with throbbing, pulsating and pounding pains and may range from mild to very severe and can be disabling. People with migraine don't always have pain in one location. Usually in migraine pain can be experienced in different locations during different migraine attacks. Migraine headaches usually affect only one side of the head and often occur with nausea, vomiting and extreme sensitivity to light or sound but some people have headaches on both sides of the head. In some people, the pain often near the eye of the affected side, may switch sides each time a headache occurs. Hormone changes may trigger migraines headaches. While the reason is not clear, changes in estrogen and progesterone seem to play a role. Some women report having migraines just prior to or just after their periods, as well as when they are pregnant or are experiencing menopause. Depending on the frequency and degree of pain, migraines may be treated with several different medications. Migraine may continue long enough to require an emergency room visit, or even hospitalization, so that stronger medications can be given to break the cycle. (status migrainous) 8

Very common as many as 4% of adults will have this pain at some point in their lives. The most common of these is a pain referred from the joints of the upper spine. The classic cervicogenic headache causes a pain in the back of the head - on one side only. The pain can spread up the back of the head and round the side towards the ear or over the top into the forehead. Most people with cervicogenic headache will have previously injured their neck (a whiplash injury is typical). Other people will have had minor injuries (often forgotten) or adopt postures or habits that contribute to poor posture, which can predispose to pain. Most middle-aged/older people with a severe one-sided headache that's been going on for months will have cervicogenic headache. In these older people there are restricted neck movements due to "wear and tear" of the joints of the upper spine (facet joints). Fortunately Cervicogenic headache treatment can be effective, and is the most common headache that might respond to physical treatment, without resorting to medication.

Cervicogenic Headaches. (cervic = neck, genic = caused by).

This another severe, sharp "back of head headache" that spread up to the top of head or into the eye on the same side. Nerve block, anti-inflammatory or Gabapentin are worth trying. Most people who are diagnosed with occipital neuralgia will actually be suffering from Cervicogenic headache. There is still controversy about whether Cervicogenic headache and Occipital Neuralgia are the same or different conditions, most are better called Cervicogenic headache. However, Occipital Neuralgia is a better description for people who have had soft tissue injury to the back of the head. About 35% of all people will get these brief intense pains in the head lasting a few seconds. They appear out of the blue, and may make you wince, or feel briefly weak at the knees if they are very intense. In a small number of people, these ice-pick pains are located, exclusively, in the neck or very back of the head. It can be very difficult to tell the difference between cervicogenic headache and ice-pick pains. Usually ice-pick pains can occur anywhere in the head, whereas Cervicogenic headache are locked to one side of the head only.

Occipital Neuralgia Headaches.

Ice-pick Headaches.

Ice-cream Headaches.

This is felt in the temples in most cases, but about 6% of young people feel this pain exclusively in the back of the head.

Sinus/Allergy Headaches.

Sinus infection is another culprit that causes pain in the head. This headache may also be seen in the front head and face. The pain tends to increase when you bend forward. Typical symptoms and indicators: pain generally mild to moderate centred around sinuses, above and below eyes pressure often makes teeth ache as well may be accompanied by feeling of pressure behind the eyes often relieved by decongestants, antihistamines, or other allergy medications. often seasonal studies have shown that the majority of self-diagnosed sinus headaches are actually Migraine. 9

Cluster headaches are not as common as tension and migraine headaches but are a rare and important type of primary headache for which there is no known cure. The average age of cluster headache sufferers is 28-30 years and may begin in childhood but they are more common in men rather than women. Cluster are recurring, during periods of time called cluster periods or episodes headaches. The headaches often begin at night, right after the person has gone to sleep, but they can occur at any time of day usually lasts about 10 minutes to 2 hours and then quickly goes away and can occur 1 to 4 times in a day. A cluster period may last for days, weeks or months and then not occur again for weeks, months or even years but are more frequent in Winter or Spring. Vascular headaches occur due to an abnormal functioning of the vascular (or, blood vessel) system. The best known type of vascular headache is a migraine, but cluster headaches are also categorized as vascular headaches. Cluster headaches are severe and often cause deep, sharp and extremely painful stabbing pain, usually around the temple or centred round the eye and just like migraine they can affect just one part of the head. The headache often occurs with a stuffy or runny nose, teary and redness in one eye and a droopy eyelid and are almost always severely incapacitating Medication and home treatment help reduce how often headaches occur, the severity of the pain and how long they last. The result of over reliance on pain medications, may be dull, sharp, or throbbing; medications actually cause the headache rather than relieving the pain. Chronic headaches last for more than 15 days out of a month, have a dull pain or feel like a tight band around the head, and can affect one or both sides of the head. Inflammatory headaches usually point to a more serious condition, such as infections (e.g. meningitis or sinus infections). Inflammatory headaches are caused by different types of inflammation, such as a sinus infection or bacterial meningitis. Different inflammatory conditions may result in different conditions. For example, an inflammatory headache associated with bacterial meningitis will usually accompany a stiff neck. A sinus headache sufferer may experience pain in the cheeks and forehead, and feel worse when bending forward or lying down. Traction headaches are the cause of a more serious medical condition, such as a tumour, abscess, strained eye muscles, or other disease of the head. Symptoms of traction headaches vary according to cause. For example, headache pains may vary from throbbing pain, persistent pain, intense shooting pain, etc. Tumours may cause headaches that feel like a strong pressure is against the head, whereas dental and oral conditions may provide headache pain in the face and entire head. Traction headaches typically point to a more serious condition, and occur when the pain-sensitive parts of the head are stretched. For example, a traction headache may occur because eye muscles have been strained.

Cluster Headaches - Vascular.

Rebound headaches.

Inflammatory Headaches.

Traction Headaches.

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Vertebrogenic Headaches.

This pain of the head is caused by misalignment of the spinal bones of the upper neck. These headaches are usually due to wrong posture, stress and tension headaches.

Cervicogenic Headaches.

This type of headache causes a pain in the back of the head. This pain occurs on one side of the head only. It occurs due to the wear and tear of the upper neck bones or in people who have suffered from an injury to the neck, like a whiplash injury. The pain can spread up the back of the head and round the side towards the ear or over the top into the forehead. This pain includes Occipital or Sub Occipital headaches, scalp pain, tenderness and paresthesia. This is generally caused due to inflammation, injury, basilar impression, tumour or pressure on the root ganglion or occipital nerves.

Craniocervical Junction Headache.

Secondary / Rare Causes of Headaches.

The Occipital Arteries run up the back of the head, and are often affected in Temporal Arteritis. As the Occipital Arteries lie right next to the greater Occipital nerve, Temporal Arteritis can cause a "back of head headache". About 30 people per 100,000 will get Temporal Arteritis in any given year. The diagnosis requires an ESR blood test and a Temporal Artery biopsy procedure. Good recovery with steroid treatment. This pain is usually seen in people over 50 years of age. You may experience impaired vision and pain that increases with chewing. You should visit the doctor immediately as this may lead to blindness.

Temporal Arthritis.

This may present with a sudden severe "back of head headache", but is even more rare than Arteritis at about 5 people per 100,000 each year. Vertebral Artery Dissection is a cause of a stroke. The best way to distinguish Vertebral Artery Dissection from Cervicogenic headache is to listen to the onset of pain. In Dissection it is usually much more rapid - onset over seconds. In Cervicogenic there will usually have been a smaller amount of pain in the preceding months or years. If your doctor considers a diagnosis of Vertebral Artery Dissection this is ruled out using an MRI scan. It would be prudent to talk to your doctor before starting physiotherapy or spinal manipulation therapy for a "back of head headache" that came on abruptly. Unfortunately there is no way to distinguish between Cervicogenic headache and Vertebral Dissection with 100% certainty - it comes down to a clinical judgement, erring on the side of caution with investigations if symptoms are in any way unusual. Statistically, Cervicogenic headache is about 800 times more commonplace than Dissection. If the wall of a weakened blood vessel in the brain ruptures, it may bleed in the brain and lead to pain in the head. Low blood pressure, high heart rate and light headedness may be seen in case of rupture. Other rare causes may include brain tumour, stroke, meningitis or encephalitis. These headaches are called secondary headaches. 11

Vertebral Artery Dissection.

Brain Aneurysm.

If you suffer from frequent and severe pain in head, consult a physician or neurologist immediately. It is very difficult to perform daily tasks living with pain in the back of the head. The doctor may advise you an X-ray or MRI to find the root cause of your suffering. The treatment of pain in the back of head is based on the type and severity of the headache. Therefore, if you suspect something wrong with the headache experienced, seek medical advice immediately. About 10% of people who come to hospital with a very sudden onset severe pain in the back of the head will be diagnosed with a brain haemorrhage (Subarachnoid haemorrhage). This sudden severe headache is called "Thunderclap Headache". If this pain happens out of the blue it requires immediate medical attention. If at the time of onset of pain there is vomiting or a faint, the risk of there being an underlying brain haemorrhage is higher than in those who had pain and no other symptom.

Subarachnoid Haemorrhage.

Back of head Headaches - Provoked by physical stimulus.

1. Headache During Orgasm.

The majority of these are experienced as sudden severe pains in the occipital area. In one paper, 77% of 30 cases were occipital orgasmic pain, lasting an average of 30 minutes, occurring in over 50% of intercourse in 93% of cases, and remitting after an average of 2 months. It is now thought that these headaches are almost all due to a condition called reversible cerebral vasoconstriction syndrome. 4 out of 98 mountain climbers at high altitude experienced their pain in the back of the head. Most of the headaches involved the entire head and about half were made worse with exertion. One series of 83 cases of headaches triggered by coughing found no cause in 74 cases. Of these 74 cases, 35% were in the back of the head. In the 9 cases with a cause found, 4 had occipital pain (44%). Cough Headache requires investigation. The most common cause found is a condition called Chiari malformation. About 50% of people on dialysis for kidney failure will get a headache after dialysis sessions. In 8 out of 30 dialysis headaches in one paper, the back of head was the site of the pain. People who play pool for prolonged periods of time may experience pain in the head and neck after playing for between 3 to 6 hours. There is one report of this, and the problem is presumably from the joints of the neck, such as over extension at the atlanto-axial joint. This is probably a form of cervicogenic headache. Pain referred from the heart can be felt in the back of the head. 11 out of 32 published cases, reviewed in 2008, had occipital pain during either an angina attack or heart attack proper. This is one of the causes of an Exercise Induced Headache, although it can also cause a Thunderclap Headache Treating the heart disease fixes the headaches. 12
6. Cardiac Cephalalgia. 5. Pool Players Headache. 4. Dialysis Headache. 3. Cough Headache. 2. High Altitude Headache.

In one series 3 out of 20 cases of this "alarm clock" headache are in the back of the head. The provoking factor is sleep! Usually they are a whole of head pain that wakens from sleep. Lithium Carbonate helps about 70%. This is an unusual back of the head syndrome. It is provoked by rotation of the neck which irritates the C2 nerve and produces a sensory disturbance in the tongue. Some will get a spasm of tongue muscle. There are nerve fibres which run in the nerve to the tongue (hypoglossal nerve) which join with fibres from the upper neck (C2 nerve), so pain from the neck can produce symptoms in the tongue.
9. Low pressure headache, usually due to Spontaneous Intracranial Hypotension. 8. Neck Tongue Syndrome.

7. Hypnic Headache.

Pain in a low pressure headache can be experienced anywhere, but most commonly it is on both sides of the head. Some people will report a severe dull ache in the back of the head that is worse while up and about, and is relieved by lying down flat for 15-30 minutes. Low pressure headaches are often associated with a muffling of hearing or buzzing in the ears that is also better on lying down. The common cause of low pressure is due to a spinal tap or lumbar puncture procedure. About 2030% of post-lumbar puncture headaches in one large series were located at the back of the head. Some people will get a spontaneous leak of spinal fluid within the spine. The spontaneous cases are called Spontaneous Intracranial Hypotension. Low pressure headache that is very severe and incapacitating can be treated with a an epidural blood patch procedure, which has a 70-80% success rate in typical cases.

Back of head Headaches - Due to a trapped nerve.

1. Neuralgia, from Lateral Atlanto-axial joint disease.

Disease of this joint can irritate the C2 nerve and cause intense sharp pains going up the back of the head. They can even cause the eye to water. Rheumatoid arthritis is the most common serious cause of this problem. Other conditions that can affect this joint or the C2 nerve include a neuroma, meningioma or pressure from a nearby blood vessel. This condition will require specialist investigation and treatment.

This is severe occipital pain due to spread of cancer into the occipital bone at the base of the skull. The XIIth cranial nerve passes through this bit of bone and supplies the muscles of the tongue. Almost everyone who gets occipital condyle syndrome will have a known history of cancer elsewhere e.g. prostrate or breast. Severe headache usually comes on a few weeks before the tongue movements start to cause speech or swallowing difficulty. Even without an occipital condyle syndrome hypoglossal nerve palsy can be painful. This may be due to compression of the inflamed nerve in the hypoglossal canal, but the exact mechanism is not certain.
3. Hypoglossal Nerve Palsy

2. Occipital Condyle Syndrome

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4. Accessory Nerve Palsy

Pain in the neck and shoulder are common if the Accesory Nerve is damaged - the usual cause is surgery in the neck to biopsy or remove a lymph gland. The pain can spread into the back of the head. The shoulder on the affected side loses its contour compared to the other and drops down. A low lying course of the posterior inferior cerebellar artery has been identified in persistent occipital neuralgia.

5. Vascular Loop Compression of Upper cervical nerve Roots

Back of head Headache - Due structural disease of the junction between Headache and neck.
1. Chiari Malformation

The brain in this condition sits much lower within the skull and can block flow of spinal fluid causing bouts of bad headache. Technically speaking, low lying cerebellar tonsils could stretch the upper cervical nerve roots and contribute to pain in the back of the head. The classic pain of Chiari Malformation is in the back of the head and is provoked by coughing or exertion, so without these provoking factors a Chiari is less likely to be the cause. One case of a teenage girl with fixed, one sided severe pain due to an accessory bone joining head to neck, which was relieved when the accessory bone was removed surgically
3. Bulbocervical Cavernoma 2. Extra-bone connecting occiput to cervical spine

Single case of severe occipital pain associated with a vascular lesion in the upper spinal cord.

Back of head Headache - Caused by primary or "Idiopathic" conditions.

Epicrania Fugax is a variant of ice-pick pains. What is different is that these are even shorter in duration and seem to "zigzag" through the head. 4 out of 10 cases in one series had pain starting in one side, at the back of the head and zigzag their way through to the front of the head. No serious cause is found.
2. Nummular Headache 1. Epicrania Fugax

This is a localised, fixed area of pain the size and shape of a coin. It is thought to be due to inflammation of one of the cutaneous nerves of the scalp, and is more a nuisance than a serious disorder.

26% of one series of 652 cases experienced cluster pains in the back of the head. There are other features of cluster that must be present for this diagnosis - watery eye, nasal symptoms, agitation and strictly one-sided pain. Oxygen and Sumatriptan injections work best for acute attacks. Verapamil is the best preventative drug. 14

3. Cluster Headache

4. Hemicrania Continua

This is a strictly one-sided headache and in most cases is at the front and side of the head. In one series 1 out of 18 had the occiput as the main site of pain. In another 5 out of 18 there was some pain there, but it was not the main site of pain.

80% of these people recall the onset of new headache several months earlier and the pain seems to persist, and no cause is found. Some of these are associated with a viral infection. 64% have bilateral pain and 60% have occipital pain. In 55% the pain is described as throbbing at times and 54% report pressure symptoms at times, and some experience both throbbing and pressure.

5. New Daily Persistent Headache

Back of head Headaches - Associated with other diseases.

This pain in the back of the head is severe to the point of preventing sleep. It has its onset over about 1 to 2 days and is associated with pain on swallowing. 35% of people with previously known Parkinson's Disease in one survey had a non-descript bilateral posterior neck and head pain 11 out of 51 people in one series of people with brain tumours reported pain in the back of the head. However, occipital pain is not a distinctive feature of brain tumours. Most brain tumours present with other neurological symptoms such as epileptic seizures Sleep apnoea and heavy snoring increase the risk of chronic headaches. 22% of headaches associated with sleep aponea in one series were located in the back of the head. Treating sleep apnoea will often help the headache.
5. Idiopathic Intracranial Hypertension 4. Sleep Apnoea Headaches 3. Brain Tumour Headache 2. Parkinson's Disease 1. Retropharyngeal Tendinitis

14% of cases of headaches were occipital. The quality of pain is pulsatile or throbbing in 83% and assoc with nausea in 57% and a feeling of stiff neck in 59%. The biggest risk for developing this condition is obesity and weight reduction through a properly directed exercise and diet programme can be curative

6. Overactive Thyroid Gland

One case of a relapse of Graves Disease (thyrotoxicosis) was associated with 2 months of severe occipital pain Dengue Fever causes a febrile illness which is usually present for about a week before diagnosis. 97% of Dengue Fever cases will have a prominent headache, of which about one in five will be in the back of the head. Headache is more pronounced in ordinary Dengue fever than in its more dangerous counterpart Dengue Haemorrhagic Fever. This is a cause of thunderclap headache, and like most thunderclap headache is experienced in the back of the head 15

7. Dengue Fever

8. Adult Aqueductal Stenosis

Physically painful and describing pain

1. achy if a part of your body feels achy, you feel a pain there that is continuous but not very strong 2. acute used for describing pain that is very strong and sharp 3. agonising very painful 4. angry an angry wound (=cut in your skin) is very red and painful 5. bad used about a part of your body that is causing you pain or is not working well 6. burning painful, and feeling as if a part of your body is touching something hot 7. chapped chapped skin or lips are dry and painful, especially because of cold weather 8. chronic a chronic illness or chronic pain is serious and lasts for a long time. A serious illness or pain that lasts only for a short time is described as acute 9. crippling causing a lot of pain or other health problems 10. dull a dull pain is not very strong but continues for a long time 11. excruciating causing extreme physical pain 12. gnawing continuously causing you pain or worrying you 13. griping a griping pain is a sharp and sudden pain in your stomach 14. heavy if a part of your body feels heavy, it is not comfortable and you cannot move it easily 15. inflamed a part of your body that is inflamed is swollen, red, and painful because of an infection or injury 16. irritated painful, red, or swollen 17. itchy if you feel itchy, you have an unpleasant feeling on your skin that makes you want to scratch it (=rub it withyour nails) 18. painful if part of your body is painful, you feel pain there, making you feel physical pain 19. painfully in a painful way 20. raging very serious, painful, or strong 21. raw if your skin is raw, it is very sore

22. severe a severe pain, injury, or illness is serious and unpleasant 23. sharp a sharp pain is sudden and severe 16

24. sore painful and uncomfortable, usually as a result of an injury, infection, or too much exercise 25. stabbing a stabbing pain is a sudden, very strong pain 26. stiff if you are stiff, or if a part of your body is stiff, you feel pain in your muscles and cannot move easily 27. stinging hitting you hard 28. tender if a part of your body is tender, it has been injured and is painful when you touch it 29. thumping a thumping headache (=pain in your head) is very severe 30. tight if your chest or another part of your body feels tight, it feels as if it is being squeezed 31. torturous causing extreme physical pain 32. unendurable too unpleasant or painful to bear 33. vice-like holding or squeezing you very tightly in a painful way 34. violent painful and difficult to control A NOTE FROM THE AUTHOR. This information on headaches has been put together from various piecemeal pieces of information found on the a number of different internet sites. Its sole aim is to provide brief and concise information about various aspects of headaches. It is undoubtedly not complete but it does cover many of the different types different headaches albeit briefly. The author does not accept any responsibility for its accuracy and would strongly suggest that sufferers consult their own doctor or physician to obtain proper medical advice about any condition that troubles them. I am not a medical person simply a layperson who has a desire and need to learn about headaches. My sole aim in producing this document was to collate all the information I had found about headaches so I could try and understand it easier as I have a friend who is troubled by them and I wanted to learn more to see if I could help them in any way. Having done so I thought that it might be helpful to put it in the public domain as it might be of some help to other and I hope it is. If you wish to add to this information or suggest any corrections I would be pleased to hear from you. Michael Simpson headacheinformation@gmail.com

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