Any unusually severe or sudden onset headache can indicate a life threatening emergency such as a subarachnoid hemorrhage or meningitis, and should be evaluated by a medical professional as soon as possible.


However stable, recurrent episodes of headaches and/or facial pain are much more common, and can be caused by muscle contraction (“tension headache”), migraine, cluster headache or trigeminal neuralgia:

Migraine Headaches

Migraine is characterized by throbbing or pounding pain, often on one-side of the head, associated with sensitivity to light, noise, and/or smells.  These headaches are associated with nausea and worsens with activity, which often results in patient disability.  About one quarter of migraine patients experience an aura, a temporary neurological syndrome that slowly progresses and then typically resolves just as the pain begins.  The most common type of migraine aura involves visual disturbances (flashing lights, zig-zags, blind spots).  However, some people experience auras consisting of numbness, confusion, trouble speaking, vertigo (spinning dizziness), and other stroke-like neurological symptoms. Some patients may even experience their auras without headaches:


The Trigeminal Autonomic Cephalgias

Cluster headaches are characterized by excruciatingly severe stabbing pain located behind one eye, often accompanied by redness and tearing of the eye, and nasal congestion. Theses headaches are usually more brief and intense than migraines, and typically occur in  “cluster”s over several weeks, followed by many months or even years of no symptoms.  During a cluster, the headaches often begin an hour or so after going to sleep, and a patient may have anywhere from one to five attacks per day:

The Hemicranias  are related one-sided headaches accompanied by mild symptoms of autonomic dysfunction in the face such as a small pupil, drooping eyelid, red or watering eye, stuffy or runny nose – similar to the symptoms of a cluster headache, but much less dramatic. These headaches often subside entirely with prescription anti-inflammatory medication:

Trigeminal Neuralgia

Trigeminal neuralgia is characterized by recurrent short episodes of one-sided zapping, shooting, or excruciating spasms of facial pain.  The pain may be so severe that the patient may cry out or visibly wince. The affected area of the face may become super-sensitive, with such minor stimulation as a light breeze, cold temperature, water from a shower, washing the face, shaving, or even eating can set off attacks of pain.

Tension Headache

Tension-type headaches are characterized by a dull pressure or band-like pain of mild to moderate intensity, and most affected people are able to carry on with their daily activities despite their symptoms, often using non-steroidal anti-inflammatories (NSAIDs) or acetaminophen. If they are frequent or severe, they are sometimes treated with some of the same preventative strategies and treatments used for migraines.


3 thoughts on “Headache

  1. Pingback: Monmouth’s Facial Pain Center on CBS News! | Neurology Update

  2. The brain by itself is a non-committal entity. It feels no pain. The pain of headache comes from the tissues surrounding the brain, the attaching structure at the base of the brain. The muscles, the scalp vessels, the vessel of the face and neck, may cause cluster headache. Or it may be specifically to blood vessels dilation or to inflammation of nerves behind the eyes.”

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    • Thanks for your comments Sherlene, I completely agree the brain itself is insensate, so headache is caused by inflammation, irritation and/or injury to the structures that surround the brain like the meninges, blood vessels, skull and scalp, and these pain impulses are carried through the trigeminal nerve. The trigeminal nerve is a critical component of migraine, cluster headache, and other neuralgiform headaches. There is currently a lot of research evaluating new drugs that may affect this pathway, but more about this later ……

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