Headache: The Head of All Aches

What is head pain or headache?

Headaches are the most common pain disorder affecting the general public worldwide. Head pain or Headache is a neurological condition where the patient complains of recurrent or persistent ache/pain around the head or face region without any definite cause visible outside. Headache affects not only physically but also mentally, as it drains out all the positivity from the mind, leading to extreme agony during periods of headaches. Headache interferes with all aspects of your life, including interpersonal relationships, sleep, work performance, and more. Headache disorders are one of the most common disorders of the nervous system. They are pandemic and, in many cases, can be recurrent and accompany the patient for their whole life. Nearly half of the world’s adult population is suffering from some active headache disorder. These disorders impose a substantial burden on headache sufferers, on their families, and on society itself. This societal burden accounts for loss of activity at work and financial loss.

History of headaches and ancient treatment

Headaches have troubled humanity since the dawn of civilization. In 7000-3000 BC, trepanation, a procedure on the skull with an instrument for headaches, was mentioned. Other methods mentioned in ancient literature are blood-sucking leeches over the head or tightening up clay crocodiles over the head. Therefore, people have tried to get relief from headaches since ancient times and even used desperate measures like trepanation of the skull.

Modern science has allowed us to treat all sorts of headaches effectively with proper medical treatment.

Types of headaches

The International Headache Society (IHS) drafted the primary classification of headache disorders. Recent International Classification of Headache Disorders 3- Beta (ICHD 3-β) has divided headache disorders into three broad groups: 1) Primary headaches, 2) Secondary headaches, and 3) Painful cranial neuropathies, other facial pains, and other headaches.


Primary headaches are the most common, comprising 1) Migraine, 2) Tension-type headaches, 3) Trigeminal autonomic cephalalgias, and 4) Other primary headache disorders.


In primary headaches, no specific physical derangement is observed in the brain or body parameters of the patient. In contrast, in secondary headaches, some obvious cause is found in the brain or other functions of the body. Secondary headaches are mostly due to problems in the brain, like tumors, clots, bleeding, infections, or trauma. These are mostly diagnosed on brain imaging, preferably MRI. Secondary headaches are uncommon and are most often dangerous.


Primary headaches are very common, and the most common of these are Migraine and Tension-type Headaches. We generally see these in the general population, where brain MRI is not required as it is mostly normal. These headaches typically start at a young age as episodic headaches but later turn into debilitating chronic headaches if not diagnosed and treated correctly. But, primary headaches are not as dangerous or life-threatening as secondary headaches but pose significant health issues in terms of quality of life, especially if they get chronic. So, it’s always a dilemma to differentiate between primary and secondary headaches. Proper neurological examination and investigations help identify headaches’ true nature. Other headache types are rare.

When to seek immediate help?

Seek immediate help or go to an emergency room if you’re having:

    • “The worst headache ever”

    • Your worst migraine ever

    • Headache with unresolved loss of vision, uncontrollable vomiting, focal deficits in the form of deviation of eyes, limb weakness, or loss of consciousness

    • Headache associated with fever and neck pain

    • Headache pain lasting longer than 72 hours with less than a four-hour pain-free period while awake

    • Headache or migraine with symptoms that are unusual or frightening for you.

How do we find out the root cause of headaches?

It is very important to find out the root cause of headaches. Diagnosis is essential for treating Headaches. Therefore, relevant investigations are necessary in treating headaches. The facility must be well equipped with all recent imaging and lab techniques required for the diagnosis of headaches. MRI machines with MRA and MRV facilities, which can even detect minuscule lesions in the brain, are needed. Functional imaging techniques are also sometimes required for the proper diagnosis of headaches. Relevant lab investigations are also necessary for appropriate diagnosis.

Headache management techniques

A detailed history of headaches and appropriate patient examination is foremost in managing headache patients. A headache specialist should first make a proper history with counseling about an illness. Lifestyle changes and stress management are essential for curtailing a few headaches. Once the diagnosis of Headache is confirmed, the doctor can start appropriate treatment for headaches. Doctors should follow treatment protocols for better results. Analgesics should be limited to avoid medication overuse . A greater occipital nerve block is also an option for a few chronic headache patients in OPD. Chronic, intractable headache patients need hospitalization for quick relief of excruciating pain. Various nerve blocks and occipital nerve stimulation are also available options for headache relief.

Finally, Headache as an illness or disease is a sleeping giant, as initially, it appears unpretentious from outside and to those who are not suffering from it, but when it is fully-fledged, its havoc on the individual who is suffering. Precious days and nights of life wasted from migraine and tension-type of Headache. Proper treatment with headache specialists is of utmost importance along with lifestyle changes for the cure of headaches.