Treatment
Not all headaches require medical attention, and many respond with simple analgesia (painkillers) such as paracetamol/acetaminophen or members of the NSAID class (such as aspirin/acetylsalicylic acid or ibuprofen).
In recurrent unexplained headaches, healthcare professionals may recommend keeping a "headache diary" with entries on type of headache, associated symptoms, precipitating and aggravating factors. This may reveal specific patterns, such as an association with medication, menstruation or absenteeism or with certain foods. It was reported in March 2007 by two separate teams of researchers that stimulating the brain with implanted electrodes appears to help ease the pain of cluster headaches.
Prevention
Some forms of headache, such as migraine, may be amenable to preventative treatment. On the whole, long-term use of painkillers is discouraged as this may lead to drug induced headaches and "rebound headaches" on withdrawal. Caffeine, a vasoconstrictor, is sometimes prescribed or recommended as a remedy or supplement to pain killers in the case of extreme migraine. This has led to the development of paracetamol/caffeine analgesic.
Petasites, magnesium, feverfew. riboflavin, CoQ10, and melatonin are "natural" supplements that have shown some efficacy for migraine prevention; a 2006 review tentatively ranked petasites and magnesium with the best evidence, and melatonin with by far the least. Adverse events included sore mouth and tongue (including ulcers) and abdominal pain for feverfew.[5]
Manual therapy
Headache sufferers often use manual therapy, such as spinal manipulation, soft tissue therapy, and myofascial trigger point treatment. A 2006 systematic review found no rigorous evidence supporting manual therapies for tension headache.[6] A 2005 structured review found that the evidence was weak for effectiveness of chiropractic manipulation for tension headache, and that it was probably more effective for tension headache than for migraine.[7] A 2004 Cochrane review found that spinal manipulation may be effective for migraine and tension headache, and that spinal manipulation and neck exercises may be effective for cervicogenic headache.[8] Two other systematic reviews published between 2000 and May 2005 did not find conclusive evidence in favor of spinal manipulation.
Spinal manipulation is associated with frequent, mild and temporary adverse effects,[10] including new or worsening pain or stiffness in the affected region.[11] They have been estimated to occur in 34% to 55% of patients, with 80% of them disappearing within 24 hours.[12] Spinal manipulation, particularly on the upper spine, can also result in complications that can lead to permanent disability or death.[10] The incidence of these complications is unknown, due to high levels of underreporting and to the difficulty of linking manipulation to adverse effects such as stroke, a particular concern.[10] Vertebrobasilar artery stroke is statistically associated with chiropractic services in persons under 45 years of age, but it is similarly associated with general practitioner services, suggesting that these associations are likely explained by preexisting conditions.[13] Weak to moderately strong evidence supports causation (as opposed to statistical association) between cervical manipulative therapy (whether chiropractic or not) and vertebrobasilar artery stroke.[14]
Other kinds of vascular headaches include cluster headaches, which are very severe recurrent short lasting headaches, often located through or around either eye and often wake the sufferers up at the same time every night. Unlike migraines, these headaches are more common in men than in women.
Muscular (or myogenic) headaches appear to involve the tightening or tensing of facial and neck muscles; they may radiate to the forehead. Tension headache is the most common form of myogenic headache.
Cervicogenic headaches originate from disorders of the neck, including the anatomical structures innervated by the cervical roots C1–C3. Cervical headache is often precipitated by neck movement and/or sustained awkward head positioning. It is often accompanied by restricted cervical range of motion, ipsilateral neck, shoulder, or arm pain of a rather vague non-radicular nature or, occasionally, arm pain of a radicular nature.
Traction/inflammatory
Positron emission tomography functional imaging shows activation of specific brain areas duringa cluster headache.
Traction and inflammatory headaches are symptoms of other disorders, ranging from stroke to sinus infection. Specific types of headaches include:
Tension headache
Migraine
Idiopathic intracranial hypertension (headache with visual symptoms due to raised intracranial pressure)
Ictal headache
Cluster headache
"Brain freeze" (also known as: ice cream headache)
Thunderclap headache
Vascular headache
Toxic headache
Coital cephalalgia (also known as: sex headache)
Hemicrania continua
Rebound headache (also called medication overuse headache, abbreviated MOH)
Red wine headache
"Spinal headache" (or: post-dural puncture headaches) after lumbar puncture or related procedure that will lower the intracranial pressure
Withdrawal (caused by medication or other dependency creating substance removal/cessation)
Hangover (caused by heavy alcohol consumption)
A headache may also be a symptom of sinusitis.
Like other types of pain, headaches can serve as warning signals of more serious disorders. This is particularly true for headaches caused by inflammation, including those related to meningitis as well as those resulting from diseases of the sinuses, spine, neck, ears, and teeth.
