Some Causes and Features of Headaches
Some Causes and Features of Headaches
Type or Cause |
Common Features* |
Diagnostic Approach† |
Primary headache (not due to another disorder) |
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A severe, piercing headache that
Inability to lie down and restlessness (sometimes expressed by pacing) On the same side as the pain: A runny nose, tearing, drooping of the eyelid (Horner syndrome), and sometimes swelling of the area below the eye |
A doctor's examination alone Occasionally MRI of the head to rule out other disorders, particularly if the headaches have developed recently or if the pattern of symptoms has changed |
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A moderate to severe headache that
Often a sensation that a migraine is beginning (called a prodrome), which may include mood changes, loss of appetite, and nausea Sometimes preceded by temporary disturbances in sensation, balance, muscle coordination, speech, or vision, such as seeing flashing lights and having blind spots (these symptoms are called the aura) |
Same as those for cluster headaches |
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Usually a mild to moderate headache that
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Same as those for cluster headaches |
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Secondary headache (due to another disorder) |
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Light-headedness, loss of appetite, nausea and vomiting, fatigue, weakness, irritability, or difficulty sleeping In people who have recently gone to a high altitude (including flying 6 hours or more in an airplane) |
A doctor's examination alone |
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Blood clots in a large vein that drains blood from the brain (cerebral venous sinus thrombosis) |
Headaches that Sometimes double or blurred vision, nausea, or ringing in the ears that occurs in time with the pulse (pulsatile tinnitus) Sometimes seizures and symptoms similar to those of a stroke (such as paralysis of an arm or leg and loss of vision) |
MRI and magnetic resonance venography |
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Brain tumor, abscess, or another mass in the brain, such as a hematoma (an accumulation of blood) |
A mild to severe headache that
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MRI or, if MRI is unavailable or contraindicated, CT |
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Carbon monoxide exposure (during winter, people may breathe this gas if heating equipment is not adequately vented) |
Possibly no awareness of the exposure because carbon monoxide is colorless and odorless |
A blood test |
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Dental infections (in upper teeth) |
Pain that is Toothache |
Dental examination |
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Encephalitis (infection of the brain) |
Headaches with varying characteristics Often accompanied by fever, worsening drowsiness, confusion, agitation, weakness, and/or clumsiness Seizures and coma |
MRI or, if MRI is unavailable or contraindicated, CT A spinal tap |
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A throbbing pain felt on one side of the head at the temple Pain when combing the hair or while chewing Sometimes tender, enlarged arteries in the temples (temporal arteries) and aches and pains, particularly in the shoulders, thighs, and hips Possibly impaired vision or loss of vision Sometimes fatigue, fever, and weight loss More common among people over 55 |
A blood test to measure the erythrocyte sedimentation rate (ESR), which can detect inflammation Biopsy of the temporal artery |
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Glaucoma—a type called closed-angle glaucoma—that starts abruptly (acute) |
Moderate or severe pain that occurs at the front of the head or in or over an eye Red eyes, halos seen around lights, nausea, vomiting, and loss of vision |
An eye examination as soon as possible |
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Head injury (postconcussion syndrome) |
Headache that begins immediately or shortly after a head injury (with or without loss of consciousness) Sometimes a faulty memory, personality changes, or both |
Sometimes a doctor's examination alone Usually CT or MRI |
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Idiopathic intracranial hypertension (increased pressure within the skull without any evidence of a cause) |
Headaches that Sometimes double or blurred vision, nausea, or ringing in the ears that occurs in time with the pulse (pulsatile tinnitus) |
MRI and magnetic resonance venography, followed by a spinal tap |
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Intracerebral hemorrhage (bleeding within the brain) |
Mild or severe pain that Possibly severe drowsiness, clumsiness, weakness, difficulty speaking or understanding speech, loss of vision, loss of sensation, or confusion Occasionally seizures or coma |
MRI or, if MRI is unavailable or contraindicated, CT |
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Low-pressure headache (which occurs when cerebrospinal fluid‡ is removed or leaks out) |
Intense headaches, often accompanied by a stiff neck and nausea Pain that worsens when sitting or standing and that is relieved by lying flat Usually occurs after a spinal tap (lumbar puncture) |
Sometimes a doctor's examination alone If the headache develops on its own (not after a spinal tap), MRI after a contrast agent is injected into a vein |
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Chronic and often daily headaches that vary in location and intensity Often present when the person awakens in the morning Often in people who have migraine or tension-type headaches Overuse of pain relievers (analgesics such as NSAIDs or opioids), barbiturates, caffeine, or sometimes triptans or other drugs to treat headaches |
A doctor's examination alone |
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A severe, constant headache Fever Neck stiffness that makes lowering the chin to the chest painful and sometimes impossible A feeling of illness, drowsiness, nausea, or vomiting |
A spinal tap (usually preceded by CT) |
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Pain that A runny nose, sometimes with pus or blood A feeling of illness, possibly a cough at night, and often a fever |
A doctor's examination alone Sometimes CT of the sinuses or endoscopy of the nose |
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Subarachnoid hemorrhage (bleeding between the inner and middle layers of tissues covering the brain) |
Severe, constant pain that Possibly brief loss of consciousness as the headache begins Possibly drowsiness, confusion, difficulty being aroused, or coma A stiff neck and nausea and vomiting |
MRI or CT If MRI or CT results are negative, a spinal tap |
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Subdural hematoma (a pocket of blood between the outer and middle layers of tissues covering the brain) |
Headaches with varying characteristics Possibly sleepiness, confusion, forgetfulness, and/or weakness or paralysis on one side of the body More common among older people and people who have dementia or who take anticoagulants§ or abuse alcohol |
MRI or CT |
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Pain when chewing hard foods Sometimes pain in or around the jaw or in the neck Sometimes clicking or popping when the mouth is opened, locking of the jaw, or difficulty opening the mouth wide |
Physical examination, sometimes by a dentist Occasionally MRI, x-rays, or CT |
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Trigeminal neuralgia |
Repeated short, lightning-like bursts of pain in the middle and lower half of one side of the face |
A doctor's examination alone |
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* Features include symptoms and results of the doctor's examination. Features mentioned are typical but not always present. |
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† Although a doctor's examination is always done, it is mentioned in this column only if the diagnosis can sometimes be made by the doctor's examination alone, without any testing. |
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‡ Cerebrospinal fluid is the fluid that surrounds the brain and spinal cord and helps cushion and support them. |
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§ Anticoagulants are drugs that prevent blood from clotting or slow the clotting process. |
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CT = computed tomography; MRI = magnetic resonance imaging; NSAIDs = nonsteroidal anti-inflammatory drugs. |
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