A headache or cephalgia is pain Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. It is the feeling common to such experiences as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone" anywhere in the region of the head or neck. It can be a symptom A symptom is a departure from normal function or feeling which is noticed by a patient, indicating the presence of disease or abnormality. A symptom is subjective, observed by the patient, and not measured of a number of different conditions of the head In anatomy, the head of an animal is the rostral part that usually comprises the brain, eyes, ears, nose and mouth (all of which aid in various sensory functions, such as sight, hearing, smell, and taste). Some very simple animals may not have a head, but many bilaterally symmetric forms do and neck.^[1] The brain tissue itself is not sensitive to pain because it lacks pain receptors A nociceptor is a sensory receptor that responds to potentially damaging stimuli by sending nerve signals to the spinal cord and brain. This process, called nociception, usually causes the perception of pain. Rather, the pain is caused by disturbance of the pain-sensitive structures around the brain. Several areas of the head and neck have these pain-sensitive structures, which are divided in two categories: within the cranium (blood vessels, meninges, and the cranial nerves) and outside the cranium (the periosteum of the skull, muscles, nerves, arteries and veins, subcutaneous tissues, eyes, ears, sinuses and mucous membranes).

There are a number of different classification systems for headaches. The most well-recognized is that of the International Headache Society The International Headache Society is a charity organization founded in 1981 for people from all professions that are working to treat headache disorders. Treatment of a headache depends on the underlying etiology or cause, but commonly involves analgesics An analgesic is any member of the group of drugs used to relieve pain (achieve analgesia). The word analgesic derives from Greek an- ("without") and algos ("pain"). Analgesic drugs act in various ways on the peripheral and central nervous systems; they include paracetamol (para-acetylaminophenol, also known in the US as.

Classification

Headaches are most thoroughly classified by the International Headache Society The International Headache Society is a charity organization founded in 1981 for people from all professions that are working to treat headache disorders's International Classification of Headache Disorders (ICHD), which published the second edition in 2004.^[2] This classification is accepted by the WHO The World Health Organization is a specialized agency of the United Nations (UN) that acts as a coordinating authority on international public health. Established on 7 April 1948, and headquartered in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health Organization, which had been an agency of the.^[3]

Other classification systems exist. One of the first published attempts was in 1951.^[4] The National Institutes of Health The National Institutes of Health is an agency of the United States Department of Health and Human Services and is the primary agency of the United States government responsible for biomedical and health-related research. It consists of 27 separate institutes and centers which includes the Office of the Director. Francis S. Collins is the current developed a classification system in 1962.^{[citation needed]}

ICHD-2

The International Classification of Headache Disorders (ICHD) is an in-depth hierarchical A hierarchy (Greek: hierarchia , from hierarches, "leader of sacred rites") is an arrangement of items (objects, names, values, categories, etc.) in which the items are represented as being "above," "below," or "at the same level as" one another and with only one "neighbor" above and below each of classification of headaches published by the International Headache Society The International Headache Society is a charity organization founded in 1981 for people from all professions that are working to treat headache disorders. It contains explicit (operational) diagnostic criteria Diagnosis is the identification of the nature of anything, either by process of elimination or other analytical methods. Diagnosis is used in many different disciplines, with slightly different implementations on the application of logic and experience to determine the cause and effect relationships. Below are given as examples and tools used by for headache disorders. The first version of the classification, ICHD-1, was published in 1988. The current revision, ICHD-2, was published in 2004.^[5]

The classification uses numeric codes. The top, one-digit diagnostic level includes 14 headache groups. The first four of these are classified as primary headaches, groups 5-12 as secondary headaches, cranial neuralgia Neuralgia is pain in one or more nerves that occurs without stimulation of pain receptor cells. Neuralgia pain is produced by a change in neurological structure or function rather than by the excitation of pain receptors that causes nociceptive pain. Neuralgia falls into two categories: central neuralgia and peripheral neuralgia. This unusual pain, central and primary facial pain and other headaches for the last two groups.^[6]

NIH

The NIH classification consists of brief definitions of a limited number of headaches.^[7]

Differential diagnosis

There are over 200 types of headache, and the causes range from harmless to life-threatening. The description of the headache, together with findings on neurological examination A neurological examination is the assessment of sensory neuron and motor responses, especially reflexes, to determine whether the nervous system is impaired. It can be used both as a screening tool and as an investigative tool, the former of which when examining the patient when there is no expected neurological deficit and the latter of which, determines the need for any further investigations and the most appropriate treatment.^[8]

Typical causes

The commonest types of headache are the "primary headache disorders", such tension-type headache A tension headache is the most common type of primary headache. The pain can radiate from the neck, back, eyes, or other muscle groups in the body. Tension-type headaches account for nearly 90% of all headaches. Approximately 3% of the population has chronic tension-type headaches and migraine Migraine is a neurological syndrome characterized by altered bodily perceptions, severe headaches, and nausea. Physiologically, the migraine headache is a neurological condition more common to women than to men. The word migraine was borrowed from Old French migraigne . The French term derived from a vulgar pronunciation of the Late Latin word. They have typical features; migraine, for example, tends to be pulsating in character, affecting one side of the head, associated with nausea Nausea , is a sensation of unease and discomfort in the upper stomach with an urge to vomit. An attack of nausea is known as a qualm, disabling in severity, and usually lasts between 3 hours and 3 days. Rarer primary headache disorders are trigeminal neuralgia Trigeminal neuralgia , tic douloureux (also known as prosopalgia) is a neuropathic disorder of one or both of the trigeminal nerves. Its nickname is "the suicide disease" because of severe associated pain, and the fact that it is not easily controlled or cured. It causes episodes of intense pain in any or all of the following: the ear, (a shooting face pain), cluster headache Cluster headache, nicknamed "suicide headache", is a neurological disease that involves, as its most prominent feature, an immense degree of pain. "Cluster" refers to the tendency of these headaches to occur periodically, with active periods interrupted by spontaneous remissions. The cause of the disease is currently unknown (severe pains that occur together in bouts), and hemicrania continua (a continuous headache on one side of the head).^[8]

Secondary causes

Headaches may be caused by problems elsewhere in the head or neck. Some of these are not harmful, such as cervicogenic headache (pain arising from the neck muscles). Medication overuse headache may occur in those using excessive painkillers for headaches, parodoxically causing worsening headaches.^[8]

A number of characteristics make it more likely that the headache is due to potentially dangerous secondary causes; some of these may be life-threatening or cause long-term damage. A number of "red flag" symptoms therefore means that a headache warrants further investigations, usually by a specialist. The red flag symptoms are a new or different headache in someone over 50 years old, headache that develops within minutes (thunderclap headache), inability to move a limb Paresis is a condition typified by partial loss of movement, or impaired movement. When used without qualifiers, it usually refers to the limbs, but it also can be used to describe the muscles of the eyes , the stomach (gastroparesis), and also the vocal cords (Vocal cord paresis). Neurologists use the term paresis to describe weakness, and plegia or abnormalities on neurological examination A neurological examination is the assessment of sensory neuron and motor responses, especially reflexes, to determine whether the nervous system is impaired. It can be used both as a screening tool and as an investigative tool, the former of which when examining the patient when there is no expected neurological deficit and the latter of which, mental confusion Confusion of a pathological degree usually refers to loss of orientation , sometimes accompanied by disordered consciousness and often memory (ability to correctly recall previous events or learn new material). Confusion as such is not synonymous with inability to focus attention, although severe inability to focus attention can cause, or greatly, being woken by headache, headache that worsens with changing posture, headache worsened by exertion or Valsalva manoeuvre (coughing, straining), visual loss Vision loss or visual loss is the absence of vision where it existed before, which can happen either acutely or chronically (i.e. over a long period of time) or visual abnormalities, jaw claudication Claudication, literally 'limping' , is used as a medical term to indicate impairment in walking (jaw pain on chewing that resolves afterwards), neck stiffness, fever Fever is a common medical sign characterized by an elevation of temperature above the normal range of 36.5–37.5 °C (98–100 °F) due to an increase in the body temperature regulatory set-point. This increase in set-point triggers increased muscle tone and shivering, and headaches in people with HIV Human immunodeficiency virus is a lentivirus (a member of the retrovirus family) that causes acquired immunodeficiency syndrome (AIDS), a condition in humans in which the immune system begins to fail, leading to life-threatening opportunistic infections. Infection with HIV occurs by the transfer of blood, semen, vaginal fluid, pre-ejaculate, or, cancer Cancer /ˈkænsər/ (medical term: malignant neoplasm) is a class of diseases in which a group of cells display uncontrolled growth (division beyond the normal limits), invasion (intrusion on and destruction of adjacent tissues), and sometimes metastasis (spread to other locations in the body via lymph or blood). These three malignant properties or risk factors for thrombosis Thrombosis is the formation of a blood clot (thrombus) inside a blood vessel, obstructing the flow of blood through the circulatory system. When a blood vessel is injured, the body uses platelets and fibrin to form a blood clot to prevent blood loss. If the clotting is too severe and the clot breaks free, the traveling clot is now know as an.^[8]

"Thunderclap headache" may be the only symptom of subarachnoid hemorrhage A subarachnoid hemorrhage (SAH, pronounced /ˌsʌbəˈræknɔɪd ˈhɛmrɪdʒ/, or subarachnoid haemorrhage in British English) is bleeding into the subarachnoid space—the area between the arachnoid membrane and the pia mater surrounding the brain. This may occur spontaneously, usually from a ruptured cerebral aneurysm, or may result from head, a form of stroke A stroke (sometimes called a cerebrovascular accident ) is the rapidly developing loss of brain function(s) due to disturbance in the blood supply to the brain. This can be due to ischemia (lack of blood flow) caused by blockage (thrombosis, arterial embolism), or a hemorrhage (leakage of blood). As a result, the affected area of the brain is in which blood accumulates around the brain, often from a ruptured brain aneurysm. Headache with fever may be caused by meningitis Meningitis is inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges. The inflammation may be caused by infection with viruses, bacteria, or other microorganisms, and less commonly by certain drugs. Meningitis can be life-threatening because of the inflammation's proximity to the brain and, particularly if there is meningism (inability to flex the neck forward due to stiffness), and confusion may be indicative of encephalitis Patients with encephalitis suffer from fever, headache and photophobia with weakness and seizures also common. Less commonly, stiffness of the neck can occur with rare cases of patients also suffering from stiffness of the limbs, slowness in movement and clumsiness depending on which specific part of the brain is involved. Nuchal rigidity may lead (inflammation of the brain, usually due to particular viruses A virus is a small infectious agent that can replicate only inside the living cells of organisms. Most viruses are too small to be seen directly with a light microscope. Viruses infect all types of organisms, from animals and plants to bacteria and archaea. Since the initial discovery of tobacco mosaic virus by Martinus Beijerinck in 1898, about 5,). Headache that is worsened by straining or a change in position may be caused by increased pressure in the skull Intracranial pressure is the pressure in the cranium and thus in the brain tissue and cerebrospinal fluid (CSF); this pressure is exerted on the brain's intracranial blood circulation vessels. ICP is maintained in a tight normal range dynamically, through the production and absorption of CSF and pulsates approximately 1mm Hg in a normal healthy; this is often worse in the morning and associated with vomiting. Raised intracranial pressure may be due to brain tumors A brain tumor is an intracranial solid neoplasm, a tumor within the brain or the central spinal canal, idiopathic intracranial hypertension Idiopathic intracranial hypertension , sometimes called by the older names benign intracranial hypertension (BIH) or pseudotumor cerebri (PTC), is a neurological disorder that is characterized by an increased intracranial pressure (pressure around the brain) in the absence of a tumor or other diseases. The main symptoms are headache, nausea and (IIH, more common in younger overweight women) and occasionally cerebral venous sinus thrombosis Cerebral venous sinus thrombosis is a rare form of stroke that results from thrombosis (a blood clot) of the dural venous sinuses, which drain blood from the brain. Symptoms may include headache, abnormal vision, any of the symptoms of stroke such as weakness of the face and limbs on one side of the body, and seizures. The diagnosis is usually by. Headache together with weakness in part of the body may indicate a stroke A stroke (sometimes called a cerebrovascular accident ) is the rapidly developing loss of brain function(s) due to disturbance in the blood supply to the brain. This can be due to ischemia (lack of blood flow) caused by blockage (thrombosis, arterial embolism), or a hemorrhage (leakage of blood). As a result, the affected area of the brain is (particularly intracranial hemorrhage Intracranial bleeding occurs when a blood vessel within the skull is ruptured or leaks. It can result from physical trauma or nontraumatic causes (as occurs in hemorrhagic stroke) such as a ruptured aneurysm. Anticoagulant therapy, as well as disorders with blood clotting can heighten the risk that an intracranial hemorrhage will occur or subdural hematoma A subdural hematoma or subdural haematoma , also known as a subdural hemorrhage (SDH), is a type of hematoma, a form of traumatic brain injury in which blood gathers within the inner meningeal layer of the dura mater (the outer protective covering of the brain). Usually resulting from tears in veins that cross the subdural space, subdural) or brain tumor. Headache in older people, particularly when associated with visual symptoms or jaw claudication, may indicate giant cell arteritis Giant cell arteritis is an inflammatory disease of blood vessels (most commonly large and medium arteries of the head). It is a form of vasculitis (GCA), in which the blood vessel wall is inflamed Vasculitis refers to a heterogeneous group of disorders that are characterized by inflammatory destruction of blood vessels. Both arteries and veins are affected. Lymphangitis is sometimes considered a type of vasculitis. Vasculitis is primarily due to leukocyte migration and resultant damage and obstructs blood flow. Carbon monoxide poisoning Carbon monoxide poisoning occurs after enough inhalation of carbon monoxide . Carbon monoxide is a toxic gas, but, being colorless, odorless, tasteless, and non-irritating, it is very difficult for people to detect. Carbon monoxide is a product of incomplete combustion of organic matter with insufficient oxygen supply to enable complete oxidation may lead to headaches as well as nausea, vomiting, dizziness, muscle weakness and blurred vision. Angle closure glaucoma Glaucoma is a disease in which the optic nerve is damaged, leading to progressive, irreversible loss of vision. It is often, but not always, associated with increased pressure of the fluid in the eye (acute raised pressure in the eyeball Intraocular pressure is the fluid pressure of the aqueous humor inside the eye) may lead to headache, particularly around the eye, as well as visual abnormalities, nausea, vomiting and a red eye with a dilated pupil.^[8]

Pathophysiology

The brain The brain is the center of the nervous system in all vertebrate, and most invertebrate, animals. Some primitive animals such as jellyfish and starfish have a decentralized nervous system without a brain, while sponges lack any nervous system at all. In vertebrates, the brain is located in the head, protected by the skull and close to the primary in itself is not sensitive to pain Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. It is the feeling common to such experiences as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone", because it lacks pain receptors A nociceptor is a sensory receptor that responds to potentially damaging stimuli by sending nerve signals to the spinal cord and brain. This process, called nociception, usually causes the perception of pain. However, several areas of the head In anatomy, the head of an animal is the rostral part that usually comprises the brain, eyes, ears, nose and mouth (all of which aid in various sensory functions, such as sight, hearing, smell, and taste). Some very simple animals may not have a head, but many bilaterally symmetric forms do and neck The neck is the part of the body, on many terrestrial or secondarily aquatic vertebrates that distinguishes the head from the torso or trunk. The Latin term signifying "of the neck" is cervical do have nociceptors, and can thus sense pain. These include the extracranial arteries, large veins, cranial and spinal nerves, head and neck muscles and the meninges.^[9]

Headache often results from traction to or irritation of the meninges and blood vessels. The nociceptors may also be stimulated by other factors than head trauma or tumors and cause headaches. Some of these include stress, dilated blood vessels and muscular tension. Once stimulated, a nociceptor sends a message up the length of the nerve fiber to the nerve cells in the brain, signaling that a part of the body hurts. ^[10]

It has been suggested that the level of endorphins in one's body may have a great impact on how people feel headaches. Thus, it is believed that people who suffer from chronic headaches or severe headaches have lower levels of endorphins compared to people who do not complain of headaches.

Headaches in children

Children can suffer from the same types of headaches as adults do although their symptoms may vary. Some kinds of headaches include: tension headaches, migraines, chronic daily headaches, cluster headache and sinuses headaches. ^[11] It is actually common for headaches to start in childhood or adolescence, for instance, 20% of adults who suffer headaches report that their headaches started before age 10 while 50% report they started before age 20. The incidence of headaches in children and adolescents is very common. One study reported that 56% of boys and 74% of girls between 12 and 17 indicated having experienced a form of headache within the past month. ^[12]

The causes of headaches in children include either one factor or a combination of factors. Some of the most common factors include: genetic predisposition, especially in the case of migraine; head trauma, produced by accidental falls; illness and infection, for example in the presence of ear or sinus infection as well as colds and flu; environmental factors, which include weather changes; emotional factors, such as stress, anxiety, and depression; foods and beverages, caffeine or food additives; change in sleep or routine pattern; loud noises. Also, excess physical activity or sun may be a trigger specifically of migraine. ^[13]

Although most cases of headaches in children are considered to be benign, when they are accompanied with other symptoms such as speech problems, muscle weakness, and loss of vision, a more serious underlying cause can be suspected. They include: hydrocephalus, meningitis, encephalitis, abscess, hemorrhage, tumor, blood clots, and head trauma. In these cases, the headache evaluation may include CT scan or MRI in order to look for possible structural disorders of the central nervous system. ^[14]

Some measures can help prevent headaches in children. Some of them are: drinking plenty of water throughout the day avoiding caffeine; getting enough and regular sleep; eating balanced meals at the proper times; and reducing stress and excess of activities. ^[15]

Diagnosis approach

The American College of Emergency Physicians have guidelines on the evaluation and management of adult patients who have a nontraumatic headache of acute onset.^[9]

While, statistically, headaches are most likely to be primary (non serious and self-limiting), some specific secondary headache syndromes may demand specific treatment or may be warning signals of more serious disorders.^{[citation needed]} Differentiating between primary and secondary headaches can be difficult.

As it is often difficult for patients to recall the precise details regarding each headache, it is often useful for the sufferer to fill-out a "headache diary" detailing the characteristics of the headache.

Imaging

When the headache does not clearly fit into one of the recognized primary headache syndromes or when atypical symptoms or signs are present then further investigations are justified.^[16] Neuroimaging (noncontrast head CT) is recommended if there are new neurological problems such as decreased level of consciousness, one sided weakness, pupil size difference, etc. or if the pain is of sudden onset and severe, or if the person is known HIV positive.^[9] People over the age of 50 years may also warrant a CT scan.^[9]

Treatment

Acute headaches

Not all headaches require medical attention, and most respond with simple analgesia (painkillers) such as paracetamol/acetaminophen or non-steroidal anti-inflammatory drugs like aspirin, ibuprofen, or diclofenac.^{[citation needed]}

Chronic headaches

In recurrent unexplained headaches keeping a "headache diary" with entries on type of headache, associated symptoms, precipitating and aggravating factors may be helpful. 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.^[17]

Acupuncture has been found to be beneficial in chronic headaches^[18] of both tension type^[19] and migraine type.^[20] Whether or not there is a difference between true acupuncture and sham acupuncture however is yet to be determined.^[20]

One type of treatment, however, is usually not sufficient for chronic sufferers and they may have to find a variety of different ways of managing, living with, and seeking treatment of chronic daily headache pains. ^[21]

There are however two types of treatment for chronic headaches meaning acute abortive treatment and preventive treatment. Whereas the first is aimed to relieve the symptoms immediately, the latter is focused on controlling the headaches that are chronic. From this reason, the acute treatment is commonly and effectively used in treating migraines and the preventive treatment is the usual approach in managing chronic headaches. The primary goal of preventive treatment is to reduce the frequency, severity, and duration of headaches. This type of treatment involves taking medication on a daily basis for at least 3 months and in some cases, for over 6 months. ^[22] The medication used in preventive treatment is normally chosen based on the other conditions that the patient is suffering from. Generally, medication in preventive treatment starts at the minimum dosage which increases gradually until the pain is relieved and the goal achieved or until side effects appear.

To date, only amitriptyline, fluoxetine, gabapentin, tizanidine, topiramate, and botulinum toxin type A (BoNTA) have been evaluated as "prophylactic treatment of chronic daily headache in randomized, double-blind, placebo-controlled or active comparator-controlled trials. Antiepileptics can be used as preventative treatment of chronic daily headache and includes Valproate. ^[23]

Psychological treatments are usually considered in comorbid patients or in those who are unresponsive to the medication.

Epidemiology

During a given year, 90% of people suffer from headaches. Of the ones seen in the ER, about 1% have a serious underlying problem.^[24]

History

The first recorded classification system that resembles the modern ones was published by Thomas Willis, in De Cephalagia in 1672. In 1787 Christian Baur generally divided headaches into idiopathic (primary headaches) and symptomatic (secondary ones), and defined 84 categories.^[7]

References

1. ^ headache at Dorland's Medical Dictionary
2. ^ "216.25.100.131" (PDF). the Headache Classification Subcommittee of the International Headache Society. http://216.25.100.131/ihscommon/guidelines/pdfs/ihc_II_main_no_print.pdf.
3. ^ Olsen et al., p. 9–11
4. ^ BROWN MR (September 1951). "The classification and treatment of headache". Med. Clin. North Am. 35 (5): 1485–93. PMID 14862569.
5. ^ Jes Olesen, Peter J. Goadsby, Nabih M. Ramadan, Peer Tfelt-Hansen, K. Michael A. Welch (2005). The Headaches (3 ed.). Lippincott Williams & Wilkins. ISBN 0781754003.
6. ^ Morris Levin, Steven M. Baskin, Marcelo E. Bigal (2008). Comprehensive Review of Headache Medicine. Oxford University Press US. ISBN 0195366735.
7. ^ ^{a b} Levine et al., p 60
8. ^ ^{a b c d e} Scottish Intercollegiate Guideline Network (November 2008). Diagnosis and management of headache in adults. Edinburgh. ISBN 978-1-905813-39-1. http://www.sign.ac.uk/guidelines/fulltext/107/.
9. ^ ^{a b c d} Edlow JA, Panagos PD, Godwin SA, Thomas TL, Decker WW (October 2008). "Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with acute headache". Ann Emerg Med 52 (4): 407–36. doi:10.1016/j.annemergmed.2008.07.001. PMID 18809105.
10. ^ "Headache - Pathophysiology". http://www.experiencefestival.com/a/Headache_-_Pathophysiology/id/1292096. Retrieved June 21, 2010.
11. ^ "Children Headaches Are Not Made Up". http://www.kidsmigraine.com/. Retrieved 2010-06-30.
12. ^ "How Common Are Headaches in Children and Adolescents?". http://www.webmd.com/migraines-headaches/guide/your-childs-headache. Retrieved 2010-06-30.
13. ^ "Causes". http://www.mayoclinic.com/health/headaches-in-children/DS01132/DSECTION=causes. Retrieved 2010-06-30.
14. ^ "What Causes Headaches in Children and Adolescents?". http://www.webmd.com/migraines-headaches/guide/your-childs-headache. Retrieved 2010-06-30.
15. ^ "Headaches in Children". http://www.achenet.org/education/patients/headachesinchildren.asp. Retrieved 2010-06-30.
16. ^ Detsky ME, McDonald DR, Baerlocher MO, Tomlinson GA, McCrory DC, Booth CM. Does this patient with headache have a migraine or need neuroimaging? JAMA 2006;296:1274–83
17. ^ Brain Stimulation May Ease Headaches. Reuters, March 9, 2007.
18. ^ Sun Y, Gan TJ (December 2008). "Acupuncture for the management of chronic headache: a systematic review". Anesth. Analg. 107 (6): 2038–47. doi:10.1213/ane.0b013e318187c76a. PMID 19020156.
19. ^ Linde, K.; Allais, G.; Brinkhaus, B.; Manheimer, E.; Vickers, A.; White, AR.; Linde, Klaus (2009). "Acupuncture for tension-type headache.". Cochrane Database Syst Rev (1): CD007587. doi:10.1002/14651858.CD007587. PMID 19160338.
20. ^ ^{a b} Linde, K.; Allais, G.; Brinkhaus, B.; Manheimer, E.; Vickers, A.; White, AR.; Linde, Klaus (2009). "Acupuncture for migraine prophylaxis.". Cochrane Database Syst Rev (1): CD001218. doi:10.1002/14651858.CD001218.pub2. PMID 19160193.
21. ^ "Chronic Headache Treatments". http://www.chronicheadache.us/treatment.html. Retrieved June 21, 2010.
22. ^ "Pathophysiology and Treatment of Migraine and Related Headache". http://emedicine.medscape.com/article/1144656-overview. Retrieved June 21, 2010.
23. ^ "Pathophysiology and Treatment of Migraine and Related Headache". http://emedicine.medscape.com/article/1144656-overview. Retrieved June 21, 2010.
24. ^ Amal Mattu; Deepi Goyal; Barrett, Jeffrey W.; Joshua Broder; DeAngelis, Michael; Peter Deblieux; Gus M. Garmel; Richard Harrigan; David Karras; Anita L'Italien; David Manthey (2007). Emergency medicine: avoiding the pitfalls and improving the outcomes. Malden, Mass: Blackwell Pub./BMJ Books. pp. 39. ISBN 1-4051-4166-2.

Further reading

• Gorman, Christine; Park, Alice (7 October 2002). The New Science of Headaches. Time. http://www.time.com/time/covers/1101021007/story.html. Retrieved 22 February 2010

External links

• National Headache Foundation
• IHS - The International Headache Classification (ICHD-2)
• American Headache Society
• Withdrawal related headache information
• HealthyCase - Headache or Cephalalgia

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