Head pain on one side
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Summary
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These studies suggest that head pain on one side can be caused by conditions such as cervicogenic headache, nummular headache, and migraines, with specific diagnostic and treatment considerations for each.
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Understanding Head Pain on One Side: Causes and Diagnostic Approaches
Head pain localized to one side, often referred to as unilateral or side-locked headache, can be a symptom of various underlying conditions. This article synthesizes research findings to provide a comprehensive overview of the potential causes and diagnostic approaches for unilateral head pain.
Unilateral Headache: Common Causes
Cervicogenic Headache (CEH)
Cervicogenic headache is a type of headache that originates from the cervical spine or neck. It is typically unilateral, starting in the neck and spreading forward to the head. The pain is usually dominant on one side and may extend to the contralateral side when severe, but it never dominates there. Key features include reduced neck range of motion and pain that can be triggered by neck movements or sustained postures.
Nummular Headache (NH)
Nummular headache is characterized by localized, coin-shaped areas of pain on the scalp. Although it usually affects a single area, there are rare cases where patients experience pain in two distinct areas on the same side of the head. This type of headache is continuous and can be exacerbated by stabbing pain episodes. The exact cause of NH is unclear, but it may involve neuropathy of scalp nerves or nociceptive pain from epicranial tissues.
Greater Occipital Nerve Sensitivity
Increased sensitivity of the greater occipital nerve (GON) has been observed in patients with side-dominant head and neck pain. These patients exhibit lower pressure pain thresholds over the GON and higher pain intensity during specific tests compared to healthy controls. This suggests that neural sensitivity could play a role in unilateral head pain.
Diagnostic Approaches
Differential Diagnosis
The differential diagnosis of side-locked headaches includes a wide range of primary and secondary headaches, as well as cranial neuropathies. Primary headaches, such as migraines, often present with unilateral pain but can also be bilateral. Secondary headaches may arise from intracranial or extracranial structures, including the neck, eyes, ears, sinuses, and teeth. A thorough history and physical examination are crucial for distinguishing between primary and secondary causes.
Imaging and Investigations
For patients with suspected secondary headaches, appropriate imaging and investigations are essential. This may include MRI or CT scans to rule out intracranial pathologies. In cases of cervicogenic headache, imaging of the cervical spine may be warranted.
Treatment Trials
Treatment trials can also aid in diagnosis. For example, local subcutaneous lidocaine application has been effective in relieving pain in some patients with nummular headache, suggesting a peripheral source of pain. Similarly, neurodynamic techniques targeting the greater occipital nerve may be beneficial for patients with increased GON sensitivity.
Conclusion
Unilateral head pain can stem from various causes, including cervicogenic headache, nummular headache, and increased sensitivity of the greater occipital nerve. Accurate diagnosis requires a comprehensive approach, including detailed patient history, physical examination, and appropriate imaging. Understanding the underlying cause is essential for effective treatment and management of unilateral head pain.
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