Headache location and causes
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Headache Location: Key Regions and Patterns
Headaches can occur in many areas of the head, including above the eyes, behind the ears, at the back of the head (occipital), in the upper neck, or across the forehead. The pain may be unilateral (one side), bilateral (both sides), focal (specific spot), multifocal, or radiating from a focal point. The location of the headache often provides important clues about its type and possible cause 467.
- Migraine headaches are usually intense and often develop on one side of the forehead. They can also be associated with sensitivity to light and noise .
- Cluster headaches typically occur in the orbital (around the eye), supraorbital (above the eye), or temporal (side of the head) regions, but can sometimes present in the occipital (back of the head) area or even in the neck and shoulders 89.
- Occipital headaches may be linked to issues with the greater occipital nerve, which emerges at the back of the head, about 3 cm below the occipital protuberance and 1.5 cm lateral to the midline .
- General headaches can be felt anywhere in the head or neck, and the pain can be dull, sharp, throbbing, or soft 47.
Causes of Headache: Primary and Secondary Factors
Headaches are broadly classified as primary or secondary:
Primary Headaches
Primary headaches are not caused by another medical condition. The most common types include:
- Migraine: Caused by hyperactive nerve cells sending impulses to blood vessels, leading to constriction and then dilation, which releases inflammatory substances and causes pain . Migraines may also be triggered by entrapment or compression of peripheral nerves, such as the greater occipital nerve .
- Cluster Headache: The exact cause is not fully understood, but it is believed to involve the trigeminal nerve system and can be triggered by various factors 59.
- Tension-Type Headache: Often related to stress, muscle tension, or physical/physiological trauma 45.
Secondary Headaches
Secondary headaches are caused by underlying medical conditions, some of which can be serious:
- Infections: Such as meningitis, which can cause severe headaches 610.
- Vascular Disorders: Including subarachnoid hemorrhage, cervical artery dissection, and cerebral venous thrombosis .
- Structural Issues: Such as brain tumors or obstructive hydrocephalus .
- Systemic Disorders: For example, untreated hypertensive crisis can result in severe headache .
- Other Causes: Headaches can also be attributed to non-neurological disorders like hypothyroidism or changes in the environment 34.
Diagnostic Approach: Importance of Location and History
A systematic approach to diagnosing headaches involves taking a detailed history and examining the location and characteristics of the pain. This helps distinguish between primary and secondary headaches and ensures that serious causes are not missed. The pain-sensitive structures around the brain—such as the meninges, blood vessels, nerves, and muscles—are often the source of headache pain, as the brain itself lacks pain receptors 37.
Conclusion
Headache location and characteristics are key to understanding their causes. While most headaches are primary and benign, some may signal serious underlying conditions. Careful attention to the site of pain, associated symptoms, and patient history is essential for accurate diagnosis and effective management 3610.
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