Cephalgia or Headache: Types, Causes, & More!

Cephalgia, also known as ‘headache’ includes any type of pain that is affecting the head, neck, or face. Headache is one of the most common conditions in the world. In today’s lifestyle, its occurrence is increasing rapidly due to increasing stress and other problems. So, if you are suffering from headaches, you’re not the only one.

ICD-9-CODES

307.81 Tension headache; 339 Other headache syndromes; 339.0 Cluster headache; 339.1 Tension-type headaches; 339.2 Post-traumatic headaches; 339.3 Drug-induced headaches; 339.4 Complicated headache syndromes; 339.8 Other specified headache syndromes

ICD-10-CODES

G43 Migraine; G44 Cluster headache; G44.209 Tension-type headaches; G44.309 Post-traumatic headaches; G44.41 Drug-induced headache; G44.51 Hemicraniacontinua; G44.80 Other primary headaches; G44.81 Hypnic headache.

Types of cephalgia:

1. Primary headaches/cephalgia

Primary are those headaches that are not very dangerous as they aren’t due to any underlying medical cause. These includes:

• Migraine
• Cluster headaches
• Tension headaches
• Trigeminal headaches

2. Secondary headaches/cephalgia

These headaches are dangerous as they are related to other medical conditions, like:

• Tumor
• Whiplash injury
• Intracranial headache
• Neck injury
• Vascular disorders
• Overuse of medications

NIH Classification of Cephalgia:

The National Institute of Health (NIH) has 5 classifications of headaches:

1. Vascular headache
   • Migraine
   • Cluster headaches
2. Muscular tension myogenic headache
3. Cervicogenic headache
4. Traction headache
5. Inflammatory headache

Signs & Symptoms:

• MIGRAINE
  • More common in women
  • Pulsating pain
  • Nausea
  • Sensitivity to light or sound
  • Pain on one or both sides of the head
  • Pain aggravates with routine activity
• CLUSTER HEADACHES
  • These are more common in men than in women
  • Severe headaches
  • These are short-lasting
  • Symptoms around the eye
• MUSCULAR TENSION/MYOGENIC HEADACHE
  • Squeezing or tightening on head
  • Mild-to-moderate pain
  • Still able to do the routine activity
• CERVICOGENIC HEADACHE
  • Disorder of the cervical spine
  • Stiff neck
  • Range of motion or mobility limited
  • One-sided pain
  • Pain radiating to the arm
• TRACTION HEADACHE
  • Can be caused by stroke
  • Severe throbbing or pulsating pain
• INFLAMMATORY HEADACHE
  • Can be caused by sinus infection with inflammation
  • By increase in intracranial pressure
  • Dull or aching headache
  • Feeling of tightness across the forehead, sides of the head, back of the head, and neck.

Possible Causes:

• It can be due to forward head posture, rounded shoulders due to tight pectoralis, or weak deep neck flexor muscles.
• Prolonged side bending of the cervical towards the impaired nerve
• Hypertrophy of the facets
• Trauma
• Light and sound
• Nutritional deficiency
• Vascular insufficiency
• Stress

Differential Diagnosis:

DISORDER	MIGRAINE	CLUSTER HEADACHE	HYPERTENSION HEADACHE	CERVICAL NEURALGIA	EYE DISORDER	SINUS,EAR, & NASAL DISORDER
SEX/AGE PREDOMINANCE	Female/20-40 years	Male/40-60 years	None	None	None	None
NATURE OF PAIN	Throbbing and intense	Stabbing, pulsating, burning	Dull, throbbing, nonlocalized	Dull pain or pressure in the head	Generalized discomfort in or around the eye	Dull, persistent
FREQUENCY	Usually not more than twice a week	1-4 episodes/day	Variable		Intensify with sustained visual effort	Variable
LOCATION	Usually unilateral	Unilateral eye, temple, forehead	Entire cranium, especially the occipital region	Bilateral occipital, frontal or facial	Entire cranium	Frontal, temporal, ear, nose, occipital
DURATION	Several hours to days	Minutes to hours	Variable	Variable	During and after visual effort	Variable
CAUSE	Vasomotor	Vasomotor	High BP	Neurological, pressure on spinal nerve roots	Infection, allergy, chemical	Blockage, inflammation, infection
OTHER SYMPTOMS	Nausea, vomiting, pallor, photophobia, mood disturbances	Ipsilateral sweating of the face, lacrimation, nasal congestion, or discharge		Dizziness, auditory disturbances	Diminished vision. sensitivity to light

Diagnosis:

1. MRI, CT: These help to visualize the region of the head or brain
2. X-RAY: They help to look if osteophytes located in the intravertebral foramen of the cervical spine

Tests & Measures:

1. Cervical spine active range of motion
2. Physical examination to rule out cervical radiculopathy:
   • Spurling test
   • Upper limb nerve tension tests
   • Diminished brachioradialis reflex

Intervention:

Usually, headaches go away with rest and mild analgesics like ibuprofen, aspirin, or paracetamol. But, not all headaches go away easily and need lifestyle changes.

1. By rest
2. Lifestyle changes: Changes in diet and sleep patterns are very effective to cure headaches.
3. Stress management: Daily meditation and relaxation techniques are also effective to cure stress headaches.
4. Proper hydration
5. Cervical distraction and traction in case of nerve compression.
6. Postural changes
7. Exercises in case of muscle weakness.
   • Deep neck flexors training
   • Strengthening of lower/middle trapezius, rhomboids, rotator cuff, serratus anterior, latissimus dorsi.

ALL THE BEST!