• involves sudden, violent pain
  • it could signal an aneurysm
• gets worse over time and includes other symptoms such as nausea and vomiting, speech changes, personality changes, etc.
  • although rare, it could be a brain tumor or a TIA ("mini-stroke")
• includes nausea, vomiting, fever, and a stiff neck
  • it could be a sign of meningitis

  

• pain usually felt in the back of the head and neck, and usually not one-sided.
• pain that lasts for weeks or months with only brief periods of relief, although it may fluctuate in severity.
• attacks that begin at any time of the day.
• pain that is often described as a "tight band," pressing, but rarely throbbing, and never accompanied by fever.

• pain that is characteristically only on one side at a time, but may involve the entire head.
• pain that is throbbing in nature and usually develops in the morning and gradually worsens after an hour or so.
• attacks that may occur every few days or weeks, or not for months. Migraines often continue for hours, but rarely last longer than a day or two.
• pain that may be aggravated by stress, alcohol, or certain foods such as chocolate and are frequently accompanied by nausea and vomiting and relieved by sleep.
• having a family history of migraine headaches.

• pain that occurs mostly in men, while typical migraines are more common in women.
• pain that is often situated behind an eye and usually the same eye.
• pain that comes on very suddenly and without warning.
• pain that peaks within 5 to 10 minutes and disappears in less than an hour.
• pain that is often triggered by alcohol.
• pain that will awaken a person from sleep and occur several times a day for weeks and then stop.

• pain that usually begins during or after a bad cold, particularly if there is postnasal drip.
• pain that it is localized to one specific area of the face or head, and comes on very quickly.
• pain that is worse in the morning before the mucus has had an opportunity to drain.
• pain that it is made worse by coughing, sneezing, or sudden movements of the head.
• pain that it is aggravated by alcohol, sudden temperature changes, and during cold seasons, going from a warm room out into the cold.
• a history of hay fever and allergies.

• pain that occurs mostly in people over age 50
• pain that is aggravated by chewing
• impaired vision
• aches and pains all over the body
• the presence of a fever
• weight loss

• benign headache
• common cold
• fever
• hangover (alcohol withdrawal)
• head injury
• head or neck infection NOT involving the brain (ear infection, mastoiditis, pharyngitis, or sinusitis)
• influenza
• medications such as indomethacin, nitrates, and vasodilators
• premenstrual syndrome (PMS)
• stress
• tooth abscess
• withdrawal from caffeine, ergotamine, sympathomimetic drugs, or other medication
• withdrawal from street drugs

• cerebral aneurysm
• brain tumor
• stroke
• TIA
• meningitis
• encephalitis

Home care:
Over-the-counter pain medications are often effective headache relievers. Avoid giving aspirin or other salicylates to children, because of the risk of Reye's syndrome and other disorders.

A massage or heat applied to the back of the upper neck can be effective in relieving tension headaches.

Headaches may be relieved by resting with the eyes closed and head supported, or by relaxation techniques such as meditation.

• the headache comes on suddenly and is expolosive or violent.
• the headache gets worse over time or is associated with visual difficulties, slurring of speech, problems in moving arms or legs, or similar problems.
• the headache is associated with fever and a very stiff neck.
• the headache is associated with head injury.
• the headache is the worst you have ever had and comes on suddenly.

• the headache has persisted more than a few days.
• the headaches are worse in the morning, no other symptoms are present.
• you have headaches frequently and there is no known cause such as allergies or chronic sinusitis.

• location
  • Is the headache located in the forehead or around the eyes (frontal or periorbital)?
  • Is the headache located in the back of the head (occipital)?
  • Is the headache located near the temples (temporal)?
  • Is the headache behind the eyeball (retrobulbar)?
  • Is the headache all over (generalized)?
  • Is the headache on one side only (unilateral)?
    • Is the headache always on same side?
• quality/type
  • Is this the worst headache in the patient's experience?
  • Is this a new type of headache for the patient?
  • Would the headache be described as pulsating (throbbing)?
  • Is it severe?
  • Is it moderately severe?
  • Is there a pressure or band-like sensation?
• time pattern
  • Does the headache occur upon awakening in the morning?
  • The headaches begin with this episode of illness?
  • How long have you had headaches?
  • How long does each headache last?
  • Does the headache awaken the patient from sleep?
  • Did other symptoms begin shortly after the headaches began?
  • Did the headaches begin suddenly?
  • Do headaches occur repeatedly (recurrent)?
    • Do they occur multiple times daily?
    • Do they occur over a period of weeks?
  • Are the headaches worse during the day and better at night?
  • Does the headache reach maximum intensity over 1 to 2 hours?
  • Did they develop rapidly?
  • At what age did headaches begin?
• aggravating factors
  • Are the headaches worse when lying down or in a reclining position?
  • Are the headaches worse when standing up?
  • Are the headaches worse when coughing, sneezing, straining, lifting (Valsalva maneuver)?
  • Are headaches triggered by reminders of a traumatic event?
  • Do they occur at a specific time related to your menstrual period (women)?
• relieving factors
  • What home treatment have you tried?
  • How effective was it?
  • Is the headache relieved by medication that contains ergotamine?
• associated complaints
  • Does nausea or vomiting accompany the headache?
  • Is the headache preceded by a pop/snap in the skull?
  • Do neurological symptoms (weakness, loss of speech, etc.) occur when you have a headache?
  • Is the headache preceded by temporary loss of half of the visual field?
  • Does the headache cause the eye to tear on the same side as where the headache is?
  • Is there nasal discharge or stuffiness on the same side?
  • What other symptoms are present?

• head CT scan
• head MRI
• sinuses X-rays
• temporal artery biopsy
• lumbar puncture