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Headaches are one of the most common neurological complaints, affecting nearly everyone at some point in their lives. Primary headaches include tension-type, migraine, and cluster headaches, while secondary headaches result from underlying conditions such as infections, trauma, or intracranial pathology.
Primary headaches involve complex interactions between the trigeminal nervous system, brainstem nuclei, and vascular structures, with neurogenic inflammation and altered pain processing playing key roles. Secondary headaches result from direct tissue damage, increased intracranial pressure, inflammation, or irritation of pain-sensitive structures including blood vessels, meninges, and cranial nerves.
Diagnosis requires careful history-taking to distinguish primary from secondary causes, with red flags including sudden onset, fever, neurological deficits, or changes in established headache patterns warranting immediate evaluation. Treatment approaches vary significantly between headache types, ranging from simple analgesics for tension headaches to specific triptans for migraines and preventive therapies for chronic conditions.
Key imaging focus: Red flags (thunderclap, worst ever, focal deficit); normal CT doesn't rule out everything