Critical Reviews™ in Physical and Rehabilitation Medicine

ISSN for PRINT: 0896-2960

For Online Access

Best Paper Award Selection - Editorial Board Site

2002, Volume14

Issue 3&4

104 pages

Issue price - $326.00

Egilius L. H. Spierings, M.D., Ph.D.
Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, 25 Walnut Street, Suite 102, Wellesley Hills, MA 02481-2106

Headache is a common complaint and manifests itself in medical practice as an acute, subacute, or chronic condition. The acute headache is generally severe in intensity and is usually presented in the emergency department. Subacute and chronic headaches, on the other hand, are presented in the office. The diagnostic considerations depend, to a great extent, on the presentation of the headache. Important causes of acute, nontraumatic headache are subarachnoid hemorrhage and meningitis. Possible causes of subacute headache are cerebral tumor, pseudotumor cerebri, ophthalmic zoster, temporal arteritis, and subdural hematoma. Cerebral tumor is especially a concern in children, pseudotumor cerebri in young adults, and ophthalmic zoster, temporal arteritis, and subdural hematoma over the age of 50 or 60. In chronic headache, the headaches are present, either intermittently or continuously, for months, years, or sometimes even decades. The two most common conditions in this headache category are tension-type headache and migraine, either in their episodic or chronic form. The conditions fall on a continuum that includes migraine, episodic and chronic tension-type headache, and tension-type vascular headache, the latter including chronic migraine. The physiological basis of the continuum lies in the interaction between the muscular and vascular mechanisms of tension-type headache and migraine, respectively. The paroxysmal headache conditions, that is, cluster headache, paroxysmal hemicrania, and stabbing headache, are part of a so-called spectrum of vascular headaches. The treatment of the chronic headache conditions is pharmacological and nonpharmacological in nature, the latter in particular in terms of preventing the occurrence of the headaches.

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