“An ache or pain in the head” (Merriam-webster, 2016) or headache is a worldwide problem that affects people of every age groups, races, income levels and geographical areas. The global prevalence of current headache disorder was estimated to be about 50% among adults by the World Health Organization (WHO) (World Health Organization, 2016). Over 90% of the general population reported at least one headache in their life. Headache on 15 or more days every month or chronic headache affects around 3% of adult population.

Headache is the most common disorder of nervous system. Most headaches are not from a serious cause, but some may result from a life-threatening condition that required emergency care. Headaches are generally classified by their cause: primary headaches, secondary headaches, and painful cranial neuropathies, facial pain, and other headaches.

Primary headache is caused by abnormal pain processing pathway in the central nervous system. The abnormal chemical in the brain, nerves, blood vessels, and muscles can contribute to head pain. The most common primary headaches are migraine, tension-type, and cluster headache.

Migraine headache is one of the most common painful condition in the world. In the Global Burden of Disease Study in 2013, migraine was ranked as the third most prevalent disorder and the seventh highest specific cause of disability globally (Steiner TJ, 2013). Migraine was characterized by moderate to severe throbbing pain (pulsatile) on one side of the head with associated symptoms such as nausea/vomiting, sensitive to light, sound, and smell. One fourth of migraineurs had transient neurological disturbances called “Aura” that usually precede or sometimes accompany the headache. Attacks are usually disabling and can last for 3 days ((IHS), 2013).

Tension-type headache is the second most prevalent disease in the world behind dental caries. Lifetime prevalence is around 30-78% in general population. It is characterized by mild to moderate pressing or tightening sensation on both sides of head especially on frontal and temporal areas. Some tension-type headache patients had sensitivity to light or sound but not associated with nausea.

Secondary headache is a symptom of a disease that can activate the pain-sensitive structures of the head. The possible causes of secondary headaches include acute sinusitis, abnormal blood vessels (aneurysm, arteriovenous malformation), intracranial bleeding, head injury, central nervous system infection (meningitis, encephalitis), Chiari malformation, dental problem, ear infection, overuse of pain medication, etc.

Painful cranial neuropathies, facial pain, and other headaches are disease that affected the nerves on face or neck. Stimulation of the nerves by compression, distortion, infection, or inflammation may cause stabbing or constant pain in the nerve innervated area. The most common conditions are trigeminal neuralgia, occipital neuralgia, Tolosa-hunt syndrome, painful trigeminal neuropathy, and central post-stroke pain.

Diagnosis of headache disorders need detailed headache history and careful neurological examination. Secondary causes should be excluded by appropriate investigations such as neuroimaging (CT or MRI scan), blood tests, spinal tap, etc. Treatment varies significantly depending on the type of headache, so definite diagnosis should be obtained by neurologist, preferably headache specialist.

Fg. Off. Kiratikorn Vongvaivanich MD.
Certificate of Headache Master (IHS)
Consultant Neurologist and Headache specialist
Bangkok Hospital Headquarter


  • (IHS), H. C. (2013). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia, 629-808. doi:10.1177/0333102413485658
  • Merriam-webster. (2016, May 15). Retrieved from Merriam-webster: http://www.merriam-webster.com/dictionary/headache
  • Steiner TJ, S. L. (2013). Migraine: the seventh disabler. Cephalalgia, 289-290. doi:10.1177/0333102412473843.
  • World Health Organization. (2016, May 15). Retrieved from WHO: http://www.who.int/mediacentre/factsheets/fs277/en/