Headache

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Signs and Symptoms

Tension Headache

Tension headache usually produces a dull, steady ache on both sides of the head. The pain usually increases over a period of hours. A small number of tension-headache patients report that, when at its worst, the pain develops a pulsating quality.

Tension headache pain has been described as pressure or tightness around the head, as though a band were pulled tightly around it or as if it were clamped in a vise.

Muscular tenderness in areas of the neck, the base of the skull, scalp, forehead, face, jaw, shoulders, or upper arms may be present in tension-headache sufferers. The scalp and forehead may be painful to the touch. Some people may show signs of clenching their teeth.

Cluster Headache

A person experiencing cluster headache may have up to 8 attacks per day, each lasting about 15 to 45 minutes or longer. Attacks often come in the early morning hours and waken the patient from sleep.

The pain of cluster headaches usually is located around one eye and is almost always on one side of the head (unilateral). There can be nasal stuffiness and tearing with the headache.

The pain is excruciating for most people and lying down often makes cluster headaches worse. Some people pace the floor and move about, unable to find relief.

Diagnosis

Diagnosis of tension or cluster headache is based on symptoms and a thorough medical examination, including the following:

• Blood tests including thyroid, liver, and kidney function tests
• Eye examination
• Family history
• Medical history (including medications and characteristics of the headache)
• Neurological examination
• Sleep habits

Imaging studies of the brain may be necessary to rule out any serious underlying medical problem, such as brain tumor, stroke, infection, and vascular malformation (e.g., aneurysm).

Imaging studies that may be performed include:

• Computed tomography (CT scan) or magnetic resonance imaging (MRI scan) to examine the tissues and structures around, on, and in the brain
  
• Electroencephalogram (EEG) to measure brain activity
  
• X-rays or magnetic resonance angiography (MRA) to evaluate the brain's blood vessels
  

Laboratory and imaging tests can help rule out secondary causes of headache, such as the following:

• Brain tumor
  
• Cerebral aneurysm
  
• High blood pressure (hypertension)
  
• Infection (e.g., meningitis, sinusitis, ear infection)
  
• Temporal arteritis
  
• Trigeminal neuralgia
  

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