Headache and Facial Pain

Abstract

Headache may be due to processes ranging from benign to life threatening. Red flags for dangerous underlying processes include thunderclap headaches, fixed neurologic symptoms, accompanying seizures, and change in headache character. Thunderclap headaches are sudden-onset, severe headaches, and are often produced by dangerous neurologic conditions such as subarachnoid hemorrhage, carotid artery dissection, pituitary apoplexy, and reversible cerebral vasoconstriction syndrome. Other serious causes of headaches include temporal arteritis, cerebral venous sinus thrombosis, meningitis, intracranial masses, pseudotumor cerebri, and hypertensive encephalopathy. Migraine and tension headaches are the most common headache disorders and have a multitude of management options. Status migrainosus is defined as migraine headaches which last longer than 72 h, and requires specialized treatment, usually in a hospital setting. Other causes of headache include sinus disease, visual strain, and spontaneous intracranial hypotension. The trigeminal autonomic cephalgias include cluster headache and the paroxysmal hemicranias. Facial pain has a variety of etiologies including trigeminal neuralgia, glossopharyngeal neuralgia, temporomandibular joint disease, and atypical facial pain syndrome.