Educational Papers

Migraine is a recurrent neurological disorder, not a sinus problem or a low pain threshold. The diagnosis is clinical: attack pattern, associated symptoms, and the absence of a dangerous cause.

The most common primary headache: bilateral pressure or tightness, mild to moderate, without clear worsening on routine activity. Because the diagnosis leans on not being migraine, a careful history matters more than a quick label.

A family of severe unilateral headaches with same-sided autonomic signs: tearing, red eye, nasal congestion, a drooping lid, or restlessness. Cluster headache is the best known, and it is often miscalled sinusitis for years.

A mixed group: cough, exercise, and sexual headache, primary thunderclap, ice-pick, external-pressure, hypnic, and new daily persistent headache. What they share is that many earn the word primary only after a dangerous cause is excluded.

Headache after head or neck injury, whiplash, or surgery. It can persist after an apparently mild injury. The force of the trauma does not always match the severity of the pain.

Headache can be the symptom of subarachnoid haemorrhage, stroke, cerebral venous thrombosis, cervical artery dissection, giant cell arteritis, or a hypertensive crisis. Here the headache is a signal, not a free-standing disease.

Intracranial pressure, tumour, cyst, and cerebrospinal fluid disorders live here. Do not dismiss morning headache, projectile vomiting, or pain worse lying down or with cough. Those features are not specific for tumour either.

Headache from a tumour usually comes from pressure change or traction on pain-sensitive structures. The classic morning headache with vomiting is uncommon and late. Progression, neurological signs, and context matter more.

Low CSF pressure usually gives an orthostatic headache: worse upright, better lying down. High pressure may bring transient visual blurring, tinnitus, and papilloedema. Both are treatable and both are easy to miss.

Drugs, alcohol, nitrates, and caffeine can cause headache, and so can stopping them suddenly. The everyday clinic pattern is headache from overuse of acute medicine.

From influenza to meningitis and abscess. Headache with fever is common and often benign, but fever with neck stiffness, a rash, falling consciousness, or a focal sign is an emergency path.

Headache is reported both in acute COVID-19 and in the weeks after. There is no fixed pattern that replaces a history. Red flags still stand, and COVID does not cancel them.

Sleep, altitude, hunger, dialysis, severe hypertension, hypothyroidism, and hypoxia. Headache here usually arrives with the underlying disturbance and improves when it is corrected. Ordinary chronic hypertension, on its own, does not explain everyday headache.

A structure in the head or neck can refer pain, but the diagnosis is used too often. Migraine and cluster headache are both repeatedly called sinusitis because they cause facial pain and nasal congestion.

The international classification rarely attributes headache directly to a psychiatric disorder. Depression and anxiety very often travel with migraine, but travelling together does not mean one caused the other. Calling it “just nerves” is wrong, and it delays treatment.

Trigeminal neuralgia, persistent facial pain, painful cranial neuropathy, and post-herpetic pain. These are not classic headache, but the person often arrives first at a headache clinic.

Most headaches are primary, but the clinician’s job is to separate the dangerous minority by history and examination, not by scanning everyone. This page is the map into the rest of the library.