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Headache cephalalgia is a common symptom often associated with disability but rarely life threatening Headaches may be a primary disorder migraine cluster or tension headache or a secondary symptom of such disorders as acute systemic or intracranial infection intracranial tumor head injuries severe hypertension cerebral hypoxia and many diseases of the eyes nose throat teeth ears and cervical vertebrae Sometimes no cause is found Headaches may result from stimulation of traction of or pressure on any of the pain-sensitive structures of the head all tissues covering the cranium the 5th 9th and 10th cranial nerves the upper cervical nerves the large intracranial venous sinuses the large arteries at the base of the brain the large dural arteries and the dura mater at the skull base Dilation or contraction of blood vessel walls stimulates nerve endings causing headache The cause of most headaches is extracranial rather than intracranial Stroke vascular abnormalities and venous thromboses are uncommon causes of headache The frequency duration location and severity of the headache the factors that make it better or worse associated symptoms and signs such as fever stiff neck nausea and vomiting and special studies help identify the cause of headache Secondary headaches may have specific characteristics An acute whole-cranial severe headache associated with fever photophobia and stiff neck indicates an infectious process such as meningitis until proved otherwise Subarachnoid hemorrhage also causes acute headache with symptoms and signs of meningeal irritation Space-occupying lesions often cause subacute progressive headache New-onset headache in an adult 40 yr always requires thorough evaluation With space-occupying lesions the following may occur headache on awakening or at night fluctuation of headache with postural changes and nausea and vomiting Additional neurologic complaints such as seizure confusion weakness or sensory changes may occur late and are ominous Tension headache tends to be chronic or continuous and commonly originates in the occipital or bifrontal region then spreads over the entire head It is
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