Headaches

• Tension headaches are very common, causing a mild ache or pressure in a band-like pattern around the head.
• Tension headaches develop and resolve gradually and do not produce visual changes.
• Various surgical interventions are possible where the symptoms of trigeminal neuralgia persist.
• Cervical spondylosis is a common condition caused by degenerative changes in the cervical spine that causes neck pain, usually made worse by movement, and often presents with headaches.
• Trigeminal neuralgia causes intense facial pain in the distribution of the trigeminal nerve, which has three branches: Ophthalmic (V 1 ), Maxillary (V 2 ), and Mandibular (V 3 ), and can affect any combination of the branches.
• Medication-overuse headache (also called analgesic headache) is a headache caused by frequent analgesia use and can be challenging to treat.
• Secondary headaches give a similar presentation to a tension headache but with a clear cause, such as infections (e.g., viral upper respiratory tract infection), obstructive sleep apnoea, pre-eclampsia, head injury, carbon monoxide poisoning, sinusitis, and hormonal headaches.
• Tension headaches may be associated with stress, depression, alcohol, skipping meals, dehydration, and can be managed with reassurance, simple analgesia (e.g., ibuprofen or paracetamol), and Amitriptyline.
• NICE CKS (updated 2022) recommend carbamazepine as first-line for trigeminal neuralgia.
• Hormonal headaches are related to low oestrogen and have similar features to migraines, with a unilateral, pulsatile headache associated with nausea.