Headache (Cephalgia)

Headache (synonyms: cephalgia, cephalalgia, cephalalgia, cephalaea; ICD-10-GM R51: headache) refers to painful sensations in the area of the head. Headaches are widespread and everyone has certainly been affected by them at some time. But often one does not even know where the pain comes from and not always the pain is so strong that a doctor is consulted. One can distinguish the following forms of headache according to the ICD-10-GM:

  • Migraine (ICD-10-GM G43; 38% of all cases).
  • Cluster headache (ICD-10-GM G44.0)
  • Vasomotor headache, not elsewhere classified (ICD-10-GM G44.1)
  • Tension headache (ICD-10-GM G44.2; 54% of all cases).
  • Chronic post-traumatic headache (ICD-10-GM G44.3)
  • Drug-induced headache, not elsewhere classified (ICD-10-GM G44.4)
  • Other specified headache syndromes (ICD-10-GM G44.8)

In addition, headache can be classified according to the International Headache Society (IHS) as follows:

  • Primary headache (idiopathic headache) – more than 92% of all headaches considered a separate disease; frequency decreases with age.
  • Secondary headache (symptomatic headache) – less than 7% (8-10%); headache occurring due to neurological or other disease or as side effects of therapies; frequency increases with age.
  • Cranial neuralgia, central and primary facial pain – less than 1% of all headaches; e.g., primary trigeminal neuralgia

The ICHD-3 lists 228 headache types. Tension headache and migraine are the two most common types of headache. Pain disorders are considered chronic if they last longer than six months. A headache is defined as a chronic headache depending on the form of the headache:

  • Migraine:
    • Episodic: 15 days/month
    • Chronic: ≥ 3 months, ≥ 15 headache days/month, including ≥ 8 that meet diagnostic criteria for migraine
  • Tension headache:
    • episodic:
      • Sporadic: < 12 headache days/year
      • Frequent: > 12 and < 180 headache days/year
    • Chronic: at least three months ≥ 15 headache days/month.
  • Cluster headache: attacks throughout the year, without a headache-free period of four weeks duration or longer.
  • Trigeminoautonomic headache (paroxysmal hemicrania; SUNCT syndrome (Short-lasting Unilateral Neuralgiform headache attacks with Conjunctival injection and Tearing; SUNA syndrome (Short-lasting Unilateral Neuralgiform headache attacks with cranial Autonomic symptoms): see Definiton cluster headache.
  • Hemicrania continua: by definition chronic headache.
  • Medication overuse headache (MOH): ≥ 3 months, headache persists at least 15 days per month
  • Posttraumatic headache: distinguish acute post-traumatic headache from persistent (or chronic) post-traumatic headache: > 3 months

In a pediatric practice, recurrent tension headache and migraine and their subtypes account for over 90% of presenting headache complaints. The prevalence (disease frequency) for chronic or recurrent (recurring) headache is 60% (in Germany). The prevalence of primary headache disorders decreases with age. The prevalence of secondary headache disorders is estimated to be about 8% across all ages, increasing to about 15% with age. Course and prognosis: Headaches are very unpleasant and sometimes severely restrict sufferers in their daily lives. Therefore, it is even more important to identify the cause of the headache (including trigger factors in migraine) in order to successfully prevent or treat it. This is especially true for secondary headaches. In case of recurrent headaches, a doctor should be consulted. These do not manifest themselves with a diagnostically clear syndrome. Note: Secondary headache due to brain tumors is the only or first symptom in less than 0.1% of all headache patients.