• Steven J. ScrivaniEmail author
  • Steven B. Graff-Radford
  • Shehryar N. Khawaja
  • Egilius L. H. Spierings
Reference work entry


Headache is defined as a pain in the region above the orbitomeatal line. Headache disorders are common and considered a major health problem that affects a large percentage of the population worldwide. The International Headache Society (IHS) has an updated classification of headache referred to as the International Classification of Headache Disorders III (ICHD-III). This classification divides headache into primary and secondary headache and, additionally, categorizes painful cranial neuralgias and other facial pain conditions. This chapter discusses the epidemiology, clinical presentation, and management of the most common primary headache disorders (migraine headache, tension-type headaches, and trigeminal autonomic cephalgias) and important secondary headache disorders (headaches attributed to ischemic stroke or transient ischemic attack, trauma or injury to head and neck region, nontraumatic intracranial hemorrhage, giant cell arteritis, increase or decrease in cerebrospinal fluid, and intracranial neoplasia). In addition, it reviews the association between headache and temporomandibular disorders.


Primary headache disorders Migraine Tension-type headaches Trigeminal autonomic cephalgias Secondary headache disorders Cluster headache Hemicrania continua Paroxysmal hemicrania Short-lasting unilateral neuralgiform headache attacks 



This chapter is dedicated to the memory of Dr. Steven B. Graff-Radford, a dear friend, colleague and leader in the field of headache medicine and orofacial pain. His knowledge, teaching and guidance will be missed. His friendship with me will also be missed.

Steven J. Scrivani


  1. Bendtsen L. Central sensitization in tension-type headache – possible pathophysiological mechanisms. Cephalalgia. 2000;20(5):486–508.PubMedCrossRefGoogle Scholar
  2. Bendtsen L, Jensen R, Olesen J. Decreased pain detection and tolerance thresholds in chronic tension-type headache. Arch Neurol. 1996;53(4):373–6.PubMedCrossRefGoogle Scholar
  3. Bendtsen L, Evers S, Linde M, Mitsikostas DD, Sandrini G, Schoenen J, EFNS. EFNS guideline on the treatment of tension-type headache - report of an EFNS task force. Eur J Neurol. 2010;17(11):1318–25.PubMedCrossRefGoogle Scholar
  4. Bigal ME, Liberman JN, Lipton RB. Age-dependent prevalence and clinical features of migraine. Neurology. 2006;67(2):246–51.PubMedCrossRefGoogle Scholar
  5. Boes CJ, Swanson JW. Paroxysmal hemicrania, SUNCT, and hemicrania continua. Semin Neurol. 2006;26(2):260–70.PubMedCrossRefGoogle Scholar
  6. Bousser MG, Good J, Kittner SJ, Silberstein SD. Headache associated with vascular disorders. In: Wolff’s headache and other head Pain. New York: Oxford University Press; 2001. p. 349–92.Google Scholar
  7. Burns B, Watkins L, Goadsby PJ. Treatment of medically intractable cluster headache by occipital nerve stimulation: long-term follow-up of eight patients. Lancet. 2007;369(9567):1099–106.PubMedCrossRefGoogle Scholar
  8. Bussone G, Usai S. Trigeminal autonomic cephalalgias: from pathophysiology to clinical aspects. Neurol Sci. 2004;25(3):s74–6.PubMedCrossRefGoogle Scholar
  9. Camarda C, Camarda R, Monastero R. Chronic paroxysmal hemicrania and hemicrania continua responding to topiramate: two case reports. Clin Neurol Neurosurg. 2008;110(1):88–91.PubMedCrossRefGoogle Scholar
  10. Chaaban MR, Illing E, Riley KO, Woodworth BA. Acetazolamide for high intracranial pressure cerebrospinal fluid leaks. Int Forum Allergy Rhinol. 2013;3(9):718–21.PubMedCrossRefGoogle Scholar
  11. Charles A. Advances in the basic and clinical science of migraine. Ann Neurol. 2009;65(5):491–8.PubMedCrossRefGoogle Scholar
  12. Crider A, Glaros AG, Gevirtz RN. Efficacy of biofeedback-based treatments for temporomandibular disorders. Appl Psychophysiol Biofeedback. 2005;30(4):333–45.PubMedCrossRefGoogle Scholar
  13. Dionne RA. Pharmacologic treatments for temporomandibular disorders. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997;83(1):134–42.PubMedCrossRefGoogle Scholar
  14. Dodick DW. Diagnosing headache: clinical clues and clinical rules. Adv Stud Med. 2003;3(2):87–92.Google Scholar
  15. Ekberg EC, Nilner M. Treatment outcome of short- and long-term appliance therapy in patients with TMD of myogenous origin and tension-type headache. J Oral Rehabil. 2006;33(10):713–21.PubMedCrossRefGoogle Scholar
  16. Ekbom K, Hardebo JE. Cluster headache: aetiology, diagnosis and management. Drugs. 2002;62(1):61–9.PubMedCrossRefGoogle Scholar
  17. Fernandes G, Franco AL, Goncalves DA, Speciali JG, Bigal ME, Camparis CM. Temporomandibular disorders, sleep bruxism, and primary headaches are mutually associated. J Orofac Pain. 2013;27(1):14–20.PubMedGoogle Scholar
  18. Ford RG, Ford KT, Swaid S, Young P, Jennelle R. Gamma knife treatment of refractory cluster headache. Headache. 1998;38(1):3–9.PubMedCrossRefGoogle Scholar
  19. Franco AL, Fernandes G, Goncalves DA, Bonafe FS, Camparis CM. Headache associated with temporomandibular disorders among young Brazilian adolescents. Clin J Pain. 2014;30(4):340–5.PubMedCrossRefGoogle Scholar
  20. Furto ES, Cleland JA, Whitman JM, Olson KA. Manual physical therapy interventions and exercise for patients with temporomandibular disorders. Cranio. 2006;24(4):283–91.PubMedCrossRefGoogle Scholar
  21. Goadsby PJ, Edvinsson L, Ekman R. Release of vasoactive peptides in the extracerebral circulation of humans and the cat during activation of the trigeminovascular system. Ann Neurol. 1988;23(2):193–6.PubMedCrossRefGoogle Scholar
  22. Goadsby PJ, Cittadini E, Cohen AS. Trigeminal autonomic cephalalgias: paroxysmal hemicrania, SUNCT/SUNA, and hemicrania continua. Semin Neurol. 2010;30(2):186–91.PubMedCrossRefGoogle Scholar
  23. Greene CS. Diagnosis and treatment of temporomandibular disorders: emergence of a new care guidelines statement. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;110(2):137–9.PubMedCrossRefGoogle Scholar
  24. Haldeman S, Dagenais S. Cervicogenic headaches: a critical review. Spine J. 2001;1(1):31–46.PubMedCrossRefGoogle Scholar
  25. Headache Classification Committee of the International Headache Society (IHS). The international classification of headache disorders, (3rd edition). Cephalalgia. 2018;38(1):1–211.
  26. Herman CR, Schiffman EL, Look JO, Rindal DB. The effectiveness of adding pharmacologic treatment with clonazepam or cyclobenzaprine to patient education and self-care for the treatment of jaw pain upon awakening: a randomized clinical trial. J Orofac Pain. 2002;16(1):64–70.PubMedGoogle Scholar
  27. Holroyd KA, Drew JB. Behavioral approaches to the treatment of migraine. Semin Neurol. 2006;26(2):199–207.PubMedCrossRefGoogle Scholar
  28. Izumi H. Nervous control of blood flow in the orofacial region. Pharmacol Ther. 1999;81(2):141–61.PubMedCrossRefGoogle Scholar
  29. Jackson JL, Kuriyama A, Hayashino Y. Botulinum toxin a for prophylactic treatment of migraine and tension headaches in adults: a meta-analysis. JAMA. 2012;307(16):1736–45.CrossRefGoogle Scholar
  30. Kristoffersen ES, Lundqvist C. Medication-overuse headache: epidemiology, diagnosis and treatment. Ther Adv Drug Saf. 2014;5(2):87–99.PubMedPubMedCentralCrossRefGoogle Scholar
  31. La Jolla Donald J. Wolff’s headache and other head pain. New York: Oxford University Press; 2001.Google Scholar
  32. Lanza DC, Kennedy DW. Adult rhinosinusitis defined. Otolaryngol Head Neck Surg. 1997;117(3_suppl):S1–7.PubMedCrossRefGoogle Scholar
  33. Leao AA. Further observations on the spreading depression of activity in the cerebral cortex. J Neurophysiol. 1947;10(6):409–14.PubMedCrossRefGoogle Scholar
  34. Leone M, Bussone G. Pathophysiology of trigeminal autonomic cephalalgias. The Lancet Neurology. 2009;8(8):755–64.PubMedCrossRefGoogle Scholar
  35. Leone M, Franzini A, Cecchini AP, Broggi G, Bussone G. Hypothalamic deep brain stimulation in the treatment of chronic cluster headache. Ther Adv Neurol Disord. 2010;3(3):187–95.PubMedPubMedCentralCrossRefGoogle Scholar
  36. LeResche L. Epidemiology of temporomandibular disorders: implications for the investigation of etiologic factors. Crit rev Oral Biol med. 1997;8(3):291–305.PubMedCrossRefGoogle Scholar
  37. Levine SM, Hellmann DB. Giant cell arteritis. Curr Opin Rheumatol. 2002;14(1):3–10.PubMedCrossRefGoogle Scholar
  38. Lipton RB, Bigal ME, Diamond M, Freitag F, Reed ML, Stewart WF, A. A. Group. Migraine prevalence, disease burden, and the need for preventive therapy. Neurology. 2007;68(5):343–9.CrossRefGoogle Scholar
  39. List T, Axelsson S, Leijon G. Pharmacologic interventions in the treatment of temporomandibular disorders, atypical facial pain, and burning mouth syndrome. A qualitative systematic review. J Orofac Pain. 2003;17(4):301–10.PubMedGoogle Scholar
  40. Lobato RD, Rivas JJ, Cordobes F, Alted E, Perez C, Sarabia R, Cabrera A, Diez I, Gomez P, Lamas E. Acute epidural hematoma: an analysis of factors influencing the outcome of patients undergoing surgery in coma. J Neurosurg. 1988;68(1):48–57.PubMedCrossRefGoogle Scholar
  41. Loder E, Burch R, Rizzoli P. The 2012 AHS/AAN guidelines for prevention of episodic migraine: a summary and comparison with other recent clinical practice guidelines. Headache. 2012;52(6):930–45.PubMedCrossRefGoogle Scholar
  42. Manzoni GC. Cluster headache and lifestyle: remarks on a population of 374 male patients. Cephalalgia. 1999a;19(2):88–94.PubMedCrossRefGoogle Scholar
  43. Manzoni GC. Epidemiological and clinical aspects of cluster headache: relation with the migrainous syndrome. Ital J Neurol Sci. 1999b;20(2 Suppl):S4–6.PubMedCrossRefGoogle Scholar
  44. Marcelis J, Silberstein SD. Spontaneous low cerebrospinal fluid pressure headache. Headache: The Journal of Head and Face Pain. 1990;30(4):192–6.CrossRefGoogle Scholar
  45. Matharu MS, Goadsby PJ. Functional brain imaging in hemicrania continua: implications for nosology and pathophysiology. Curr Pain Headache rep. 2005;9(4):281–8.PubMedCrossRefGoogle Scholar
  46. May A, Goadsby PJ. Cluster headache: imaging and other developments. Curr Opin Neurol. 1998;11(3):199–203.PubMedCrossRefGoogle Scholar
  47. May A, Bahra A, Büchel C, Frackowiak RS, Goadsby PJ. Hypothalamic activation in cluster headache attacks. Lancet. 1998;352(9124):275–8.PubMedCrossRefGoogle Scholar
  48. McNeely ML, Armijo Olivo S, Magee DJ. A systematic review of the effectiveness of physical therapy interventions for temporomandibular disorders. Phys Ther. 2006;86(5):710–25.PubMedGoogle Scholar
  49. Meltzer EO, Hamilos DL, Hadley JA, Lanza DC, Marple BF, Nicklas RA, Bachert C, Baraniuk J, Baroody FM, Benninger MS. Rhinosinusitis: establishing definitions for clinical research and patient care. J Allergy Clin Immunol. 2004;114(6):155–212.PubMedCrossRefGoogle Scholar
  50. Mokri B. Headaches caused by decreased intracranial pressure: diagnosis and management. Curr Opin Neurol. 2003;16(3):319–26.PubMedCrossRefGoogle Scholar
  51. Nilsson H, Limchaichana N, Nilner M, Ekberg EC. Short-term treatment of a resilient appliance in TMD pain patients: a randomized controlled trial. J Oral Rehabil. 2009;36(8):547–55.PubMedCrossRefGoogle Scholar
  52. Pascual J, Quijano J. A case of chronic paroxysmal hemicrania responding to subcutaneous sumatriptan. J Neurol Neurosurg Psychiatry. 1998;65(3):407.PubMedPubMedCentralCrossRefGoogle Scholar
  53. Pascual J, Lainez MJ, Dodick D, Hering-Hanit R. Antiepileptic drugs for the treatment of chronic and episodic cluster headache: a review. Headache. 2007;47(1):81–9.PubMedCrossRefGoogle Scholar
  54. Peres MF, Silberstein SD, Nahmias S, Shechter AL, Youssef I, Rozen TD, Young WB. Hemicrania continua is not that rare. Neurology. 2001;57(6):948–51.PubMedCrossRefGoogle Scholar
  55. Pfund Z, Szapary L, Jaszberenyi O, Nagy F, Czopf J. Headache in intracranial tumors. Cephalalgia. 1999;19(9):787–90.PubMedCrossRefGoogle Scholar
  56. Rasmussen BK, Jensen R, Olesen J. A population-based analysis of the diagnostic criteria of the international headache society. Cephalalgia. 1991a;11(3):129–34.PubMedCrossRefGoogle Scholar
  57. Rasmussen BK, Jensen R, Schroll M, Olesen J. Epidemiology of headache in a general population--a prevalence study. J Clin Epidemiol. 1991b;44(11):1147–57.PubMedCrossRefGoogle Scholar
  58. Schiffman EL, Look JO, Hodges JS, Swift JQ, Decker KL, Hathaway KM, Templeton RB, Fricton JR. Randomized effectiveness study of four therapeutic strategies for TMJ closed lock. J Dent Res. 2007;86(1):58–63.PubMedPubMedCentralCrossRefGoogle Scholar
  59. Schiffman E, Ohrbach R, Truelove E, Look J, Anderson G, Goulet JP, List T, Svensson P, Gonzalez Y, Lobbezoo F, Michelotti A, Brooks SL, Ceusters W, Drangsholt M, Ettlin D, Gaul C, Goldberg LJ, Haythornthwaite JA, Hollender L, Jensen R, John MT, De Laat A, de Leeuw R, Maixner W, van der Meulen M, Murray GM, Nixdorf DR, Palla S, Petersson A, Pionchon P, Smith B, Visscher CM, Zakrzewska J, Dworkin SF. Diagnostic criteria for temporomandibular disorders (DC/TMD) for clinical and research applications: recommendations of the international RDC/TMD consortium network* and orofacial pain special interest Groupdagger. J Oral Facial Pain Headache. 2014;28(1):6–27.PubMedPubMedCentralCrossRefGoogle Scholar
  60. Schmidt-Wilcke T, Leinisch E, Straube A, Kämpfe N, Draganski B, Diener H, Bogdahn U, May A. Gray matter decrease in patients with chronic tension type headache. Neurology. 2005;65(9):1483–6.PubMedCrossRefGoogle Scholar
  61. Scrivani SJ, Keith DA, Kaban LB. Temporomandibular disorders. N Engl J med. 2008;359(25):2693–705.PubMedCrossRefGoogle Scholar
  62. Silberstein SD. Practice parameter: evidence-based guidelines for migraine headache (an evidence-based review): report of the quality standards Subcommittee of the American Academy of neurology. Neurology. 2000;55(6):754–62.PubMedCrossRefGoogle Scholar
  63. Silberstein SD, Holland S, Freitag F, Dodick DW, Argoff C, Ashman E, Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Evidence-based guideline update: pharmacologic treatment for episodic migraine prevention in adults: report of the quality standards Subcommittee of the American Academy of neurology and the American headache society. Neurology. 2012;78(17):1337–45.PubMedPubMedCentralCrossRefGoogle Scholar
  64. Singer E, Dionne R. A controlled evaluation of ibuprofen and diazepam for chronic orofacial muscle pain. J Orofac Pain. 1997;11(2):139–46.PubMedGoogle Scholar
  65. Sjaastad O, Bakketeig L. Cluster headache prevalence. Vågå study of headache epidemiology. Cephalalgia. 2003;23(7):528–33.PubMedCrossRefGoogle Scholar
  66. Slade GD, Bair E, By K, Mulkey F, Baraian C, Rothwell R, Reynolds M, Miller V, Gonzalez Y, Gordon S, Ribeiro-Dasilva M, Lim PF, Greenspan JD, Dubner R, Fillingim RB, Diatchenko L, Maixner W, Dampier D, Knott C, Ohrbach R. Study methods, recruitment, sociodemographic findings, and demographic representativeness in the OPPERA study. J Pain. 2011;12(11 Suppl):T12–26.PubMedPubMedCentralCrossRefGoogle Scholar
  67. Slade GD, Bair E, Greenspan JD, Dubner R, Fillingim RB, Diatchenko L, Maixner W, Knott C, Ohrbach R. Signs and symptoms of first-onset TMD and sociodemographic predictors of its development: the OPPERA prospective cohort study. J Pain. 2013;14(12 Suppl):T20–32. e1–3PubMedCrossRefGoogle Scholar
  68. Tarabichi M. Endoscopic management of cholesteatoma: long-term results. Otolaryngol Head Neck Surg. 2000;122(6):874–81.PubMedCrossRefGoogle Scholar
  69. Truelove E, Huggins KH, Mancl L, Dworkin SF. The efficacy of traditional, low-cost and nonsplint therapies for temporomandibular disorder: a randomized controlled trial. J Am Dent Assoc. 2006;137(8):1099–107.PubMedCrossRefGoogle Scholar
  70. Vargas BB. Tension-type headache and migraine: two points on a continuum? Curr Pain Headache rep. 2008;12(6):433–6.PubMedCrossRefGoogle Scholar
  71. Vázquez-Barquero A, Ibanez F, Herrera S, Izquierdo J, Berciano J, Pascual J. Isolated headache as the presenting clinical manifestation of intracranial tumors: a prospective study. Cephalalgia. 1994;14(4):270–1.PubMedCrossRefGoogle Scholar
  72. Williams MH, Broadley SA. SUNCT and SUNA: clinical features and medical treatment. J Clin Neurosci. 2008;15(5):526–34.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Steven J. Scrivani
    • 1
    Email author
  • Steven B. Graff-Radford
    • 2
  • Shehryar N. Khawaja
    • 3
  • Egilius L. H. Spierings
    • 4
  1. 1.Chief, Division of Oral and Maxillofacial Pain, Department of Oral and Maxillofacial SurgeryMassachusetts General HospitalBostonUSA
  2. 2.Director, Division of Headache and Orofacial Pain, Pain CenterCedar Sinai Medical CenterLos AngelesUSA
  3. 3.Resident, Orofacial Pain Program, Department of Oral and Maxillofacial SurgeryMassachusetts General HospitalBostonUSA
  4. 4.Professor, Craniofacial Pain Center, Tufts University School of Dental Medicine, Headache and Facial Pain Program, Department of NeurologyTufts Medical Center and Tufts School of MedicineBostonUSA

Personalised recommendations