Headache is one of the most common problems. In the majority of cases it is annoying but otherwise quite a harmless problem. However, sometimes it can be a symptom of serious or even life-threatening diseases. It is simply not possible to list all conditions connected with headache emergence and this article is devoted only to those most common or most serious.


Headache cases can be divided for better understanding into primary and secondary. Primary headache can be considered as an individual disease like migraine, tension-type headache and cluster headache. Secondary headache is merely a symptom of another pathological condition.


Tension headache

This is probably the most common form of headache. It occurs during stress, fatigue and exhaustion. Is rather dull and can not be accurately localized. Skull muscles may play certain role as they get contracted and cause unpleasant pressure. Duration of pain is different; it may take minutes, hours, or even days. Treatment is difficult. It helps to better manage stress and to regularly perform relaxation exercises. Weaker anti-inflammatory drugs or muscle-relaxants may be used during pain attacks.


Migraine is a very common female disease with no clear cause. In addition to headaches it manifests as general irritability, intolerance to loud sounds and bright light, fatigue and inefficiency. Migraine is repeated in attack alternated with periods of calm. Many patients are able to recognize incoming attack prematurely. As a therapy we use standard anti-inflammatory drugs or modern and more effective anti-migraine drugs called triptans.

Cluster headache

This special clinical entity occurs mainly in men. These headaches emerge in rapid series with long asymptomatic periods. The cause is not completely clear. Pain usually occurs in one half of the head behind the eye. Triptans are effective like in migraines. During a pain attack oxygen inhalation proved to bring some relief.

Neck-related pain

This is again a very common cause of headache. Stiff neck muscles and blocked cervical spine may start relatively intense headaches. Technically this is referred to as CC syndrome (cervical-cranial or "neck-head" syndrome). Anti-inflammatory drugs, muscle-relaxants, bed rest and rehabilitation (cervical spine rehabilitation, massages) are the best ways of therapy.

High blood pressure

High blood pressure usually has no symptoms, but sometimes headaches, nosebleed or fatigue is observed.

Mineral or metabolic disorders

The vast majority of mineral concentration fluctuations is followed by headache, the same applies to dehydration and the accumulation of waste products and toxic substances in the body (such as by acute kidney failure, chronic kidney failure and liver failure). This group even includes the headache in hangover – a complex result of ethanol waste products accumulation, dehydration and mild hypoglycemia. Headache is also one of symptoms of lead poisoning and carbon monoxide poisoning.

Subarachnoid hemorrhage

This is one of the most dangerous causes of headache. Headache occurs suddenly and it is extremely strong. The most common cause is a sudden burst of a sac-shaped aneurysm of cerebral vessels. For that reason it is always important not to underestimate a sudden acute headache. Extensive bleeding into subarachnoid space is often fatal even with urgent correct diagnostic or treatment.

Increased intracranial pressure

It is usually accompanied by conditions associated with cerebral edema (brain swelling). The increase of pressure may occur for many reasons – primary brain tumors and metastases of other tumors, brain infections, subdural and epidural hematomas, extensive bleeding in the brain, etc.

Brain infections including meningitis

Inflammation of brain tissue (encephalitis) and meningitis cause not only headache, but also fever, photophobia and vomiting. Especially during meningitis there is a pain in the back of neck when bending head forward.

Increased body temperature

Any infection in the body, that is associated with fever, often manifests by a headache. Very strong headache is present by kidney infection (pyelonephritis). It could even mimic meningitis.


A headache might be present, but is not the most common symptom. Stroke causes more often muscle paralysis, impaired speech or impaired consciousness.

Head injuries

Most head and brain injuries are associated with pain. As the least serious injury of brain tissue can be described as a concussion, which is annoying, but not associated with any neurological disorder or finding on computed tomography of brain.

Diagnostic approach

It is important to distinguish between serious causes of headaches from banal ones. It is easy to say it, but in praxis it is often very challenging. The basic examination method is neurological examination supported by brain computed tomography or magnetic resonance imaging. In addition to imaging techniques it is advisable to check the basic physiological values that might have some relationship to headache – blood pressure measurement, blood test, etc.

Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Contact: jiri.stefanek@seznam.cz
 Sources: basic text sources