2. International Classification of Headache Disorders (ICHD)
Headaches
Primary Secondary

3.  A headache that is not caused by another
underlying disease,trauma or medical
condition.
 Accounts for about ninety percent of all
headaches.
secondary headache
 Caused by exogenous disorders

4.  TENSION TYPE HEADACHE
 MIGRAINE
 CLUSTER HEADACHE
 ATYPICAL FACIAL PAIN
 TRIGEMINAL NEURALGIA
 BENIGN PAROXYSMAL

5.  Ice pick
 Ice cream
 Exertional
 Cough
 Chronic paroxysmal hemicrania
 SUNCT(Short-lasting unilateral neuralgiform
head ache with conjunctival injection and
tearing)

6.  Intracerebral bleeding
 Raised intracranial pressure
 Infection
 Inflammatory disease
 Post-herpetic neuralgia
 Referred pain from other structures

7.  Stimulation of primary nociceptors
 Lesions in pain-producing pathways of
PNS&CNS

8.  Scalp
 Middle meningeal artery,
 Dural sinuses,
 Falx cerebri &
 Proximal segments of the large pial arteries

9.  The ventricular ependyma, choroid plexus, pial
veins, and much of the brain parenchyma are
not pain-producing.

10. Key structures involved
 Large intracranial vessels and dura mater
 Peripheral terminals of the trigeminal nerve
that innervate these structures
 Caudal portion of the trigeminal nucleus,
which extends into the dorsal horns of the
upper cervical spinal cord and receives input
from the first and second cervical nerve roots
(the trigeminocervical complex)
 Pain modulatory systems in the brain that
receive input from trigeminal nociceptors

12.  Trigeminal nerve
 First 3 cervical nerves
 Fascial nerve
 Glossopharyngeal and vagus nerve

14.  Distension,traction or dilatation of i/c or e/c
arteries.
 Traction or displacement of large intracranial
veins or their envelope.
 Meningial irritation & raised ICT.

15.  Compression ,traction or inflammation of
cranial or spinal nerves.
 Spasm ,inflammation & trauma to cranial &
cervical muscles.
 Disturbance of intracerebral serotonic
projection/activtn of brain stem structures.