The Skull, Brain and Associated Structures: Part II The Patient with a Headache

Abstract

Headaches are defined as the symptom of pain anywhere in the region of the head or neck. Like dizziness, they are one of the most common neurological problems which present to general practitioners and neurologists. They may also attend the emergency department. For many patients headaches can be painful and debilitating and are important cause of absence from work or school. It is important to appreciate that headache is only a symptom, and therefore it is not a diagnosis. Pain can arise from of a wide number of differing conditions involving the head, neck, eyes, face and beyond. Untreated hypertensive crisis, a systemic disorder, can result in severe pain. The brain itself is not sensitive to pain, as it lacks pain receptors. The sensation of pain is instead caused by the pain-sensitive structures sited around the brain. These include the periosteum of the skull, the meninges, muscles, nerves, arteries and veins, subcutaneous tissues, eyes, ears, sinuses and mucous membranes. Each of these structures can become irritated, diseased or deformed by a wide variety pathologies, resulting in a wide range of symptoms and underlying diagnoses. Pain can not only arise as a result of local pathology but can also be referred. This can make the diagnosis of headaches difficult.