Headache is a common symptom.
It is often associated with debility.
Headaches may be a primary disorder (migraine, cluster, or tension headache) or a secondary symptom of such disorder as acute systemic, intracranial or extracranial causes.
CAUSES OF HEADACHE
Systemic causes –
Anemia
Caffeine withdrawal
Fever
Hypercapnia
Hypertension
Hypoxia
Vasoactive Chemicals
Viremia
Intracranial
Arteriovenous malformations
Benign intracranial Hypertension
Brain Abscess
Encephalitis
Intracerebral Hematoma
Meningitis
Obstructive Hydrocephalus
Subarachnoid Hemorrhage
Subdural hematoma
Stroke
Vasculitis
Extracranial
Cervical Spine disorder
Dental Disorders
Giant Cell Arteritis
Galaucoma
Optic Neuritis
Sinusitis
TM Joint Disorders

MIGRAINE
The term migraine stems from Galen's usage of hemicrania to describe a periodic disorder consisting of paroxysmal blinding hemicranial pain, vomiting, photophobia, recurrence at regular intervals, and relief by dark surroundings and sleep.
A working definition - it is a benign recurring headache and/or neurologic dysfunction usually attended by pain-free interludes and often provoked by stereotyped stimuli.
Migraine may be identified by its activators (red wine, menses, hunger, lack of sleep, glare, perfumes, periods of letdown) and its deactivators (sleep, pregnancy, exhilaration).
more common in women; and there is a hereditary predisposition toward attacks.
CLINICAL SUBTYPES
Common Migraine
Benign periodic headache of several hours' duration, often attributed to ‘tension’ by its sufferers.
Common migraine is the most frequent headache type reported by patients.
Classic Migraine
Denotes the syndrome of headache associated with characteristic premonitory sensory, motor, or visual symptoms
The most common premonitory symptoms reported are visual, arising from dysfunction of occipital lobe neurons.
Scotomas and/or hallucinations occur in about one-third of patients and usually appear in the central portions of the visual fields.
A highly characteristic syndrome occurs in about 10 percent of patients - which begins as a small paracentral scotoma, that slowly expands into a "C" shape. Luminous angles appear at the enlarging outer edge, becoming colored as the scintillating scotoma expands and moves toward the periphery of the involved half of the visual field. It eventually disappears over the horizon of peripheral vision, the entire process taking 20 to 25 min. This phenomenon never occurs during the headache phase of an attack and is pathognomonic for migraine. It is commonly referred to as a fortification spectrum.
Basilar Migraine
Symptoms referable to a disturbance in brainstem function, such as vertigo, dysarthria, or diplopia, occur as the only neurologic symptoms of the attack.
They present with stereotyped sequence of dramatic neurologic events, often comprising total blindness and sensorial clouding, that is common among adolescent women.
These episodes begin with total blindness accompanied or followed by admixtures of vertigo, ataxia, dysarthria, tinnitus, and distal and perioral paresthesia.
In about one-quarter of patients, a confusional state supervenes.
The neurologic symptoms persist for 20 to 30 min and are followed by a throbbing occipital headache.
This basilar migraine syndrome is known to occur also in children and in adults over age 50.
An altered sensorium may persist for as long as 5 days and may superficially resemble psychotic reactions. Full recovery after the episode is the rule.
Carotidynia
The carotidynia syndrome, also called lower-half headache or facial migraine, is most common among older patients, with the incidence peaking in the fourth through sixth decades.
Pain is usually located at the jaw or neck, occasionally periorbital or maxillary pain occurs;
It may be continuous, deep, dull, and aching, and it becomes pounding or throbbing episodically.
There are often superimposed sharp, ice pick-like jabs.
Attacks occur one to several times per week, each lasting several minutes to hours.
Tenderness and prominent pulsations of the cervical carotid artery, and soft tissue swelling overlying the carotid, usually are present ipsilateral to the pain
Many patients also report throbbing ipsilateral headache concurrent with carotidynia attacks as well as between attacks.
Dental trauma is a common precipitant of this syndrome.
Complicated migraine
This term is used to describe migraine with dramatic focal neurologic features, thus overlapping with classical migraine.
It has also been used to describe a migraine attack that leaves a persisting residual neurologic deficit.
PATHOGENESIS
Current concepts of the pathogenesis of migraine focus on three mechanisms and anatomic regions.
First, there is a vasomotor component mediated by constriction or dilation of arteries within and outside the brain.
Second, there is a midbrain trigger, perhaps in serotonergic neurons of the dorsal raphe.
Third, there is activation of a trigeminal-vascular system, consisting of medullary neurons in the trigeminal nucleus caudalis that terminate on the walls of arteries and release vasoactive neuropeptides.
The role of each of these in the production of specific symptoms of migraine is unknown
It is possible that activation of any of the three may be sufficient for headache production, and that one mechanism may dominate in a particular migrainous syndrome.
The genetic basis of migraine is largely unknown.
Family studies indicate that genetic heterogeneity is likely to be present.
Genetic linkage analysis has been successful in one rare migraine syndrome, autosomal dominant familial hemiplegic migraine.
Autosomal Dominant Familial Hemiplegic Migraine
In this disorder, hemiplegia and hemisensory loss develop and persist for hours to days, after which headache supervenes.
In approximately half of the families, a mutation in a P/Q-type calcium channel 1-subunit gene located on chromosome 19 has been found.
TREATMENT
Nonpharmacologic Approaches
Patients with migraine do not encounter more stress than headache-free individuals.
Over-responsiveness to stress appears to be the issue.
Stresses of everyday living cannot be eliminated, lessening one's response to stress by various techniques is helpful for many patients, as long as these methods are practiced continually.
They include yoga, transcendental meditation, hypnosis, and conditioning techniques such as biofeedback.
CLUSTER HEADACHE
Raeder's Syndrome/ Histamine Cephalalgia/ Sphenopalatine Neuralgia
Episodic type is most common
characterized by one to three short-lived attacks of periorbital pain per day over a 4- to 8-week period, followed by a pain-free interval that averages 1year
The chronic form
may begin de novo or several years after an episodic pattern
characterized by the absence of sustained periods of remission.
Each type may transform into the other.
Men are affected seven to eight times more often than women;
Hereditary factors are usually absent.
The onset is generally between ages 20 and 50.
PATHOGENESIS
No consistent cerebral blood flow changes accompany attacks of pain.
The strongest evidence for a central mechanism is the periodicity of attacks
Existence of a central mechanism also is suggested by the observation that autonomic symptoms that accompany the pain are bilateral and are more severe on the painful side.
The hypothalamus may be the site of activation in this disorder.
The posterior hypothalamus contains cells that regulate autonomic functions
The anterior hypothalamus contains cells (in the suprachiasmatic nuclei) that constitute the principal circadian pacemaker in mammals.
Activation of both is necessary to explain the symptoms of cluster headache.
CLINICAL FEATURES
Periorbital, or, less commonly, temporal, pain begins without warning and reaches a crescendo within 5 min.
It is often excruciating in intensity and is deep, nonfluctuating, and explosive in quality; only rarely it is pulsatile.
Pain is strictly unilateral and usually affects the same side in subsequent months.
Attacks last from 30 min to 2 h; there are often associated symptoms of homolateral lacrimation, reddening of the eye, nasal stuffiness, lid ptosis, and nausea.
Alcohol provokes attacks in about 70 percent of patients but ceases to be provocative when the bout remits; this on-off vulnerability to alcohol is pathognomonic of cluster headache.
Only rarely foods or emotional factors do precipitate pain, in contrast to migraine.
There is a striking periodicity of attacks in most of the patients
At least one of the daily attacks of pain recurs at about the same hour each day for the duration of a cluster bout.
Onset is nocturnal in about 50 percent of the cases, and in that case the pain usually awakens the patient within 2 h of falling asleep.
TREATMENT
During the attacks, oxygen inhalation (9 L/min via a loose mask) is the most effective modality
15 min of inhalation of 100% oxygen is often necessary.
TENSION HEADACHE
Definition
Headache that lasts 30 min to 7 days
is nonpulsating,
mild to moderate in severity,
bilateral,
not aggravated by exertion,
and not associated with nausea, vomiting, or sensitivity to light, sound, or smell.
Patients frequently complain of poor concentration and vague nonspecific symptoms, in addition to constant daily headaches that are often vise-like or tight in quality and may be exacerbated by emotional stress, fatigue, noise, or glare.
The headaches are usually generalized, may be most intense about the neck or back of the head, and are not associated with focal neurologic symptoms.
Causes
co-morbid migraine,
mood disorders,
sleep dysfunction, and
anxiety states.
Treatment
Techniques to induce relaxation are useful and include massage, hot baths, and biofeedback.
Exploration of underlying causes of chronic anxiety is often rewarding.
More disabled patients require a multidimensional approach. 
Migraine is often associated with chronic tension headaches, so treatment overlaps.

HOMOEOPATHIC THERAPEUTICS
Important Remedies
AGAR,   ANT-C, ASAF, BRY, CHIN, COFF, GELS, IGN, IP, IRIS
NAT-M,  NUX-V, PHOS, PULS, SANG, SIL, THUJ, ZINC
Other Remedies
anac, arg-m, ars, asar, bell, cact, calc, calc-p, cedr, cham, cocc 
eup-per, glon, kali-bi, kali-p, nat-s, sep, spig, stram, sulph, tab, ther, valer
Agaricus
Dull headache; must move the head to and fro.
Headache > after stool or urine; headache with nose-bleed or thick mucus discharge.
Pain as from nail in right side of head.
Head is in constant motion.
Head drawn towards shoulders.
Antim crud
Aches from bathing in cold water or from disordered stomach < candy or acid wines fruits fats ascending stairs.
Tendency to take cold about head.
heaviness in forehead with vertigo, nausea and nosebleed.
Headache after stopped coryza.
Asafoetida
Headaches in occipital region, > stool.
Irritable and sensitive. Boring pain above eyebrows. Pressive pain from within outward.
Many symptoms appear while sitting and are better in open air. Touch better pain in head, on touch pains cease or change place. Worse after noise.
Bryonia
BURSTING; SPLITTING OR HEAVY crushing headache; frontooccipital region
< moving eyes, coughing, straining at stools etc.
Pain over left eye pressive going to occiput thence spreading over whole body.
DIZZY OR FAINT ON RISING UP.
Scalp very sensitive can not bear even a soft brush every hair pains.
Headache; from ironing; when constipated.
China
Bursting throbbing pain with throbbing of carotids.
Sensation as if brain were swashing to and fro causing pain;
bruised pain in brain more in temples.
Stitches from temple to temple.
Sore sensitive scalp < touching or combing hair.
Headache < in sun > by moving head up and down, hard pressure and rubbing.
Coffea
Seems as if brain were torn to pieces shattered or crushed.
As if a nail were driven into the head.
Head feels too small.
Feels and hears a cracking in vertex.
Temples throbbing with burning in eyes.
Worse - Noise; Touch; Air - open cold windy; Mental exertion; emotions; Overeating; Alcohol; Night; Narcotics; Strong smells.
Gelsemium
Dull HEAVY or band like headache; around the occiput to over eyes < tight cap > shaking, lying with head high, after profuse urination.
Swollen feeling in head. Can not hold erect.
Pressure pain from the vertex to shoulders.
Pain in temples extending into ear, wing of nose and chin.
Soreness of the scalp.
Head hot with cold limbs.
Migraine begins at 2 or 3 am.> in the afternoon.
Ignatia
Head ache as if a nail were driven out through the sides, end in yawning and vomiting; alternate with backache.
Headache < or > by stooping.
Throws head backwards; from weight at occiput
Loud talking < headache.
Headache from abuse of snuff, tobacco smoke, coffee, from close attention.
Iris versicolor
Aches begin with blurring of vision.
Sick headaches with diarrhoea.
Shooting in temples with contractive feeling of the scalp.
Headache with mental exhaustion (studying, sewing) < coughing, cold air, > gentle motion.
Pulsatilla
Head aches from overwork, suppressed sexual excitement, indigestion, starts in vertex.
Occipital ache < coughing.
Semilateral headaches pulsating, bursting; with scalding lachrymation on the affected side.
Profuse sweat on scalp.
Headache of school girls at the time of puberty.
Headache > walking in open air.
Head seems heavy can not hold upright can not raise it.
Sanguinaria
Pain over right eye or ASCENDING FROM OCCIPUT TO OVER RIGHT EYE.
Hemicrania increases and decreases with the sun.
Distension of veins in the temples.
Pain in the occiput like a flash of lightning.
Headache if he goes without food.
Headache >sleep vomiting and after copious flow of urine.
Silicia
Periodical headaches. Ascending occipital pains > pressure.
Headache followed by blindness.
Vertex throbs with profuse sweat on head.
Profuse urination > headache.
Headache < by exertion study noise motion jar light cold air talking and straining at stools and > by wrapping warmly and pressure.
Headache while fasting or when not eating at proper time.
Chronic headaches since some severe disease.
Zincum met
Meningitis. Headache of varying intensity.
Pressive pain over vertex; at the root of the nose; extending to eyes with weak vision hard pressure and open air.
Heavy aching pain in temples
Dragging down back from occiput as of a blow on occiput then weak legs.
Crashing in head on falling to sleep. Rolls head; bores in pillows and grinds teeth.
Occiput hot forehead cold.
Headaches of overtaxed school children; Headache with dim vision < heat, from drinking small quantity of wine.

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