Primary headache – causes and differential diagnosis

Abstract

It is estimated that 30–80% of the population in Europe and the United States experience frequent and recurrent headaches, the most common of which are tension-type, migraine and cluster headaches. Migraine can also overlap with tension-type headache, which is referred to as vasomotor or mixed headache. According to the 3rd edition of the International Classification of Headache Disorders (ICHD-3 beta), these entities are classified as idiopathic (primary) headaches, where pain is both the essence and the main symptom of the disease. Idiopathic headaches are difficult to diagnose as they differ mainly in intensity. When collecting medical history, the focus should be placed on the duration and location of pain. Therefore, a thorough interview to assess subjective pain intensity is one of the basic elements of the diagnostic workup. Tension-type headache, migraine and cluster headaches are also characterised by specific symptoms, identification of which is essential for the diagnosis. Cluster headache produces the most typical symptoms. Since these types of headaches require different therapeutic strategies, it is necessary to differentiate them. Their treatment requires interdisciplinary cooperation of, among others, dentists, neurologists, and physiotherapists. In this paper, we made an attempt to discuss the pathogenesis, symptoms and differential diagnosis of tension headache, migraine and cluster headache, based on literature review.