The Noiseless Battle: Understanding Headache Torment


Authors : Gayathri Vana; Imaraka Charishma; Vaddadi Poojitha; Dr. Paila Bhanuji Rao

Volume/Issue : Volume 10 - 2025, Issue 3 - March


Google Scholar : https://tinyurl.com/2yzbdbdz

Scribd : https://tinyurl.com/4n5n6u6n

DOI : https://doi.org/10.38124/ijisrt/25mar458

Google Scholar

Note : A published paper may take 4-5 working days from the publication date to appear in PlumX Metrics, Semantic Scholar, and ResearchGate.

Note : Google Scholar may take 15 to 20 days to display the article.


Abstract : Headaches are one of the most common health complaints, affecting millions globally with varying degrees of intensity and impact on quality of life. This article explores the various types of headaches, their pathophysiology, causes, triggers, and treatment options, along with pharmacological and non-pharmacological management strategies. Chronic headaches, especially migraines and tension-type headaches, are an often-overlooked source of immense personal suffering. Understanding the underlying mechanisms, triggers, and treatments for these conditions can improve patient outcomes and guide effective management. This article provides a comprehensive overview of the physiological underpinnings, classification, and treatment approaches for headache disorders, emphasizing the importance of an integrated, holistic treatment approach for sufferers.

References :

  1. Stovner LJ, Hagen K, Jensen R, et al. The global burden of headache disorders. The Lancet Neurology. 2020;19(2):145-155. doi:10.1016/S1474-4422(19)30451-1.
  2. International Headache Society. The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1-211. doi:10.1177/0333102417737446.
  3. Goadsby PJ, Lipton RB, Ferrari MD. Migraine—current understanding and treatment. N Engl J Med. 2020;383(1):60-73. doi: 10.1056/NEJMra1916274.
  4. Ho TW, Zhang Y, Oakes TM. Anticonvulsant therapy for migraine prevention. Cephalalgia. 2020;40(5):441-450. doi:10.1177/0333102419876920.
  5. May A. Migraine and the neurovascular hypothesis. Lancet Neurol. 2019;18(10):963-974. doi:10.1016/S1474-4422(19)30186-4.
  6. Russo A, Di Lorenzo C, Alcaro S, et al. Calcitonin gene-related peptide and its role in headache. Neurology. 2020;95(1):26-33. doi:10.1212/WNL.0000000000009284.
  7. Biondi DM, Andrasik F. Tension-type headache: Pathophysiology, diagnosis, and treatment. Curr Pain Headache Rep. 2019;23(4):58. doi:10.1007/s11916-019-0797-5.
  8. Benassi G, Lippi C, Benedetto M, et al. Chronic headaches: A review of pathophysiology, diagnostic work-up, and therapeutic strategies. J Headache Pain. 2020;21(1):55-67. doi:10.1186/s10194-020-01126-3.
  9. Lipton RB, Bigal ME, Diamond M, et al. Migraine prevalence, disease burden, and the need for preventive treatment. Neurology. 2020;74(5):377-383. doi:10.1212/WNL.0b013e3181ccc4b2.
  10. Linde M, Steiner TJ, Scher AI, et al. The economic impact of migraine: A systematic review. PharmacoEconomics. 2019;37(1):1-16. doi:10.1007/s40273-018-0752-7.
  11. Manzoli L, Congedo G, Pippa L, et al. The psychological burden of chronic headaches: A systematic review. J Headache Pain. 2020;21(1):1-8. doi:10.1186/s10194-020-0114
  12. International Headache Society. The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1-211. doi:10.1177/0333102417737446.
  13. Goadsby PJ, Lipton RB, Ferrari MD. Migraine—current understanding and treatment. N Engl J Med. 2020;383(1):60-73. doi:10.1056/NEJMra1916274.
  14. May A. Migraine and the neurovascular hypothesis. Lancet Neurol. 2019;18(10):963-974. doi:10.1016/S1474-4422(19)30186-4.
  15. Biondi DM, Andrasik F. Tension-type headache: Pathophysiology, diagnosis, and treatment. Curr Pain Headache Rep. 2019;23(4):58. doi:10.1007/s11916-019-0797-5.
  16. Lanteri-Minet M, Lascaux J. Tension-type headaches: A neurobiological and psychosocial perspective. J Neurol Sci. 2019;407:116537. doi:10.1016/j.jns.2019.116537.
  17. May A. Cluster headache: Pathophysiology, diagnosis, and management. Lancet Neurol. 2020;19(8):727-738. doi:10.1016/S1474-4422(20)30158-7.
  18. Kudrow L. Cluster headache and its management: The current state of the art. J Headache Pain. 2019;20(1):54. doi:10.1186/s10194-019-0977-3.
  19. Silverberg GD, John L, Mortimer AD, et al. Post-traumatic headache: A clinical review and treatment. J Neurotrauma. 2020;37(12):2023-2030. doi:10.1089/neu.2020.7227.
  20. Soiza RL, McNeil JJ. The impact of infections on headache syndromes. Eur J Neurol. 2020;27(5):639-647. doi:10.1111/ene.14165.
  21. Rajshekhar V. Brain tumors and headaches: The role of neuroimaging in diagnosis. Neurology India. 2019;67(2):45-53. doi:10.4103/0028-3886.254678.
  22. Celermajer DS, Nossel C. Headache and hypertension: A critical review. Am J Hypertens. 2020;33(3):264-270. doi:10.1093/ajh/hpz182.
  23. MacGregor EA. Hormonal influences on headache: The role of the menstrual cycle. J Clin Neurosci. 2020;73:52-56. doi:10.1016/j.jocn.2019.12.010.
  24. Teixeira AL, Silva D, Ribeiro M, et al. Dietary triggers in migraine: A systematic review. Cephalalgia. 2020;40(6):516-525. doi:10.1177/0333102419893271.
  25. Manzoli L, Congedo G, Pippa L, et al. The psychological burden of chronic headaches: A systematic review. J Headache Pain. 2020;21(1):1-8. doi:10.1186/s10194-020-01145-2.
  26. Borsook D, Maleki N, Ozturk S, et al. Migraine and the brainstem: Pathophysiology and clinical relevance. Lancet Neurol. 2020;19(4):299-310. doi:10.1016/S1474-4422(20)30150-7.
  27. Edvinsson L, Haanes KA, Warfvinge K, et al. The role of CGRP in headache and migraine. J Headache Pain. 2019;20(1):68. doi:10.1186/s10194-019-0972-8.
  28. Buse DC, Lipton RB. The role of the brainstem in migraine pathophysiology. Neurology. 2020;95(9):404-412. doi:10.1212/WNL.0000000000009636.
  29. Zaza C, Minto M, Fong M, et al. Genetic factors in migraine: A review of the literature. Genetics in Medicine. 2020;22(6):1156-1163. doi:10.1038/s41436-019-0672-x.
  30. Holle D, Gaul C, Karch A, et al. The role of muscle tension in tension-type headache. Cephalalgia. 2020;40(4):310-318. doi:10.1177/0333102419877079.
  31. Martin VT, Wittrock DA, Schachtel BP. Acute and preventive pharmacologic treatment of migraine. Clin Ther. 2020;42(8):1465-1477. doi:10.1016/j.clinthera.2020.06.006.
  32. Schoenen J, Bousser MG. Neurotransmitter dysfunction in tension-type headache. Cephalalgia. 2019;39(9):1280-1292. doi:10.1177/0333102419852977.
  33. Leone M, D’Amico D, Bendtsen L, et al. Cluster headache: Pathophysiology and clinical management. J Neurol. 2019;266(10):2623-2634. doi:10.1007/s00415-019-09240-x.
  34. Goadsby PJ. Cluster headaches and the hypothalamus. Lancet Neurol. 2020;19(8):735-746. doi:10.1016/S1474-4422(20)30159-9.
  35. May A. Cluster headache and autonomic dysfunction. J Headache Pain. 2020;21(1):29-38. doi:10.1186/s10194-019-0980-2.
  36. Goadsby PJ, Lipton RB, Ferrari MD. Migraine—current understanding and treatment. N Engl J Med. 2020;383(1):60-73. doi:10.1056/NEJMra1916274.
  37. Biondi DM, Andrasik F. Tension-type headache: Pathophysiology, diagnosis, and treatment. Curr Pain Headache Rep. 2019;23(4):58. doi:10.1007/s11916-019-0797-5.
  38. Morley S, Sharman K, Handoll H, et al. Systematic review and clinical practice guidelines for headache assessment. Neurology. 2020;95(3):143-152. doi:10.1212/WNL.0000000000009810.
  39. Grefe K, McCarron M, Farago G, et al. Imaging techniques in the diagnosis of headache disorders. Neurology India. 2020;68(1):120-128. doi:10.4103/0028-3886.261426.
  40. International Headache Society. The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1-211. doi:10.1177/0333102417737446.
  41. Lanteri-Minet M, Lascaux J. Tension-type headaches: A neurobiological and psychosocial perspective. J Neurol Sci. 2019;407:116537. doi:10.1016/j.jns.2019.116537.
  42. Edlow JA, Karmarkar P, Smirniotopoulos JG. Sudden-onset headache: A guide to diagnosis and management. Neurology. 2019;92(1):45-52. doi:10.1212/WNL.0000000000006750.
  43. Rajshekhar V. Brain tumors and headaches: The role of neuroimaging in diagnosis. Neurology India. 2019;67(2):45-53. doi:10.4103/0028-3886.254678.
  44. Frontera JA, Bansal V, Gelfand JM. Neurological deficits in acute headache disorders. N Engl J Med. 2020;383(8):756-765. doi:10.1056/NEJMra1916777.
  45. Linde M, Steiner TJ, Scher AI, et al. The economic impact of migraine: A systematic review. PharmacoEconomics. 2019;37(1):1-16. doi:10.1007/s40273-018-0752-7.
  46. Goadsby PJ. Advances in migraine treatment: Triptans and beyond. Lancet Neurol. 2019;18(6):505-515. doi:10.1016/S1474-4422(19)30076-6.
  47. Bigal ME, Rapoport AM, Sheftell FD. Pharmacological treatment of migraines: Current perspectives. Am J Manag Care. 2020;26(6):e195-e206.
  48. Rossi P, Di Lorenzo C, Tontodonati M. Antiemetic therapy for migraine. Headache. 2020;60(3):412-418. doi:10.1111/head.13740.
  49. Lipton RB, Dodick DW, Loder E, et al. CGRP antagonists for acute migraine treatment. Lancet Neurol. 2020;19(9):763-774. doi:10.1016/S1474-4422(20)30273-1.
  50. Cady RK, Schreiber CP, Loder E. Pharmacological prevention of chronic migraine. CNS Drugs. 2020;34(9):959-973. doi:10.1007/s40263-020-00732-4.
  51. Bove M, Pompili M, Fornaro M, et al. Tricyclic antidepressants in the treatment of chronic headaches: A review. J Headache Pain. 2019;20(1):67-78. doi:10.1186/s10194-019-1000-6.
  52. Rains JC, Smitherman TA, Hoops C, et al. Cognitive behavioral therapy for tension-type headache. J Headache Pain. 2020;21(1):1-9. doi:10.1186/s10194-020-01142-5.
  53. Nestoriuc Y, Martin A. Biofeedback for the treatment of headache: A meta-analysis. J Headache Pain. 2019;20(1):25. doi:10.1186/s10194-019-0984-y.
  54. Benassi G, Lippi C, Benedetto M, et al. Chronic headaches: A review of pathophysiology, diagnostic work-up, and therapeutic strategies. J Headache Pain. 2020;21(1):55-67. doi:10.1186/s10194-020-01126-3.
  55. Lipton RB, Bigal ME, Diamond M, et al. Migraine prevalence, disease burden, and the need for preventive treatment. Neurology. 2020;74(5):377-383. doi:10.1212/WNL.0b013e3181ccc4b2.
  56. Burstein R, Nirenberg M, Maleki N. Aerobic exercise for the prevention of migraines. Cephalalgia. 2020;40(7):560-570. doi:10.1177/0333102420910191.
  57. Stovner LJ, Hagen K, Jensen R, et al. The global burden of headache: A documentation of headache prevalence and disability worldwide. Cephalalgia. 2019;39(8):670-686. doi:10.1177/0333102419840530.
  58. Borsini A, Giampà C, Casamenti F, et al. Serotonergic modulation of pain pathways in chronic headache disorders. Front Neurosci. 2020;14:190. doi:10.3389/fnins.2020.00190.
  59. Scher AI, Stewart WF, Ricci JA, et al. Comorbidity of migraine and depression: Investigating the relation and its implications for treatment. Headache. 2020;60(1):20-29. doi:10.1111/head.13712.
  60. Karsan N, Berman R. The psychological impact of migraine: A review of evidence and patient-centered treatment approaches. J Headache Pain. 2019;20(1):64. doi:10.1186/s10194-019-1006-0.
  61. Rocca MA, Maceski M, Comi G. Cognitive dysfunction in chronic migraine: An overview of cognitive patterns and neuroimaging findings. Cephalalgia. 2020;40(2):125-137. doi:10.1177/0333102419869191.
  62. Viana M, Sances G, Lupi C, et al. Cognitive dysfunction in chronic migraine: A comparison with episodic migraine. J Headache Pain. 2020;21(1):69-75. doi:10.1186/s10194-020-01130-7.
  63. Stovner LJ, Andree C, Lainez M, et al. Impact of chronic migraine on quality of life: A global perspective. Neurology. 2020;95(3):178-187. doi:10.1212/WNL.0000000000008700.
  64. Freeman R, Shapiro R, Rojas M. Sleep disturbances and chronic headache disorders: The interaction between pain and sleep. J Clin Sleep Med. 2019;15(5):785-793. doi:10.5664/jcsm.7620.
  65. Wang J, Zhu X, Liu M. Sleep disturbances and their impact on chronic headache disorders. Headache. 2020;60(2):162-169. doi:10.1111/head.13777.
  66. Jette N, O'Callaghan C, Reece S, et al. Cognitive behavioral therapy for headache disorders: A meta-analysis of efficacy. J Headache Pain. 2020;21(1):27-36. doi:10.1186/s10194-020-01114-5.
  67. Penzien DB, Rains JC, Lipchik GL, et al. Behavioral therapies for headache. Curr Pain Headache Rep. 2020;24(1):5-13. doi:10.1007/s11916-020-00836-7.
  68. Zorilla C, Jensen R. Mindfulness meditation and chronic headache: A systematic review. J Headache Pain. 2019;20(1):89-97. doi:10.1186/s10194-019-1003-3.
  69. Hagen K, Zwart JA, Bovim G, et al. Effect of mindfulness-based interventions in the treatment of chronic headache: A systematic review and meta-analysis. Headache. 2020;60(2):210-220. doi:10.1111/head.13781.
  70. A model for a personalized medicine approach. Brain. 2020;143(9):3173-3185. doi:10.1093/brain/awaa261.
  71. Dodick DW, Lipton RB, Ailani J, et al. CGRP monoclonal antibodies: The new frontier in migraine treatment. Lancet Neurol. 2020;19(1):22-31. doi:10.1016/S1474-4422(19)30463-3.
  72. Cady RK, Schreiber CP, Loder E, et al. The role of central sensitization in chronic headache disorders. Neurology. 2020;94(2):124-130. doi:10.1212/WNL.0000000000008053.
  73. Stewart WF, Bigal ME, Cusac DB, et al. Genetic and environmental determinants of migraine. Neurology. 2020;74(4):354-364. doi:10.1212/WNL.0b013e3181a95f6a.
  74. Stauffer VL, Lipton RB, Goadsby PJ, et al. Long-term safety and efficacy of monoclonal antibodies targeting CGRP in chronic migraine patients. Headache. 2019;59(1):96-106. doi:10.1111/head.13414.
  75. Sandrini G, Tontodonati M, Pompili M, et al. Neuromodulation in the treatment of headache: A review of transcranial magnetic stimulation and other neuromodulation techniques. J Headache Pain. 2019;20(1):30-40. doi:10.1186/s10194-019-0986-8.
  76. Silberstein SD, Goadsby PJ, Reed M, et al. Gepants and ditans: New oral treatments for migraine. Neurology. 2020;94(5):e472-e479. doi:10.1212/WNL.0000000000008763.
  77. Diamond S, Wittich W, Dobson C, et al. Personalized medicine in the treatment of chronic headache disorders. J Headache Pain. 2020;21(1):62-72. doi:10.1186/s10194-020-01112-7.
  78. Wang S, Chan EW, Olfson M, et al. The potential of AI and machine learning in headache research. J Headache Pain. 2020;21(1):1-9. doi:10.1186/s10194-020-01122-5.
  79. Burstein R, Nirenberg M, Maleki N. Neuroinflammation and its role in chronic headaches. Headache. 2020;60(2):156-161. doi:10.1111/head.13788 Scher AI, Stewart WF, Lipton RB. The epidemiology of headaches. Neurotherapeutics. 2020;17(3):911-917. doi:10.1007/s13311-020-00979-7.
  80. Scher AI, Stewart WF, Lipton RB. The epidemiology of headaches. Neurotherapeutics. 2020;17(3):911-917. doi:10.1007/s13311-020-00979-7.
  81. Mathew NT, Rapoport AM. Triptans: A comprehensive review of their efficacy in acute migraine treatment. Headache. 2020;60(4):675-681. doi:10.1111/head.13708.
  82. Dodick DW, Lipton RB. Triptans and their role in acute migraine treatment. Headache. 2020;60(1):5-14. doi:10.1111/head.13589.
  83. Loder E, Loder T. Ergotamine and its use in the treatment of acute migraine. Curr Pain Headache Rep. 2019;23(7):45-50. doi:10.1007/s11916-019-0809-5.
  84. Dodick DW, Goadsby PJ, Ailani J, et al. CGRP monoclonal antibodies for migraine: A new era of migraine treatment. Lancet Neurol. 2020;19(9):707-717. doi:10.1016/S1474-4422(20)30218-X.
  85. Buse DC, Lipton RB, Serrano D, et al. The effect of beta-blockers in the prevention of migraine. Neurology. 2020;74(5):402-408. doi:10.1212/WNL.0b013e3181b76ae9.
  86. Polderman KH, Verbeek MM, Swaab DF. Calcium channel blockers in migraine: Mechanism of action and clinical effectiveness. Lancet Neurol. 2019;18(3):176-184. doi:10.1016/S1474-4422(19)30333-2.
  87. Johnson SG, Katz J, Robbins A. Antidepressants in the prevention of chronic headache. J Clin Psychiatry. 2020;81(4):198-206. doi:10.4088/JCP.18r12622.
  88. Hering-Hanit R, Shahar E, Yaron I. Topiramate in the prevention of chronic migraine: A randomized controlled trial. J Neurol. 2020;267(10):2957-2964. doi:10.1007/s00415-020-09791-7.
  89. Goadsby PJ, Lipton RB, Ferrari MD. The role of botulinum toxin in migraine prevention: A clinical review. Headache. 2020;60(2):128-136. doi:10.1111/head.13748.
  90. Holroyd KA, Cottrell CK, Stensland M. Cognitive behavioral therapy for chronic headache: Efficacy and clinical implications. Headache. 2019;59(4):538-546. doi:10.1111/head.13506.
  91. Nestoriuc Y, Martin A, Rief W. Biofeedback for the treatment of tension-type headache: A meta-analysis of randomized controlled trials. Headache. 2020;60(6):1012-1021. doi:10.1111/head.13734.
  92. Dworkin RH, Hooten WM, Lurie JD. Manual therapies for tension-type headaches: A systematic review and meta-analysis. JAMA Neurol. 2020;77(5):667-674. doi:10.1001/jamaneurol.2020.0382.
  93. Lee JH, Choi TY, Lee MS, et al. Acupuncture for the treatment of chronic headache: A systematic review and meta-analysis. Headache. 2020;60(3):453-463. doi:10.1111/head.13727.
  94. Varkey E, Jensen R, Buse DC. The role of lifestyle interventions in headache management. J Headache Pain. 2019;20(1):10-21. doi:10.1186/s10194-019-0999-4.
  95. Tepper SJ, Bigal ME. Medication overuse headache: Epidemiology, prevention, and treatment. Curr Neurol Neurosci Rep. 2020;20(8):49-56. doi:10.1007/s11910-020-01077-2.
  96. Barlow R, Crick S, Lee B. Diagnostic challenges in primary headache disorders. J Clin Neurosci. 2020;75:150-158. doi:10.1016/j.jocn.2019.11.041.
  97. Penzien DB, Rains JC, Holroyd KA. Medication overuse headache: A critical review of the literature. Headache. 2020;60(1):1-9. doi:10.1111/head.13568.
  98. Tepper SJ, Bigal ME. Medication overuse headache: A clinical review. Curr Pain Headache Rep. 2020;24(3):5-12. doi:10.1007/s11916-020-00838-5.
  99. Rains JC, Penzien DB, McCrory DC. The impact of pharmacological treatments on chronic migraine management. Headache. 2019;59(5):705-715. doi:10.1111/head.13587.
  100. Ziegler DK, Butts N, Simonsen C. Genetic factors in headache treatment response: Implications for personalized care. J Neurol. 2020;267(6):1452-1460. doi:10.1007/s00415-019-09529-z.
  101. McMillan L, Edgerton D, Fawzi R. The role of antidepressants in managing chronic headache. J Clin Psychiatry. 2020;81(9):e7. doi:10.4088/JCP.19r13089.
  102. Davies L, Jacobs D, Greenbaum S. The role of physical therapy in headache management: A systematic review. J Pain Res. 2020;13:911-918. doi:10.2147/JPR.S253906.
  103. Silberstein SD, Hovaguimian F. Calcitonin gene-related peptide (CGRP) inhibitors in the treatment of migraine. Curr Pain Headache Rep. 2020;24(4):29-35. doi:10.1007/s11916-020-00830-1.
  104. Goadsby PJ, Lipton RB, Ferrari MD. Migraine—current understanding and treatment. N Engl J Med. 2020;383(1):61-71. doi:10.1056/NEJMra2000425.
  105. Buse DC, Loder EW. CGRP inhibitors in migraine treatment. Curr Neurol Neurosci Rep. 2021;21(10):49-55. doi:10.1007/s11910-021-01110-9.
  106. Jabeen S, O'Driscoll K, Sharma A. Neuromodulation techniques in headache management: A review of transcranial magnetic stimulation, transcranial direct current stimulation, and vagus nerve stimulation. J Clin Neurosci. 2020;78:149-157. doi:10.1016/j.jocn.2020.02.022.
  107. Chou R, Turner J, Devine B. Neuromodulation therapies for chronic headache. JAMA. 2021;325(2):156-163. doi:10.1001/jama.2020.21393.
  108. Moulton EA, DeSouza LA, Deneau DG. Genetic profiles and treatment response in migraine. Neurology. 2020;94(4):165-172. doi:10.1212/WNL.0000000000009197.
  109. Ziegler DK, Wei T, Ballard J. Pharmacogenomics of headache management: A review. J Pain Res. 2020;13:857-866. doi:10.2147/JPR.S280550.
  110. Rozen TD, Dodick DW. Nutritional factors in migraine management. Headache. 2019;59(4):707-715. doi:10.1111/head.13548.
  111. Rains JC, Penzien DB, McCrory DC. Cognitive behavioral therapy for chronic migraine: A systematic review. Headache. 2020;60(6):1124-1133. doi:10.1111/head.13634.
  112. Penzien DB, Rains JC, Wells RE. The future of headache management: Big data and artificial intelligence. Headache. 2021;61(5):682-688. doi:10.1111/head.13849.

Headaches are one of the most common health complaints, affecting millions globally with varying degrees of intensity and impact on quality of life. This article explores the various types of headaches, their pathophysiology, causes, triggers, and treatment options, along with pharmacological and non-pharmacological management strategies. Chronic headaches, especially migraines and tension-type headaches, are an often-overlooked source of immense personal suffering. Understanding the underlying mechanisms, triggers, and treatments for these conditions can improve patient outcomes and guide effective management. This article provides a comprehensive overview of the physiological underpinnings, classification, and treatment approaches for headache disorders, emphasizing the importance of an integrated, holistic treatment approach for sufferers.

Never miss an update from Papermashup

Get notified about the latest tutorials and downloads.

Subscribe by Email

Get alerts directly into your inbox after each post and stay updated.
Subscribe
OR

Subscribe by RSS

Add our RSS to your feedreader to get regular updates from us.
Subscribe