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Classification according to ICD-10
R51 Headache,
facial pain N / A
ICD-10 online (WHO version 2019)

As headache or headache ( cephalalgia , Kephalgie , cephalalgia , Zephalgie , cephalea ) are painful sensations referred to the area of the head. They are based on the irritation of pain-sensitive head organs ( skull , meninges , blood vessels in the brain , cranial nerves or uppermost spinal nerves ). The actual brain substance (part of the central nervous system ) is not sensitive to pain. According to ICD-10 R50-R69, headache is one of the general symptoms .


Headache cartoon

In addition to back pain, headache is one of the most common health impairments: around 4–5% of the German population suffer from daily and around 70% suffer from seizure or chronic (recurring) headaches. In a large German study, around 60% of those questioned over 14 years of age said they had had a headache. It showed that women and residents of cities with more than 50,000 inhabitants often suffer from headaches.

More than 90% of headache disorders are attributable to the two primary forms of headache, migraine and tension headache , which can also occur in combination. The primary headaches also include cluster headache and drug-associated headache . They have in common that no visible correlate can be found with imaging diagnostics .

In primary headaches, the pain itself is the disease. Its cause is still not exactly known and therefore cannot always be eliminated. The prevention aims aim to avoid known triggers and factors for the development. The treatment consists in a rapid and sustained pain relief .

Secondary headaches, i.e. those that accompany another disease, are much rarer. However, they must be carefully monitored and their causes must be eliminated quickly if necessary. A cause of secondary headache can, for example, be a so-called craniomandibular dysfunction , in which tooth misalignment and misalignment of the jaws cause tension that can lead to headaches and back pain .


There are over 250 different types of headache known to today's medicine. In 2013, the third edition of the international headache classification was published in a beta version with 367 main diagnoses.

Until 1960 there was no international, accepted and uniformly used classification basis for headaches worldwide. It was not until 1962 that an ad hoc committee of the National Institute of Health published a classification of headache disorders for the first time. This classification was based on a primarily aetiological approach. Attempts were made to assign definable causes of headache to different diagnostic groups. The headache disorders were characterized by short glossary definitions. The International Headache Society (IHS) was founded in 1982. In 1985 the IHS set up a headache classification committee, which was supposed to develop an international, consensual headache classification. In subcommittees, operationalized criteria were drawn up on the basis of empirical findings and, if these were not available, on the basis of consensus building between the experts. In 1988, a headache classification based on such operationalized diagnostic criteria was published for the first time, the Classification and diagnostic criteria for headache disorders, cranial neuralgias, and facial pain, ICHD-1 . The World Health Organization (WHO) has adopted the headache classification of the International Headache Society and included it in the ICD-10 and ICD-10 NA (NA: Neurological Application). The 2nd edition of the International Classification of Headache Disorders (ICHD-2) was published in January 2004. The 3rd edition followed in July 2013 (IHS-ICHD-3 Beta).

Headaches are broken down on the one hand according to their cause and on the other hand according to their type, whereby the clinical subdivision is not strictly separated.

According to the cause

According to Art


Due to the many different forms of headache, the therapy is also very diverse. Various active ingredients are available for self-medication, which are derived from plants or synthetically.

  • Vegetable: The classic here is peppermint oil, it is applied externally, can be used from the age of 6 and also during pregnancy.
  • Tension headache: Tension headache therapy also includes heat applications, massages and stretching exercises. Tension headaches arise e.g. Sometimes when the tension in the neck muscles continues into the head area. In this case, it helps to loosen the muscles.
  • Migraine : In migraine therapy, you should always consult your doctor first as to whether it is really a migraine. Here, too, there are several active ingredients to choose from, a specific group of active ingredients are the triptans .

A doctor should be consulted in the case of attack-like headache, cluster headache, headache that lasts longer than 3 days, headache associated with nausea and vomiting, headache with impaired kidney or liver function, headache associated with the use of other medications and in children under 7 years of age become.

Less common forms of headache

  • benign cough headache : lasts less than 60 seconds; mostly present on both sides with a focus on the back of the head.
  • Benign exertion headache: In connection with (strong) physical exertion, bilateral throbbing headache, which is optionally accompanied by vegetative symptoms (nausea, vomiting), can last up to 24 hours.
  • (Post) coital headache : A dull, pulsating, bilateral, mostly occipitally localized headache during or after sexual intercourse can persist for minutes to days. The most important differential diagnosis that must absolutely be ruled out (through imaging tests and clinical examination) is subarachnoid hemorrhage .
  • Dialysis headache : Occurs during or after dialysis treatment and can be treated well with paracetamol.
  • Hemicrania continua describes a persistent, unilateral headache that responds well to indomethacin and acetylsalicylic acid.
  • Cold headache / "Ice-Cream Headache" is triggered by a cold stimulus on the palate and is a mostly temporally localized headache lasting 20 to 30 seconds. Colloquially called "brain freeze".
  • Dissection of extra- and intracranial vessels : headache with a localization characteristic of the dissected vessel: internal carotid artery (internal carotid artery) temporal and unilateral on the neck; Vertebral artery: at the back of the head, back of the neck; Brainstem artery (basilar artery): ringing around the entire skull. Dissections, v. a. the vertebral artery require immediate neurological clarification. Chiropractic therapy (straightening) must not be carried out if a dissection is suspected.
  • Post-puncture headache : Mostly position-dependent headache at the back of the head and / or forehead that occurs 24 to 48 hours after a CSF puncture.



Reference books


Web links

Wiktionary: headache  - explanations of meanings, word origins, synonyms, translations

Individual evidence

  1. Andreas Straube, Bernhard Aicher, Steffanie Förderreuther, Thomas Eggert, Janin Köppel, Stefan Möller, Roland Schneider, Gunther Haag: Period prevalence of self-reported headache in the general population in Germany from 1995-2005 and 2009: results from annual nationwide population -based cross-sectional surveys. In: The Journal of Headache and Pain. 14, 2013, p. 11, doi: 10.1186 / 1129-2377-14-11 .
  2. IHS Classification ICHD-2. Retrieved July 4, 2016 .
  3. ^ Website The International Headache Classification (ICHD-3 Beta) . Retrieved August 29, 2016.
  4. ^ Ad Hoc Committee on Classification of Headache: Headache Classification. In: Journal of the American Medical Association. No. 179 (1962), pp. 717-718.
  5. ^ Headache Classification Committee of the International Headache Society: Classification and diagnostic criteria for headache disorders, cranial neuralgias, and facial pain. In: Cephalalgia: an international journal of headache. No. 8 Suppl 7 (1988), pp. 1-96.
  6. Headache Classification Committee, Olesen J, Bousser MG, Diener HC, Dodick D, First M, Goadsby PJ, Göbel H, Lainez MJ, Lance JW, Lipton RB, Nappi G, Sakai F, Schoenen J, Silberstein SD, Steiner TJ: The International Classification of Headache Disorders 2nd edition. In: Cephalalgia: an international journal of headache. No. 24 Suppl 1 (2004), pp. 1-160.
  7. ^ Headache Classification Committee of the International Headache Society (IHS): The International Classification of Headache Disorders, 3rd edition (beta version) Cephalalgia.  ( Page no longer available , search in web archivesInfo: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice. 2013; 33, pp. 629-808.@1@ 2Template: Dead Link / cep.sagepub.com  
  8. Jes Olesen: ICHD-3 Beta is published. Use it immediately.  ( Page no longer available , search in web archivesInfo: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice. In: Cephalalgia. 2013; 33, pp. 627-628.@1@ 2Template: Dead Link / cep.sagepub.com  
  9. ^ Website The International Headache Classification (ICHD-3 Beta) . Retrieved August 29, 2016.
  10. Patient guide "Treating headaches holistically" , accessed on July 3, 2014
  11. Therapy recommendations. on the website of the German Migraine and Headache Society
  12. ^ Herbert Gebler, Gerd Kindl: Pharmacy for practice . 6th edition. German Apotheker-Verlag, Stuttgart 2013, ISBN 978-3-7692-4790-9 .