Headaches are one of the most common disorders of the nervous system. So-called primary headaches, i.e. those not caused by an underlying illness, are the most frequent, and include migraines, tension headaches and vascular facial algia. While migraines are generally confined to one half of the skull, they are pulsating and exacerbated by light and noise, and are often combined with nausea and/or vomiting. They are traditionally triggered by stress, certain odours or foods, teeth-grinding (bruxis) or sight problems. Tension headaches most generally affect both sides of the head and are constrictive, with no obvious associated factor, and usually occurring in a context of stress.

Vascular algia of the face, associated with unilateral headaches, are very intense and spasmodic; key elements associated with this condition include symptoms such as red eyes, watering eyes, and a nasal obstruction and/or runny nose restricted to a single nostril.

Unlike primary headaches, so-called secondary headaches are an expression of lesions such as a stroke, brain haemorrhages or tumours. They may also reflect an abnormal increase in intra-cranial pressure or may be the result of a neck problem. 

The final category is "neuralgia", which causes sharp pains, often in the form of electrical discharges, mainly affecting the face (trigeminal neuralgia) or the back of the head (occipital or Arnold’s neuralgia).

Given the numerous causes involved, the treatment of headaches requires an individualised approach, often based on the combination of several treatment options, including medication (standard pain-killers, triptans, anti-epileptics or anti-depressants, etc.), non-medicinal treatment (acupuncture, physiotherapy, lifestyle changes, etc.), injections or neurosurgery for cases of particularly resistant neuralgia or those that are resistant to appropriate medicinal treatments. 

In order to confirm the possibility of a primary headache, while not neglecting the possibility of a secondary headache, brain imaging, and especially a brain MRI scan, can be a valuable aid for patients whose  headaches are of recent origin or are unusual in terms of their characteristics, frequency or duration.