• SHARANYA MOGILICHERLA Department of Pharmacy Practice, Balaji Institute of Pharmaceutical Sciences, Laknepally, Narsampet, Warangal, Telangana, India.
  • POOJITHA MAMINDLA Department of Pharmacy Practice, Balaji Institute of Pharmaceutical Sciences, Laknepally, Narsampet, Warangal, Telangana, India.
  • DEEPTHI ENUMULA Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal, Karnataka, India.


Headache disorders, characterized by recurrent headache, are among the most common disorders of the nervous system. Headache disorder is classified mainly into two major types, primary headache and secondary headache by the International Classification of Headache Disorders. Most types of headache are diagnosed by the clinical history and from headache classification committee of the International Headache Society (IHS). A number of intrinsic or extrinsic factors can trigger headache attack which release neurotransmitters and activate trigeminal vascular system. The grading of headache intensity is done by headache severity scale of IHS. Headache management includes pharmacological and non-pharmacological treatment.

Keywords: Clinical history, International classification of headache disorders, International Headache Society, Primary headache, Secondary headache


1. Stovner LJ, Hagen K, Jensen R, Katsarava Z, Lipton RB, Scher AI, et al. The global burden of headache: A documentation of headache prevalence and disability worldwide. Cephalalgia 2007;27:193-210.
2. Terrin A, Toldo G, Ermani M, Mainardi F, Maggioni F. When migraine mimics stroke: A systematic review. Cephalalgia 2018;38:2068-78.
3. Bakal DA. Headache: A biopsychological perspective. Psychol Bull 1975;82:369-82.
4. Robbins MS, Lipton RB. The epidemiology of primary headache disorders. Semin Neurol 2010;30:107-19.
5. Kunkel RS. Migraine aura without headache: Benign, but a diagnosis of exclusion. Cleve Clin J Med 2005;72:529.
6. Silberstein SD, Lipton RB, Sliwinski M. Classification of daily and near-daily headaches: Field trial of revised IHS criteria. Neurology 1996;47:871-5.
7. Friedman DP, Finley KH, Graham J, Kunkle EC, Ostfeld AM, Wolff HG. From the National Institute of Neurological Diseases and Blindness. Classification of Headache 1962;12:378.
8. Yang FC, Chou KH, Kuo CY, Lin YY, Lin CP, Wang SJ. The pathophysiology of episodic cluster headache: Insights from recent neuroimaging research. Cephalalgia 2018;38:970-83.
9. Goadsby PJ, Raskin NH. Migraine and other primary headache disorders. In: Harrison’s Principles of Internal Medicine. 19th ed. United States: McGraw-Hill Education; 2015.
10. Goadsby PJ, Lipton RB. A review of paroxysmal hemicranias, SUNCT syndrome and other short-lasting headaches with autonomic feature, including new cases. Brain 1997;120:193-209.
11. Shah B, Pandey DR. Migraine. EJBPS 2017;4:226-30.
12. Elrington G. Migraine: Diagnosis and management. J Neurol Neurosurg Psychiatry 2002;72:10-5.
13. Headache Classification Committee of the International Headache Society (IHS). The international classification of headache disorders, 3rd edition (beta version) Cephalalgia 2013;33:629-808.
14. Ligthart L, Boomsma DI, Martin NG, Stubbe JH, Nyholt DR. Migraine with aura and migraine without aura are not distinct entities: Further evidence from a large Dutch population study. Twin Res Hum Genet 2006;9:54-63.
15. Jäger HR, Giffin NJ, Goadsby PJ. Diffusion and perfusion-weighted MR imaging in persistent migrainous visual disturbances. Cephalalgia 2005;25:323-32.
16. Schott GD. Exploring the visual hallucinations of migraine aura: The tacit contribution of illustration. Brain 2007;130:1690-703.
17. Schwedt TJ. Multisensory integration in migraine. Curr Opin Neurol 2013;26:248-53.
18. Cutrer FM, Huerter K. Migraine aura. Neurologist 2007;13:118-25.
19. Lord GD. Clinical characteristics of the migrainous aura. In: Amery WK, Wauquier A, editors. The Prelude to the Migraine Attack. London: Bailliere Tindall; 1986. p. 87-98.
20. Natoli JL, Manack A, Dean B, Butler Q, Turkel CC, Stovner L, et al. Global prevalence of chronic migraine: A systematic review. Cephalalgia 2009;30:599-609.
21. Ashina M. Neurobiology of chronic tension-type headache. Cephalalgia 2004;24:161-72.
22. Loder E, Rizzoli P. Tension-type headache. BMJ 2008;336:88-92.
23. Crystal SC, Robbins MS. Epidemiology of tension-type headache. Curr Pain Headache Rep 2010;14:449-54.
24. Ligthart L, Huijgen A, Willemsen G, de Geus EJ, Boomsma DI. Are migraine and tension-type headache genetically related? An investigation of twin family data. Twin Res Hum Genet 2018;21:112-8.
25. Silvers SM, Simmons B, Wall DS, Wears RL, Molzen GW, Suter RE, et al. Clinical policies committee and subcommittees, clinical policy: Critical issues in the evaluation and management of patients presenting to the emergency department with acute headache. Ann Emerg Med 2002;39:1.
26. Chowdhury D. Tension type headache. Ann Indian Acad Neurol 2012;15:83-80.
27. Cittadini E, Matharu MS. Symptomatic trigeminal autonomic cephalalgias. Neurologist 2009;15:305-12.
28. Goadsby PJ. Trigeminal autonomic cephalalgias. Contin Lifelong Learn Neurol 2012;18:883-95.
29. Matharu MS, Goadsby PJ. Trigeminal autonomic cephalgias. J Neurol Neurosurg Psychiatry 2002;72:19-26.
30. Trucco M, Mainardi F, Maggioni F, Badino R, Zanchin G. Chronic paroxysmal hemicrania, hemicrania continua and SUNCT syndrome in association with other pathologies. Cephalalgia 2004;24:173-84.
31. Peres MF, Silberstein SD, Nahmias S, Shechter AL, Youssef I, Rozen TD, et al. Hemicrania continua is not that rare. Neurology 2001;57:948-51.
32. Viana M, Tassorelli C, Allena M, Nappi G, Sjaastad O, Antonaci F.Diagnostic and therapeutic errors in trigeminal autonomic cephalalgias and hemicrania continua. J Headache Pain 2013;14:14.
33. Evers S, Goadsby PJ. Hypnic headache clinical features, pathophysiology and treatment. Neurology 2003;60:905-9.
34. NICE. Clinical Guideline (150); Headaches: Diagnosis and Management of Headaches in Young People and Adults. Israel: NICE; 2012.
35. Schankin CJ, Straube A. Secondary headaches: Secondary or still primary? J Headache Pain 2012;13:263-70.
36. Sjaastad O, Fredriksen TA, Petersen HC, Bakketeig LS. Grading of headache intensity. A proposal. J Headache Pain 2002;3:117-27.
37. Sivanandy P, Rosman AN, Shapheri AD, Chew TT, Lau NJ, Yeong MZ, et al. Comparison of efficacy and safety of newer drugs approved for the treatment of migraine disorder: A review. Int J Pharm Pharm Sci 2020;12:1-9.
38. El Hasnaoui A, Vray M, Richard A, Nachit-Ouinekh F, Boureau F, MIGSEV Group. Assessing the severity of migraine: Development of the MIGSEV scale. Headache 2003;43:628-35.
39. Kassem AA, Labib GS. Flash dissolving sublingual almotriptan malate lyotabs for the management of a migraine. Int J Pharm Pharm Sci 2017;9:125-31.
40. Muthyala N, Qadrie ZL, Suman A. Migraine and migraine management: A review. PharmaTutor 2018;6:8-17.
41. Johnston MM, Rapoport AM. Triptans for the management of migraine. Drugs 2010;70:1505-18.
42. Link AS, Kuris A, Edvinsson L. Treatment of migraine attacks based on the interaction with the trigemino-cerebrovascular system. J Headache Pain 2008;9:5-12.
43. Tfelt-Hansen PC. Triptans and ergot alkaloids in the acute treatment of migraine: Similarities and differences. Expert Rev Neurother 2013;13:961-3.
44. Negro A, Spuntarelli V, Sciattella P, Martelletti P. Rapid referral for headache management from emergency department to headache centre: Four years data. J Headache Pain 2020;21:25.
45. Penzien DB, Taylor FR. Behavioural and other non-pharmacologic treatments for headache. J Head Face Pain 2014;54:955-6.
46. Selby G, Lance JW. Observations on 500 cases of migraine and allied vascular headache. J Neurol Neurosurg Psychiatry 1960;23:23-32.
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How to Cite
MOGILICHERLA, S., MAMINDLA, P., & ENUMULA, D. (2020). A REVIEW ON CLASSIFICATION, PATHOPHYSIOLOGY, DIAGNOSIS, AND PHARMACOTHERAPY OF HEADACHE. Innovare Journal of Medical Sciences, 8(6), 1-12. https://doi.org/10.22159/ijms.2020.v8i6.37667
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