Feeling and seeing headaches

The aim is to deepen our understanding of headache by three approaches. First, by trying to feel patients’ total experience by eliciting their symptoms in detail, and from their reactions to these experiences. Second, by trying to remember one’s own experience of headache, and observing a few patients during different headache types. Third, by attempting to see the different mechanisms of headaches by their sites of origin and their pathophysiology. Migraine, tension–type and cluster headache are the three headaches examined by these approaches. Migraine seems to arise from disturbances of the brain’s cortex followed by meningeal pain – hence is intracranial in origin. Tension–type headache seems to arise from extracranial muscles, although the pain derives from the fascia or tendons of those muscles; common sites are the masticatory apparatus and the neck – hence extracranial. Cluster headache remains a mystery although vasodilatation provokes, and vasoconstriction stops, attacks – hence vasomotor control is therapeutically valuable. It is concluded that we need more adventurous ideas to deepen our understanding of these and other headaches.