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Mechanisms of headache

Authoring team

The physiological mechanisms that produce the subjective sensation of headache include:

  • skeletal muscle contraction e.g. tension headache
  • arterial dilatation:
    • extracranial, as in migraine
    • intracranial, as in nitrate vasodilators, hypertension, systemic infections
  • traction on arteries:
    • raised intracranial pressure
    • tumour
    • haemorrhage

  • traction or dilatation of venous sinuses, for example post-lumbar puncture headache

  • inflammation
    • extracranial, for example temporal cell arteritis
    • intracranial, for example meningitis

  • referred pain, for example disease of ears, sinuses, eyes, cervical spine - ankylosing spondylitis

  • psychogenic

MaassenVanDenBrink A, Ibrahimi K, Edvinsson L. Intracranial and extracranial arteries in migraine. Lancet Neurol 2013; 12: 847–848.

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