Mechanisms of headache

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.