Mechanisms of headache.

It is thus evident that the mechanisms of headache differ widely from one syndrome or symptom complex to another. Both intracranial and extracranial structures may be involved. Knowledge of headache mechanisms is indispensable to the clinician charged with the management of his patient's complaints. Such knowledge should guide the investigations which may be required, and the treatment program to be instituted. As knowledge of headache mechanisms is broadened and our current concepts are altered, we can expect to learn more, not only about the complicated nature of the subject, but also about patients. Future research on headache will almost certainly concentrate on headache mechanisms and will be concerned with molecular mechanisms, immunity and the biochemistry of vascular mediators. That is as it should be, as the pursuits become increasingly focused and scientific. Yet it must also be emphasized that headaches occur, so far as we know, only in man, that they are unique to the human situation, and they cannot be understood without considering the personality, environment, and hopes and aspirations of the individual. In the end, many headaches will be seen to be a problem of inappropriate life adjustment, of poor tempo, a type of conditioned response evoked by the individual's attempts to deal with the vicissitudes of life. This "headache mechanism," so frequently a part of the human condition, will be understood by the perceptive physician as a symptom of his patient's dysfunction, and treated accordingly.