Some reflections on the etiologic role of depression in head pain.

TLDR: Though headache is common, it is relatively rare to find a single specific illness producing it, even though both the physician and the patient may have convinced themselves that they have, in fact, discovered the etiology in a particular case.

Abstract: THE PHYSICIAN confronted by the patient who complains of chronic face pain or headache not infrequently finds himself in a diagnostic and therapeutic morass. Headache is considered the commonest complaint for which a patient seeks medical aid; though, in truth, the manner in which that oft-quoted statement was obtained has so far eluded this writer. Suffice it to say that headache is an extremely common affliction, and that all physicians who deal with patients are familiar with it. Yet the genesis of an individual's head pain may be most elusive. The reasons for this are multiple. The brain is encased in the cranium and, therefore, relatively impervious to study except by the most indirect and gross methods. Sensation cannot be measured, and many patients describe their complaints poorly. Though headache is common, it is relatively rare to find a single specific illness producing it, even though both the physician and the patient may have convinced themselves that they have, in fact, discovered the etiology in a particular case. Furthermore, headache may be the most benign of symptoms or it may be the only expression of the most malignant of diseases. Some clinical categories of headache are precise and well-defined, but others are not. The patient with a brain tumor may describe his head pain in desultory terms. Patients with migraine may experience agonizing discomfort, yet migraine is usually (but not always) a benign disease.