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Shooting pain in the head is an important and worrisome symptom that should be addressed by a clinician especially if it becomes persistent or frequently repeated. Although patient's description provides important clues to the diagnosis, it cannot stand alone without clinical examination and medical imaging, which provide valuable information from a structure protected by the skull.

Shooting pain could be an uncommon presentation or solely a patient's description of a commonly benign headache such as, migraine, tension or cluster headaches, but, they can also be the symptom of an important disease such as an aneurysm or an infection, which should be closely assessed by a clinician.

An important cause for a shooting pain is bleeding. Bleeding might happen due to numerous conditions. It can happen after a mild trauma to the head or it might be the heralding presentation of important vascular diseases. Most notably are aneurysm (abnormal dilation of a vessel wall) and arteriovenous malformation (abnormal communication between arteries and veins).

Tumor is another culprit that can cause this type of pain. It does not have anything to do with the nature of the tumor i.e. benign (good and favorable) versus malignant (bad and unfavorable), rather the anatomical location of the tumor causes this symptom. Therefore, other lesions such as a cyst or a malformation (not normally shaped structure) can cause a shooting pain. The majority of these conditions are identifiable in brain imaging.

Increase blood pressure, known as hypertension, can cause this form of pain. The picture becomes more complicated when bleeding and hypertension accompany each other. This is frequently seen in clinical practice. Another factor that can accompany and complicate any other cause is an infection. Infection can also account for a similar pain by itself. The diagnosis of these conditions is also in need of imaging and performing laboratory tests.

A number of endocrine (organs secreting hormones within the blood) diseases can also cause a shooting pain in the head. Part of our endocrine system lies within our head and it can increase in size in the setting of a disease. Then it is behaving literally as a tumor. Other endocrine conditions mimic the presence of a tumor when there is in fact no real tumor in the head.

Finally, in a considerable number of people, no actual cause could be identified despite implementing all diagnosing methods. In these patients, the pain could be elicited due to a temporary change of the blood flow of the brain or a transient change in brain activity. Nevertheless, this cannot justify abandoning clinical examination and brain imaging that unveil important diseases that are in need of immediate care.

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