Headache
GENERAL ASPECTS
Approximately half of all adults have had a headache in the past year and it is one of the most common causes of disability in the world. In fact, it is estimated that nearly half of all adults have some active headache-causing disorder.
TYPES OF HEADACHE
The International Headache Society divides headaches into two groups: primary headaches and secondary headaches. Primary headaches are those headaches in which no alteration that justifies the pain is demonstrated; while secondary headaches are those headaches in which, by means of physical examination or complementary studies (analysis or head imaging tests), a specific cause of the headache is demonstrated.
In particular, in primary primary headaches several types can be distinguished:
It is the most common primary headache, affecting 40% of adults. The pain is almost always bilateral, of oppressive type and is sometimes described as the sensation of a helmet or of the head being surrounded by a band. Most of the time the pain intensity is mild-moderate and does not usually interfere with daily activities. The onset of pain is usually more gradual than in migraine. And once it starts it usually lasts from a few hours to a week. Sometimes it can persist for months or years.
It is characterized by recurrent episodes of headache, is less frequent than tension headache, and is estimated to affect 10-15% of adults. The pain is usually severe, localized on one or both sides of the head. At times the pain may be throbbing, as if the heartbeat were felt in the head, and is usually worse with light (photophobia), noises (phonophobia) and physical activity. Nausea and vomiting may occur and, once started, persists for several hours to 3 days.
Primary headaches are trigemino-autonomic headaches: cluster headache, paroxysmal hemicrania, continuous hemicrania, unilateral neuralgiform headache with conjunctival injection and lacrimation and unilateral neuralgiform headache with cranial autonomic symptoms.
There are also several types of secondary headaches:
- Headache attributed to trauma or injury to the head and/or neck.
- Headache attributed to cranial and/or cervical vascular disorder.
- Headache attributed to non-vascular intracranial disorder.
- Headache attributed to a substance or its withdrawal.
- Headache attributed to infection.
- Headache attributed to homeostasis disorder.
- Headache or facial pain attributed to disorder of the skull, eyes, ears, sinuses, teeth, mouth or other cranial or facial structures.
- Headache attributed to psychiatric disorder.
- Painful cranial nerve injuries and other facial pain.
HEADACHE DIAGNOSIS
Clinical history and neurological examination are the most commonly used methods for the diagnosis and treatment of headaches and, although there are different guidelines for the indication of diagnostic tests in headaches, they are not designed to replace clinical judgment when treating individual patients.
Most headache patients present with primary headaches. In these cases, by applying the diagnostic criteria of the International Headache Society, a clinical diagnosis can be made with reasonable confidence. However, in certain cases, it is necessary to perform complementary studies to exclude other possibilities.
TREATMENT
Depending on the type of headache there are different treatments:
Simple analgesics such as paracetamol or acetylsalicylic acid, or other anti-inflammatory drugs such as ibuprofen, naproxen or dexketoprofen are often useful. These drugs are suitable for short periods of time, because if taken frequently they can facilitate the chronification of pain. In cases where pain is frequent, prolonged treatment with drugs that relieve anxiety or depression (e.g. amitriptyline) may be appropriate. However, some patients improve with measures such as mild aerobic physical exercise, massage, meditation and relaxation techniques.
The first preventive measure to be considered is the convenience of modifying lifestyle because it has been shown that there are factors that increase the risk of migraine attacks such as obesity, sleep disorders, excessive consumption of coffee or analgesics, psychiatric disorders and a history of head and neck injuries. Treatment should be individualized and, once the first symptoms appear, it is advisable to start as soon as possible and to use the appropriate dose of the drug. In the case of nausea and/or vomiting, antiemetics and sublingual, nasal or subcutaneous drugs can be used.
Also, if migraine attacks are frequent (more than three per month), if they cause significant interference with daily activity, or if acute medications are ineffective, contraindicated or excessively consumed, preventive treatment can be used. These therapies include drugs, pharmaceuticals with natural ingredients, neurostimulation and psychological-behavioral treatment.
FREQUENT QUESTIONS
When to consult a physician for a headache?
Although most headaches are not the manifestation of a serious disease, a neurological assessment is advisable when they are sudden in onset, severe, accompanied by other neurological symptoms (e.g. visual disturbances, slurred speech, loss of strength), general symptoms (e.g. fever) or are frequent.
When to go to the emergency room for a headache?
A hospital emergency room should be consulted when the headache is of sudden onset, very severe and/or accompanied by other neurological symptoms (e.g. visual disturbances, slurred speech, loss of strength) or general symptoms (e.g. fever, vomiting).
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