Headaches

Headaches are one of the most frequentl sufferings for people around the world. They cause significant changes in a person's quality of life, restricting the normal course of life, reducing work capacity or adversely affecting leisure opportunities.

Headaches are caused by pain signals – interactions between the brain, blood vessels and nerves in the head. During a headache, the pain signals are not transmitted from the brain, as most believe, but rather they come from the activated nerves around the skull, blood vessels and head muscles. For this reason, the diagnosis and treatment of headaches is a rather complex process, which depends on various important side factors and should be entrusted to a team specialists from several fields.

More information about the types of headaches is avaliable in the section Headache types.

Headache types

In the diagnosis and treatment of headaches, it is important to identify the type of headache or even the ways in which the patient suffers. The most common headaches are divided into two groups – primary and secondary headaches.

Primary headaches

Persistent headache as the main symptom, the origin of which is not related to health disorders or specific diseases. They tend to be very distressing with a tendency to recur relatively often and regularly, but are not life-threatening.

The most common primary headaches are migraine and tension headaches.

Migraine is a disease characterized by excruciating headache attacks, which often do not respond to conventional painkillers and last on average from 4 to even 72 hours. Migraine attacks can affect anyone, more often women and young people. Migraines affect an average of 13% of the world's population, with 4-12% children suffering from migraines. 

However, the mechanism of tension headaches has not been fully elucidated, it is considered to be multifactorial. Excessive tension, stress and fatigue are the main causes of tension headaches. They are contributed not only by emotional, but also physical factors – fatigue, incorrect posture, prolonged sitting at the computer. They may be due to muscle tension in the head. 

Symptomatic or secondary headache

A symptom that is most often caused by a serious illness that requires immediate, serious medical attention. Symptomatic headaches tend to be more life-threatening than primary headaches, but symptomatic headaches can be prevented if the cause is identified.

It is important that headaches are properly diagnosed, as the symptoms are often the same, both those that indicate a serious illness and those that are not life-threatening.

Migraine

Migraine is one of the most common primary headaches. It is a condition characterized by excruciating headache attacks, which often do not respond to conventional painkillers and last for an average of 4 to even 72 hours. Migraine attacks can affect anyone, more often women and young people. Migraines affect an average of 13% of the world's population, with 4-12% of children suffering from migraines.

During a migraine attack, four phases are distinguished: precursors, aura, headaches and residual phenomena.

Before the attack of the migraine there could be several symptoms, for example, mood swings, drowsiness, palpitations, depression and other. The next phase – aura – is experienced by one third of all migraine sufferers. Aura is characterized by peculiar sensations from 2 to 60 minutes before a migraine such as visual, sensory or speech problems.

During the headache phase, people usually experience the following symptoms:

• pain which lasts for several hours, but sometimes even several days
• the pain may be on one or both sides of the head (most commonly in the temples and forehead)
• the pain tends to intensify and become throbbing
• light, sound or smell creates a feeling of discomfort
• physical activity can be difficult
• particularly severe headaches may cause nausea and/or vomiting.

The last phase of migraine is a residual phenomenon that occurs after a migraine attack, lasts an average of one hour and manifests as weakness, increased irritability and sensitivity, drowsiness or apathy, and decreased ability to concentrate.

Migraine causes and provoking factors

The understanding of migraine's nature has changed significantly over the years with migraine being a disease associated with many physiological aspects, including the central nervous system, neurotransmitters, and other chemical compounds in the brain. Migraine is thought to be a neurovascular disease that affects both the vascular and nervous systems.

Using the latest technology, it has been discovered that activity increases in certain areas of the brain during migraine attacks. It has also been found that there is a decrease of gray matter in those parts of brain that are responsible for pain for people with migraine attacks.

An inherited combination of several genes

There is a relatively high chance of inheriting a migraine. Studies show that there are families with a specific combination of genes that are migratory attacks, but migraine inheritance can vary from generation to generation. Genes representing rare forms of migraine have been identified, while genes responsible for more common forms of migraine - have not.

Altered nerve impulses

The main nerves responsible for headaches are the trigeminal nerve and the occipital nerve. The first branch of the trigeminal nerve goes to the forehead and eyebrow area. From the branch moving to the upper jaw and lower jaw, a small branch goes up to the temples. In the back of the head the pain is related to the nerves in the neck. These are also the places where headaches are localized. And it is being studied how, by involving these nerve branches, the process that takes place in the substance of the brain that causes headaches. A practise for treating headaches involves stimulating the trigeminal nerve branches.

Lifestyle

Undeniable causes of migraines can be found in the lifestyle chosen by individuals. The progressiveness or even the onset of a migraine is the same as our minds, emotions and overall interactions with the environment. People with migraines are more emotional, more sensitive to irritation, stress, addictive substances, and sleep changes. The electrical activity in their brains is a little different.

There are also commonly observed triggers or triggers for migraine attacks that should be assessed individually to reduce the occurrence or intensity of migraine attacks:

• stress

• malnutrition or infrequent/missing meals

• specific foods (more often those containing caffeine, tyramine, alcohol, monosodium glutamate)

• sleeping disorders (too much or too little sleep, disrupted sleep, for example due to work shift schedules)

• hormonal factors (menstruation, birth control pills, hormone replacement therapy, menopause)

• excessive effort - both physical and mental

• surges of excessive emotions (such as tantrums or sadness)

• ambient conditions (loud noises, bright/flashing lights, strong odors, choked air, etc.)

• changes in weather conditions.

However, how a person perceives and lives with his or her illness is important. In most cases, migraines accompany people throughout their lives, but with a well-chosen regimen developed in collaboration with and adherence to specialists, migraines can be made significantly less frequent or less intense.

Tension headaches

Tension headaches are one of the most common types of primary headaches. The mechanism of this headache has not been fully elucidated, it is considered to be multifactorial. 

Excessive tension, stress and fatigue are the main causes of tension headaches. They are contributed not only by emotional, but also physical factors – fatigue, incorrect posture, prolonged sitting at the computer. They may be due to muscle tension in the head.

Headaches are pressing, dull, mild to moderate in intensity, usually bilateral. Patients sometimes describe headaches as a "pressing hoop around their head." The duration can range from 30 minutes to even 7 days.

Tension headaches can be rare episodic, frequent episodic or chronic, depending on the frequency. Chronic tension headaches are headaches that continue for more than 15 days a month for a period of at least 3 months.

Non-medical therapy has an important role in treatment of tension headaches – regular physical activity, physiotherapy, various relaxation exercises, psychotherapy, especially cognitive behavioral therapy (CBT). In case of chronic tension-type headaches, your doctor may recommend a course of preventive medication.

Symptomatic headaches

Symptomatic, also known as secondary headaches, tend to be more life-threatening than primary headaches, but symptomatic headaches can be prevented if the cause is determined. There are many different causes of secondary headaches:

1. Trauma. Concussion, contusion of the brain. Headaches can also appear after long-term injuries several years later. A stronger injury does not mean a stronger headache. It depends on how badly certain parts of the brain are damaged.

2. Diseases of various organs in head: eyes, ears, teeth, sinuses, tonsils, tongue, scalp, head muscles - everything in the head, except the brain. Many people experience intolerable ear and tooth pain when headaches are just one of the symptoms. Often headaches are caused by inflammation of the sinuses.

3. Infectious diseases. For example, flu or colds, including encephalitis and meningitis, etc. infectious diseases.

4. Metabolic disorders: thyroid diseases, other diseases of the endocrine glands.

5. Cardiovascular diseases. Various heart conditions that interfere with blood circulation in the heart and brain, such as stroke or bruising. Headaches can be combined with paralysis, sensory or speech problems.

6. High or low blood pressure. The pain is mostly localized in the occipital region. They can be smooth or pulsating.

7. Trigeminal neuralgia. The nerve provides sensation in the face, head and its fibers are also located in the roots of the teeth, meninges, so in case of inflammation, illness or injury, severe pain occurs. This pain is strong, firing, just like with electricity.

8. Drug-induced headaches. Headaches are associated with the use or withdrawal of medication. This group also includes alcohol, its use and hangovers. The annotations of many medications state that they can cause headaches, so their use should always be approached critically, and the benefits and harms should be evaluated.

9. Smoking marijuana. It can cause brain damage, causing headaches or even psychosis.

10. Mental illness. For example, depression, anxiety, neurosis.

Headache treatment

Headache treatment is not the easiest task, as it depends on various side factors, which often require the involvement of different specialists.

First of all, if one has complaints about headaches, he or she should immediately pay a visit to a family doctor, who assesses the general state of health, sends for tests and immediately prescribe the initial treatment.

However, there are cases when family doctor alone is not able to solve the patient's problem, so the next step is involving other specialists - a neurologist or an algologist (pain management doctor).

If necessary additional diagnostic examinations and consultations with specialists from other fields are prescribed. At the end of the visit, an individual treatment plan will be provided, including a comprehensive approach: reviewing lifestyle, regimen and eating habits, as well as choosing the most appropriate medications and procedures.

To make the visit and the treatment process even more effective, we recommend filling out the Headache Calendar beforehand and showing the findings to the doctor, as well as reading the section Preparing for the visit.

Headache calendar

Headache calendar can be useful for recording observations about headaches and migraine attacks – in particular how often do the attacks occur, how intense are they, what medications does the patient take, how much, how often, and so on.

The observations obtained will help:

• the doctor to make diagnosis and suggest the most appropriate type of treatment;
• to recognize the factors that provoke seizures and warning signs to prevent further seizures;
• assess whether the medications a person is currently taking are helping.

Preparing for the visit

The first visit to a specialist is important, because during this visit the doctor learns about the symptoms of your disease, and in turn, you understand the possible causes of the disease and the most effective treatment methods. For the visit to be successful, it is necessary to prepare for it, thus facilitating mutual cooperation.

Before the visit:

• Observe conditions that exacerbate or relieve headaches;
• Please take with you: examinations, tests, conclusions of other consultants (if any), hospital statements, list of medicines you are taking or have taken. Examinations made several years ago may also be useful, and may be important information for the doctor in diagnosing headaches and planning further examinations;
• Interview your immediate family members and relatives about your headache experience, as migraines are often inherited;
• Think about all the questions you want to ask the doctor.