Headache

What is a headache?

A headache is pain in any area of the head.

Headaches are a very common health problem and can:

• Occur on one or both sides of the head
• Be localized or diffuse
• Be chronic or episodic, depending on how frequently they occur
• Be primary, meaning they do not have an underlying cause
• Be secondary, meaning they are caused by another health issue or medication

Causes and symptoms of headaches

A primary headache is caused by overactivity or structural issues in the brain related to pain. Brain activity, nerves, blood vessels, and the muscles of the head and neck can all contribute to primary headaches.

Primary headaches include:

• Tension Headache: The most common type, diffuse, mild to moderate, often described as a tight band around the head.
• Cluster Headache: Occurs in cycles, lasting days to months, very severe, typically localized around or behind the eyes on one side of the head
• Migraine: Chronic, intense headache usually on one side of the head, lasting hours to days, often accompanied by nausea, vomiting, sensitivity to light and sound, severely impacting daily life.
• Migraine with Aura: In addition to typical migraine symptoms, visual or sensory disturbances appear before or during the headache, such as flashes of light, blind spots, or tingling in the face.
• Chronic Headache: If you have headaches more days than not, it may indicate chronic migraines, chronic tension-type headaches, or hemicrania continua.

Primary headaches may be triggered or worsened by factors such as alcohol consumption, lack of sleep, irregular meals, or stress.

A secondary headache results from an existing condition that activates pain-sensitive nerves in the head, such as acute sinusitis, hypertension, brain aneurysm, meningitis, or a benign/malignant brain tumor.

How is a headache diagnosed?

Accurate diagnosis is the most important step for proper headache management. A detailed medical history is usually sufficient for diagnosis, with most cases requiring no special tests.

However, in cases of secondary headaches, patients may show “red flag” symptoms requiring further investigation to identify the underlying disease. Common red flags include:

• Severe and explosive headache
• First-time headache in patients under 10 or over 50 years old
• New headache in a patient with a history of cancer
• New headache in a patient with HIV infection
• Gradually worsening headache
• Migraine with aura that differs in type or duration and is accompanied by motor problems

How are headaches treated?

Tension Headaches:

During the acute phase of a headache, simple painkiller like aspirin, or prescription drugs such as naproxen, indomethacin, and ketorolac are administered. In some cases, the doctor may prescribe triptans or opioid analgesics.

For preventive measures, tricyclic antidepressants, other antidepressants, muscle relaxants, and antispasmodic medications are often given to the patient.

Cluster Headaches:

During the acute phase Oxygen therapy via mask may relieve symptoms within 15 minutes. Triptans, octreotide, injectable dihydroergotamine, or inhaled lidocaine can be administered. Local anesthetic and corticosteroid injection around the occipital nerve (behind the 2nd cervical vertebra) may provide temporary relief.

As preventive measures, corticosteroids, calcium channel blockers, lithium carbonate are given to the patient.

Migraine and Migraine with Aura:

During the acute phase simple or prescription analgesics, triptans, injectable or inhaled dihydroergotamine, opioids, anti-nausea medications are administered.

Preventive measures in the form of antihypertensives, tricyclic or other antidepressants, or Botox injections are administered.

In addition to medication, chronic headaches may benefit from alternative therapies such as acupuncture and biofeedback, while psychological support for stress management is important, as stress can worsen the frequency and intensity of symptoms.

Did you know…

Tension headaches affect 60–80% of the general population, making them the most common type?
Migraine peaks in both sexes during the most productive years, 25–55 years?
Chronic migraine affects 2% of the global population?