What are headaches?

Headaches are headaches that can be located anywhere. 90% of them are considered an isolated phenomenon and are called primary headaches. However, if they appear as a result of some disease, it is called secondary headache and they can be a reason for neurological consultation.

Among primary headaches, more frequent are the tension headache and migraines. Cluster headaches or headaches induced by cold, physical exertion, cough, or sexual activity (not associated with structural injuries) can also occur.

Why do headaches appear?

The mechanism of headache production is not exactly known. They know each other neural mediators implicated in migraine and cluster headache and some are known factors that can be triggers for some types of headaches. They can be produced by:

• Certain family predisposition
• Triggers (alcohol, menstruation, stress, fasting, and sleep disorders)
• Consumption of certain drugs

Behavioral disturbances, confusion, or seizures during headache suggest an expansive brain process and should be analyzed with special attention.

Types of headaches

Tension headache

It is usually a pain all over the head, oppressive, recurring, lasting up to a week but less severe than other types of headaches. They do not affect daily activities or sleep but respond poorly to treatment.

Cluster headache

Cluster headaches are the only headache that occurs most frequently in men between the ages of 30 and 40. Alcohol can trigger a crisis.

They are crises of very severe unilateral pain in the periorbital, accompanied by unilateral autonomic manifestations such as lacrimation, nasal congestion, edema and sweating. In cluster headaches, the intensity of the pain makes the patient unable to remain still and is in continuous movement. With treatment, they usually have a good prognosis.

migraines

migraines appear more frequently in women, with an age of onset between 10 and 30 years and they recur over time. They come in the form of throbbing pain in the middle of the skull along with vegetative symptoms such as nausea, vomiting, photophobia and sonophobia. In migraine, the patient seeks rest and tranquility, if possible, in a dark environment

migraines are headaches of high intensity like cluster headache. Sometimes the patient experiences symptoms that precede the crisis, called "aura«. They are alterations that can manifest in the form of light flashes, speech disturbances, sensory or motor disturbances.

Secondary headaches

Secondary headaches can have different causes: fever, neck pain, dental problems, pharmacological side effects, eye problems, sinusitis to brain tumors, cranial hypertension, meningitis and subarachnoid hemorrhage. Horton's arteritis also causes a secondary headache.

How are they diagnosed?

It is essential to carry out a complete questioning of the patient since the diagnosis of headaches is made based on their symptomatology. You should initially collect the family and personal history, especially the abuse of toxins and the use of drugs. You will be wondering about the characteristics of headaches:

• Form of onset (abrupt or progressive)
• Duration
• Triggers
• Duration and intensity
• Location
• Situations that make it worse or better
• Treatments used and the response to them
• Affection of the general state
• Changes in the type of headache,
• Neurological focus

A physical examination should also be performed with comprehensive neurological exam, you can even perform complementary tests such as the Brain CT and, in doubtful cases, a Brain MRI.

You can also request a analytical with determination of the sedimentation rate (ESR) if you want to rule out temporal arteritis and sinus x-ray if the trigger is suspected to be sinusitis or cervical spine involvement.

Identify if it is a primary or secondary headache

• If the headache is of sudden and intense onset, a subarachnoid hemorrhage, meningitis or migraine must be ruled out.
• Long-standing headaches usually correspond to tension headaches or migraines
• Those that awaken the patient at night are suggestive of cluster headaches, brain tumors, or migraines.

It influences the age at which they begin to manifest

• If it appears in people over 50 years old think of temporal arthritis, tumors or injuries due to increased intracranial tension.
• In younger patients they suggest a migraine or tension headache as usual.

Location also helps classify headache

• If the headache appears throughout the head (holocranial) it will be directed towards tension headache
• If the pain is hemicranial, towards a migraine
• If periorbital, towards a cluster headache
• If it appears in the area of ​​the temporal artery, it will be directed towards a temporal arteritis.

Is there treatment?

As a general rule, avoid low-dose drug combinations and drugs with codeine and caffeine due to the high frequency of chronic headache. Thus, there is a specific treatment for each headache.

• Tension headache: Non-steroidal anti-inflammatory drugs combined with paracetamol. Preventive treatment with amitriptyline may be indicated (if treatment is required more than 8 days per month).
• migraine: in mild to moderate cases metamizole and non-steroidal anti-inflammatory drugs (aspirin, naproxen and diclofenac). In severe attacks, use of intramuscular non-steroidal anti-inflammatory drugs or triptans (sumatriptan, rizatriptan, zolmitriptan…).
• Cluster headache: triptans (sumatriptan), 100% oxygen for 15 minutes. Preventive treatment with verapamil or prednisone can be started.
• Temporal arteritis: corticosteroids at high doses with progressive reduction.

Treatments should be started at the onset of seizures and as a general recommendation, the patient should be placed in a dark and noise-free environment.

The preventive treatment It begins when the seizures are very recurrent, of high intensity, with ineffective treatment and with significant interference in daily life. Drugs such as beta-blockers (propanolol, nadolol), calcium antagonists (flunarizine, verapamil), amitriptyline and naproxen (mainly in menstrual migraines) are used.