Headache (cephalgia)

Headaches can occur occasionally, in attacks or chronically. In most cases, headaches are passé and harmless. However, headaches can also be potentially dangerous (e.g. meningitis, subarachnoid haemorrhage) and a symptom of serious illnesses.

Over 90% of people with chronic or acute recurrent headaches suffer from a primary headache disorder. Often, neither the physical examination nor imaging provides any indication of an organic headache trigger. Secondary headaches are triggered by infections or traumatic brain injury, for example.

According to the International Headache Society (IHS), headaches can be divided into the following headache types depending on the cause:

• Primary headaches: The pain is the main symptom, there is no organic correlate or structural problem (e.g. insufficient blood supply to the brain).

• Secondary headaches: These are also known as symptomatic headaches. They are based on a disease or a triggering circumstance (e.g. stroke) that must be treated as a priority.

• Central and primary facial pain or other types of headache: Here the headache is triggered by nerve pain (neuralgia) and is felt in the areas supplied by the nerves.

Why some people suffer from primary headaches is not yet fully understood. It is possible that a genetic component plays an important role here. Known triggers for headache attacks are, for example: a change in the day-night rhythm, skipping meals, stress or being at high altitudes.

Primary headache disorders can be divided into

• Migraine

• Tension-type headache

• Trigeminal autonomic headache (e.g. cluster headache)

• Other primary headache disorders (e.g. primary stabbing headache)

If the diagnostic criteria for one of the primary headache types are not met or if the headache is acute or new, it must be assumed to be a symptomatic (secondary) headache. In this case, an in-depth medical diagnosis is necessary. As a rule, the physical examination findings or the medical history interview will already point the way.

Tension headache

Tension headaches occur episodically or chronically. The frequency ranges from occasional to daily. The pain usually affects the entire head or the forehead area. The character of the pain is described by those affected as dull, pressing, pulling, squeezing or non-pulsating. The intensity of the pain ranges from mild to moderate. No other accompanying symptoms occur in the course of a tension headache. Tension headaches are often triggered by muscular tension, climate change, lack of sleep, emotional stress and alcohol.

Migraine

Migraines can be divided into the following types:

• Migraine without aura

• Migraine with aura

• Chronic migraine

The aura symptoms (e.g. visual symptoms) usually precede the headache, but they can also occur during or after the headache. The duration of a migraine attack is often 4 to 72 hours, and attacks can occur occasionally or several times a month. Around 60% of migraines are localized on one side. The pain is pulsating, drilling or hammering. The intensity of the pain is usually described by sufferers as moderate to severe. Accompanying symptoms include hypersensitivity to sound (phonophobia), sensitivity to light (photophobia) and nausea or vomiting. Migraine attacks are often triggered by stress, hormonal fluctuations, certain foods and the climate. Another criterion for migraines is that attacks are often intensified by physical activity.

A headache can either be one of many symptoms of an illness or the only symptom of an illness.

The intensity of the pain can also vary greatly, ranging from mild to extremely intense. The pain can be perceived as dull, pressing, stabbing, pulsating or drilling. In some cases, the headache can occur in combination with nausea, nausea, sensitivity to noise and light or visual disturbances.

If a headache occurs for the first time or in combination with symptoms that are atypical for a primary headache, a symptomatic headache must be assumed.

Warning symptoms for the presence of a symptomatic (secondary) headache are

• severe headache occurring for the first time or for the first time

• Progression of the headache

• so-called focal neurological signs (e.g. stroke)

• signs of intracranial pressure (e.g. severe nausea)

• Neck stiffness (so-called meningismus)

• fever

• impaired consciousness

• Cerebral seizures

• Eye pain (e.g. in the case of glaucoma)

In most cases, a medical history and a thorough physical examination are sufficient to clarify headaches. However, in the case of abnormal symptoms (red flags) or persistent symptoms, further measures (e.g. imaging procedures) may be necessary. In most cases, no further diagnostics are indicated for headaches.

Important questions in the medical clarification of headaches are

• What exactly does the pain feel like?

• Where and since when does it hurt?

• Do you already have these symptoms?

• Do you have any other symptoms?

• Are you currently taking any medication?

The medical history should include the following points:

• Time (duration, frequency per month, course)

• Type of pain (localization, character, intensity)

• Accompanying symptoms (e.g. fever, nausea)

• Triggers or intensifiers (e.g. physical exercise)

• General medical history (e.g. nicotine or alcohol abuse)

Additional examinations in the search for causes of the headache include laboratory diagnostics (e.g. inflammation parameters), imaging procedures (e.g. magnetic resonance imaging, computer tomography) and other diagnostic measures (e.g. electroencephalography or cerebrospinal fluid puncture).

The treatment of headaches depends on the type of headache. If sufferers feel affected by the headache, painkillers such as acetylsalicylic acid (ASA), ibuprofen or paracetamol can be taken in the short term. Painkillers should only be taken for a short period of time (no more than 10 days a month and three days in a row). Relaxation exercises, such as progressive muscle relaxation according to Jacobsen, can help with stress-related headaches. Endurance training and stress management measures are also useful.

Migraine:

A combination of medicinal and non-medicinal measures can be helpful in treating migraines. If a pain attack occurs, rest in a darkened room, for example, can have a pain-relieving effect, as light and noise often make the situation worse during an attack. Movement can also lead to nausea and vomiting. For mild migraine attacks, for example, an anti-nausea medication (antiemetic) and a painkiller can be taken. Possible painkillers include paracetamol and anti-inflammatory painkillers (NSAIDs) such as acetylsalicylic acid, ibuprofen or diclofenac. Triptans (e.g. sumatriptan) are often used for severe migraine attacks. They take effect at the onset of the headache and also alleviate the typical accompanying symptoms such as nausea and vomiting.

Those affected by tension headaches can use a pain diary to identify the possible triggers of the headache attacks. Too frequent use of painkillers can also trigger headaches. For example, the diary should record when the headache started and how long it lasted. It is also important to record what you ate and drank and what medication you took. For women, the respective menstrual cycle should not be forgotten. This diary should be kept regularly for one to two months and then discussed with the doctor.

Some people benefit from relaxation exercises, endurance sports or yoga for headaches. Preventive therapy with beta-blockers can be helpful for migraines.

Home remedies:

If an acute headache occurs, it can be helpful to drink enough fluids. Water or tea are best for this, but coffee (caffeine) can also provide relief in some cases. Cool compresses or hot, moist compresses on the neck and forehead can often provide relief. Invigorating peppermint oil or tea tree oil applied to the temples can also be helpful in certain circumstances.

As described above, it is advisable to keep a headache diary if you suffer from regularly recurring headaches. This also helps the doctor to make a diagnosis and identify possible causes.

Accompanying symptoms, such as nausea or visual disturbances, are also important for a reliable diagnosis of the type of headache. In some cases, the causes can already be precisely identified, for example the consumption of certain foods such as coffee or alcohol, a prolonged stay in the cold or great emotional stress.

If pain medication is taken regularly, this should also be noted in the diary.