symptoms

The pain can be located in one part of the head or it can affect the whole head more generally. The intensity of the pain is usually moderate or severe, and with certain frequency it can be incapacitating for the patient, forcing him to lie down and suspend all his activity. The frequency of the episodes is variable, ranging from one to four or five per month. The duration of a migraine attack usually does not exceed 24 hours, although they can be very brief (three or four hours) or very long (up to three days).

The type of pain that could indicate a headache is divided as follows:

• Electrical pain (cramp)
• Oppressive pain (like a helmet)
• Pulsatile pain (like a heartbeat)
• Terebrante pain (like a drill).
• Explosive pain.

Visibly, the following symptoms can be detected:

• Eyelid edema: more closed eyelids.
• Facial spasms
• Fallen eyelids.
• Anisocoria: differences between the dilation of the pupils.
• Lachrymation
• Redness of eyes
• Giddiness .
• Nausea and vomiting.

There are certain symptoms that also require a practically immediate visit to the doctor:

• Alterations in vision: (black spots, bright lights, visual distortion, double vision, etc.).
• Tingling sensation in arms and legs.
• Rashes.
• Dizziness and instability when standing up.
• Drooping eyelids or changes in the size of the pupil.
• Rigidity in the neck
• Fever.

Prevention

There are ways to prevent a headache from developing beyond what it should ; These are some of the recommendations:

• Try to lead an orderly life.
• Perform physical exercise as usual.
• Have healthy eating habits, taking more fruits and vegetables and avoiding fats.
• Avoid alcohol and tobacco.
• Avoid abuse of medication or caffeine.
• Request help for depressive symptoms, which can be a trigger for pain or aggravation.
• Go to the neurologist in front of any kind of unexpected pain.

Types

Broadly speaking, headaches can be divided between primary and secondary. Primary headaches , which account for 90 percent of all cases, are those in which the headache is the only symptom, while secondary headaches are those headaches that arise from a specific disease.

Migraines

The  migraine  or migraine is a  constitutional hereditary disorder with base is characterized by recurrent episodes of headache . It is located in a part of the head (hemicranial) or in the whole head, it has pulsating character with a throbbing sensation and it is accompanied by nausea and occasionally vomiting, as well as from an exaggerated discomfort due to the  lights  (photophobia) and  noise  ( phonophobia). Usually pain is triggered in relation to various stimuli such as stress, menstruation, certain drugs or foods, climatic changes or physical exertion. It is a pain that usually worsens with physical activity and improves with rest.

Tension headache

It is a type of primary headache. It occurs in the form of pain that is located in the occipital region of the head or forehead, sometimes reaching the cervical region. The pain is of moderate intensity (less than migraine) and is not usually accompanied by nausea, photophobia or phonophobia. Nor does it usually get worse with physical exercise. It is usually present all day and usually does not prevent the person from developing their usual physical activity. Some patients with episodic headaches begin to develop headaches with greater frequency and intensity, to the point of presenting them daily or most days. This situation is usually associated with a high consumption of analgesics and ergotics, which is favored by the broad and easy access that presents the consumption of these drugs, usually taken without medical prescription.

Tension headache is the most common of all headaches , grouping 78 percent of cases according to the Spanish Society of Neurology (SEN). Tension headache can last from 30 minutes to seven days, but most often lasts four to 13 hours.

The causes of a tension headache are not entirely clear: the term “tension” is usually used since it can be inferred that it may be caused by muscular or mental tension, but other types of factors are not ruled out:

• Environmental factors: Stress, anxiety or depression are usually associated with tension headache. These emotional factors can cause tension in the pericranial muscles.
• Genetic factors: If a person’s parents or siblings have had frequent episodes of tension headache, the chances of the person suffering from them also increase.
• Peripheral mechanisms: The increase of muscle sensitivity can affect the tension of the pericranial muscles, due to the overstimulation of the nociceptive receptors (nerve endings that transmit the painful sensation).
• Central mechanisms: When the neurons of the central nervous system are more sensitive than usual to stimuli are always interpreted as painful.

Chronic daily headache

It is also a type of primary headache. It represents a group of headaches characterized by the almost daily frequency of headache. They present headache more than 15 days a month for at least 3 months. In most cases, these patients have previously had migraine or tension headache. Frequently, they are associated with a high consumption of analgesics and ergotics, usually by self-medication.

Cluster headache

It consists of a headache that appears grouped during several days at certain times of the year. It is a very rare type of headache that only affects one in 1,000 people, and three times more frequent in men than in women.

They are pains that occur daily at the same time, of a duration between 15 and 180 minutes, and that can last a few weeks or months. They usually affect only one side of the head, in the orbital region near the eyes or the temple. As secondary symptoms they also present redness in the eyes, tearing, drooping of the eyelids and feeling of nasal congestion.

Other primary headaches

There are other headaches that are not due to a brain injury, although they are very rare, with less than one percent of all headaches.

• Headaches associated with physical exertion : They appear as an excess of physical activity. Some of these headaches are the primary or benign cough of the cough, due to physical exertion, associated with sexual activity or thunderclap headache (great intensity of pain in a very short time, due to efforts or changes in temperature).
• Headaches by direct physical stimuli : They can come from a cold stimulus in direct contact in the head, which is swallowed or inhaled; or by external pressure in the pericranial soft tissues (when pulling hair, for example).
• Epicranial headaches : They are classified as sharp headache or “ice pick” , which records pain similar to that of several brief pangs; or the nummular or coin-shaped headache , which registers pain in a very small area of ​​the scalp, about 2 to 6 centimeters in diameter.
• Hypical headache or alarm : It is a headache that only occurs during sleep, so that it interrupts.
• De novo persistent daily headache : It is a headache that appears suddenly for unknown reasons and persists without interruption.

Diagnosis

The doctor must make a careful clinical history asking about:

• The characteristics of pain (pulsatile).
• The location (hemicranial or frontal).
• The time of evolution of pain.
• The factors that trigger or aggravate it (menstruation, stress, etc.).
• The factors that alleviate it.
• Symptoms that are associated with pain (nausea, vomiting, photophobia, phonophobia) It is also necessary to ask if there are any symptoms that precede the pain, such as visual disturbances (bright lights, black spots, visual defects, alterations in sensitivity) , among others). Another question is about the family history, in case you have a relative who has headaches similar to yours (there is usually a history). Then a physical and neurological examination is performed (the examination of reflexes with a hammer, cranial auscultation with a stethoscope or the fundus examination, for example) can be highlighted.

Treatments

First, you must know what type of headache the patient suffers from. Pharmacological treatment when the pain crisis occurs consists of  beta-blockers  and  anti-depressants and  anti-inflammatory analgesics  in the acute phase of the disease. These medications should not be taken for more than two days a week, because doing so can cause a chronic pain. Nor should drugs be combined with others.

For people whose headaches last more than two days a week, it is possible to resort to a preventive treatment based on taking antidepressants such as amitriptyline , lasting three to six months, or other preventive drugs from different pharmacological groups.

Relaxation techniques are another alternative to reduce pain, as well as eating a balanced diet. Other options that do not involve taking drugs are to try to follow some healthy habits : maintain a regular sleep schedule, exercise or avoid tobacco and alcohol.

Treatment of cluster headaches

The drugs will be used for cases in which headaches occur episodically. To treat the moments of crisis of pain, some medication of the family of triptans is prescribed , while for preventives, corticosteroids are recommended .

The Lithium is also effective against this type of headache, but its use should be very cautious because it could cause problems with kidney function, thyroid, causing diarrhea or mental confusion.

If the headaches do not stop with this type of treatment, we can resort to an intervention such as neurostimulation .

Other data

Although it is generally thought that the brain is the affected organ during a headache, the truth is that it is not , since the brain tissues are not sensitive to pain. The affected parts, in fact, correspond to the external structures of the brain: the trigeminal-vascular system, the brainstem or the cerebral cortex.

Forecast

The majority of headaches can be overcome without any type of problem . Treatments for primary headaches, the most common, have been shown to have a very high effectiveness and recovery with a very positive response. More complicated would be to determine the expectations of secondary headaches, since the cure of these will be connected to the treatment of the disease that caused it.

When should I contact a medical professional?

Most headaches can be cured by taking analgesics without the need for a prescription. However, if the headache is secondary (it has been caused by another disease), it is advisable to go to the neurologist to determine the best way to cure it.

In general, to determine when to visit a doctor, the following indications are followed:

• The pain is sudden and very intense.
• Chronic pain and has worsened with respect to previous episodes.
• Pain appears for the first time in older people who have not suffered it before.
• The pain causes to wake up at night.
• Pain always occurs on the same side of the head.
• The treatment to counteract the pain does not work.
• Pain prevents any habitual activity such as going to work or school.

Epidemiology

Headaches are one of the most frequent symptoms in the population . As a whole, it is estimated that between 73 and 89 percent of men have suffered some headache at some point in their lives; In the case of women, this percentage rises between 92 and 99 percent.

Tension headaches are quite frequent; The Spanish Foundation for Neurological Diseases estimates that between 30 and 78 percent of the population has suffered them at some time. They tend to occur more in women and, as age advances, they appear less frequently.