Headache clinic

Headache is defined as pain in any part of the head. It may be unilateral or bilateral, localized or diffuse, of gradual onset or sudden appearance, stabbing or dull in nature, and may last from less than an hour to several days. It is among the most common neurological conditions and, according to available data, headache is the most frequent diagnosis during an initial neurological examination (approximately 19%).

There are more than 150 types of headaches, but the main classification divides them into primary and secondary headaches.

Although the most common type of primary headache is tension-type headache, migraine is the leading reason for visits to the Headache clinic due to its significant impact on quality of life and the level of disability it causes. Cluster headaches occur in cyclical periods and represent one of the most intense types of headaches. They typically appear suddenly during the night, affecting the area around one eye on one side of the head. Frequent headache attacks in typical "cluster" periods can last from several weeks to several months, followed by remission during which the headaches do not occur.

Secondary headaches are associated with other medical conditions such as: cerebrovascular disease, head trauma, high blood pressure, infection, medication overuse, sinus congestion, tumor, stroke, glaucoma, neuralgias and others.

Who should visit the Headache clinic?

Candidates for a consultation at the Headache clinic include:

• Patients whose headache does not resolve with simple analgesics.
• Patients who experience side effects from taking analgesics.
• Patients who experience frequent headaches (four or more days per month).
• Patients who use analgesics for headaches more than eight days per month.
• Patients whose headaches significantly reduce their quality of life or interfere with daily activities.
• Patients with exclusively one-sided headaches.

Before deciding on treatment, it is important to rule out patients who exhibit so-called "red flags," which may indicate the presence of a serious or potentially life-threatening condition. These situations include:

• fever
• neurological deficit such as altered consciousness
• sudden-onset headache
• new-onset headache after the age of 50
• significant change in previously known headache characteristics
• headache triggered by changes in body position
• headache worsened by sneezing, coughing or physical exertion
• painful eye with tearing, pupil changes or drooping eyelid
• headache following recent head trauma
• headache in individuals with weakened immune systems

Evaluation and treatment of headache patients 

Treatment at the Headache clinic includes an individualized approach to planning the therapeutic protocol. Depending on the results of the requested work-up and the established diagnosis, specific pharmacological therapy is prescribed if necessary, including acute therapy aimed at suppressing the headache and preventive therapy aimed at reducing the frequency of headaches. In the case of secondary headaches, the treatment plan includes the elimination of the underlying cause of the headache.

In diagnosing the type of headache, the International Classification of Headache Disorders is also used, which defines all known headaches based on symptoms. Additionally, questionnaires are used to assess the impact of headaches on daily life (e.g. MIDAS for migraine, GAD-7, PHQ-9). Headache diaries and calendars are then used for monitoring and making treatment decisions.

Among other tests used in headache diagnostics, the most commonly performed are:

• laboratory testing (CBC, biochemistry, thyroid hormones)
• ophthalmological examination
• brain MRI with TOF angiography

All additional tests are recommended only if indicated by the medical history and neurological status.

The approach to headache treatment must be comprehensive, taking into account the patient’s lifestyle and treatment must necessarily include support in making lifestyle changes, primarily in maintaining proper sleep hygiene, healthy nutrition and regular physical activity.

Most common headache types diagnosed at the Headache clinic are: 

• migraine
• tension-type headache
• trigeminal autonomic cephalalgias (e.g., cluster headache)
• other primary headaches
• medication-overuse headache (MOH)
• cranial neuralgias (trigeminal, glossopharyngeal, occipital)

If you suffer from frequent or severe headaches, schedule an evaluation and begin treatment as soon as possible to prevent further complications.