Centres of Excellence -> Neurology -> Headaches


Headache is pain in any part of the head, it can be unilateral or bilateral, specific localization or spreading diffusely, gradual onset or sudden onset, piercing or dull in character, it can last from a few seconds to an hour or even several days. It is the main cause of absenteeism from work and school and affects family and social life. The basic division of headaches is into primary and secondary headaches.

What are primary headaches?

Primary headaches are those that are not caused by another medical condition, the main cause of the problem is precisely the headache, which can be very intense, but not life-threatening. The most common primary headaches are:

  • Migraine is characterized by an intense stabbing or throbbing headache, usually localized on one side of the head and associated with nausea, vomiting and excessive sensitivity to light and noise. It can last for hours or days and have a significant impact on the quality of life. In some cases, the headache itself may be preceded by warning symptoms known as an aura, including visual symptoms (flashes, outbursts in the visual field) or other neurological symptoms (slurred speech, tingling, weakness in a part of the body, etc.). Medicines available today can help in the acute treatment of migraines and there are also medicines that can reduce the frequency of headaches. Acupuncture has also proven to be an effective therapeutic method and with a change in lifestyle, it is possible to significantly improve the quality of life of migraine patients.
  • Tension headache is a diffuse, mild to moderate headache that is usually described as a tight ring around the head. The treatment of tension headaches includes the application of healthy habits, effective additional treatment methods and, if necessary, medication.
  • Cluster headache occurs in cyclical periods and represents one of the most intense headaches. It usually occurs suddenly during the night, affecting the area around the eye on one side of the head. Frequent headache attacks in typical "cluster" periods can last for several weeks to several months, followed by remission when headaches do not occur. Available therapeutic procedures can reduce the frequency and severity of headaches.

What are secondary headaches?

Secondary headaches are associated with other medical conditions such as: disease of the blood vessels in the brain, head injury, high blood pressure, infection, excessive medication, sinus congestion, tumor, stroke, glaucoma, neuralgia and others.

  • Trigeminal neuralgia (TGN) is a condition that causes flashes of strong, sharp pain in the area of innervation of the trigeminal nerve - in the area of the jaw, eyes, scalp, forehead, which last about two minutes and can be triggered by touching "trigger" points on the cheek, e.g. when chewing, shaving or brushing teeth.
  • Occipital neuralgia is a type of chronic headache that involves throbbing or stabbing pain in the back of the head and upper neck, usually on one side only. Symptoms may also include sensitivity to light and painful sensitivity in the scalp area.
  • Temporomandibular subluxations are painful conditions in which the pain is caused by dysfunction of the joints that connect the lower jaw to the skull. The pain may be accompanied by symptoms of "skipping" or "scratching" when moving the lower jaw, feeling stuck and/or difficulty opening the mouth completely.

During the examination, the specialist neurologist plans further diagnostic processing and treatment by reviewing all the necessary anamnestic data and the clinical picture. It is necessary to describe the headache in detail by answering the following questions:

  1. What are the characteristics of a headache (dull, throbbing, stabbing, tightening pain)?
  2. How long does the pain last in one attack?
  3. How often do headaches occur?
  4. What is the intensity of the pain you feel (on a scale of 1-10)?
  5. Are there factors ("triggers") that cause headaches (food, caffeine, events, stress)?
  6. How much caffeine do you drink per day?
  7. Are you under increased stress?
  8. How and how much do you sleep?
  9. Do you have problems at work?
  10. Does anyone in the family have headaches?
  11. Are there any additional symptoms that occur between or during the headache (vision changes, flickering before the eyes, muscle weakness, nausea, sensitivity to noise and light, mood changes, loss of sensation, dizziness, instability, crises of consciousness, elevated temperature and others) ?
  12. Have you had a head injury, inflammatory diseases of the brain or any other neurological conditions?

After taking detailed anamnestic data, the neurologist will perform a neurological examination with the aim of determining any deviations in the neurological status that could point to a secondary cause of the headache. It is recommended to keep a headache diary with a description of the headaches, frequency of occurrence, possible provoking factors, the need to take analgetics and the duration of the headaches. In the further process of diagnosing headaches, the necessary neuroradiological processing (CT of the brain, MRI of the brain, MRI angiography of the blood vessels of the head) and other individually indicated tests will be planned. After reviewing all the available data, the neurologist will explain to the patient what form of headache it is and what is the further plan for treatment and possible prevention of headaches.

It is important to emphasize that if acute symptoms appear such as: the appearance of a sudden, very strong headache like never before, associated symptoms (epileptic seizures, elevated body temperature, behavior disorder, disorientation, visual disturbances, speech difficulties, muscle weakness or sensory disturbances ), headache after a head injury (especially if it worsens), chronic headache that worsens and changes its characteristics, new headache after the age of 50, it is necessary to urgently seek medical help.

Headache treatment includes an individual approach of planning a therapeutic protocol. Depending on the results of the requested treatment and the established diagnosis, if necessary, specific drug therapy is prescribed, which can be acute or preventive therapy with the aim of reducing the frequency of headaches. In the case of secondary headaches, the removal of the cause of the resulting headache is planned and carried out. The treatment plan includes discovering and then avoiding provoking factors causing headaches, including psychological support and the application of relaxation techniques, acupuncture, biofeedback and physical procedures.

Regular monitoring of patients with headaches is very important in order to achieve a satisfactory therapeutic response and ultimately improve the patient's quality of life.

Do not delay the examination, solve your headache problems as soon as possible. Arrange an appointment for examination!

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