Headache

There is a growing tendency to suffer daily or almost daily headaches which affect the patient’s health and quality of life. Some people stop working or condition their travel plans for fear of being far from emergency care. The pain may not be serious, but it is very limiting. Headaches can be either a symptom or a disease and there are two types: Secondary headaches: are those in which the headache is a symptom and is present because of another condition. The patient has some medical condition that is causing a headache (between 5% and 10% of patients). Medical tests can reveal the cause. This type of headache is attributed to: cranial or cervical traumatisms, stroke, tumour, drug use, or infections. Primary headaches: these are the most common. There is no brain injury or underlying medical condition behind the pain. The symptom is the disease itself and there are no tests that can explain its presence. This is 90% of the cases and most of the headaches are not serious although they can be annoying for the patient. Types: migraines, tension headaches, periodic tension headaches and cluster headaches. Migraine: these last from 4 to 72 hours. Although less frequent than tension headaches, they are more limiting. These usually produce a pain located in the centre of the head that can end up in the eye. They affect 5% of men and 15% or 20% of women. More than 80% of patients have some degree of transitory disability linked to the pain crisis. Migraines may have a hereditary component that makes us more likely to have them. Women who have migraines, take contraceptives and smoke, are likely to have cardiovascular risks. There are certain foods that can cause migraines for certain people: chocolate, alcohol, some types of cheeses, sauces and fried food. Each person has their own food tolerance level. People who have at least 3 of these symptoms suffer from migraine: • When one side of the head hurts more than the other, although both sides may hurt. • The pain is pulsating. • Severe intense pain that prevents you from continuing with your activity. It can even awaken you at night. • Light and noise bother you. • Sensitivity to light, even without pain. • Chronic pain which lasts 15 to 20 days in a month. • Migraine with Aura: occurs when there are vision changes for 15 to 30 minutes, changes in speech or numbness of an arm preceding the onset of the headache. Tension headaches: these account for 63% of headaches. One can continue with an activity (unlike the migraine). Pain doesn´t increase with physical activity and is eased with muscle relaxants and analgesics. Generally, it lasts from 30 minutes to 7 days. Although muscle spasms are likely to occur with headaches, muscle spasms are not caused by headaches. Your genetics and environment can play a role: mental and physical stress. Muscle relaxants can be taken, combined with analgesics. Periodic tension headaches: These occasionally occur, especially in women and may be linked to the menstrual period, outside of which they don’t usually occur. Cluster headaches: Severe pain on one side of the head, usually behind one eye. The eye that is affected may be red and watery and a small pupil; stuffy nose; sweating on the forehead. These headaches occur in brief episodes that can go from minutes to 2 hours. They occur in series throughout the year, in different situations (some have it when the seasons change) and occur predominantly at night and in men. Trigeminal neuralgia: this type of headache can be confused with a cluster headache. Trigeminal neuralgia produces intense pain, also called neuralgia of the 5th cranial nerve. It is a pain on the face and may appear in one or more of the three branches in which the nerve is divided: upper, middle and lower branches, which divide the areas. Normally one of the branches hurts or two of them together. The pain is severe, brief, sharp, and lasts seconds, but comes and goes repeatedly. In the clinic we must rule out other causes: a blood vessel may be pressing on the trigeminal nerve. This is more common in people with multiple sclerosis. It can be diagnosed with an MRI (preferably) or a CT scan. When a patient comes to the consulting room with a headache, the first thing to do is to identify what type of pain you have, to know how to treat it since each pain will require a different treatment. The International Headache Society has studied and classified different types. When asked: “how do I distinguish the type of headache?”, it is important to know that most of the headaches are primary, it hurts a lot, but it is not caused by a brain injury or a serious illness. It is advisable to consult your GP when the headache suddenly becomes extremely intense or is accompanied by fever and vomiting. Consultation is recommended for headaches in the elderly and infants or when an altered neurological test is given. This article was made with information taken from a workshop on "Headaches " conducted by Dr. Diana Yorio and Dr. Alejandro Scaramelli at the hospital in 2017.