What Can It Tell You?

The location of your head pain can be an important clue in determining what type of headache you have and the potential remedies.

Headaches are very common. In fact, it’s estimated that about half to three quarters of adults have experienced some type of headache within the last year.

Chronic headache, which means 15 or more headache days every month, affects between 1.7 to 4 percent of adults.

Let’s take a closer look at the most common types of headaches based on location, as well as when it’s important to seek medical care.

The whole-head headache can feel like there’s a tight band around your head. This often indicates a tension headache, the most common primary headache disorder.

However, it’s important to point out that there are times when migraine pain can be holocranial. This means the pain can be felt around the head instead of just on one side.

With a tension headache, pain and pressure may extend to your neck, and you may also feel pain and tenderness around your forehead.

Tension headaches are caused by muscle contractions in your head and neck. This type of headache tends to last a few hours, but can linger for days.

A tension headache can be caused by stress or neck problems. However, you might also have an all-over headache from:

• caffeine withdrawal
• physical exertion
• hunger
• hangover
• fatigue
• having a cold or flu
• head trauma
• eye strain or staring at a computer for too long
• using too much headache medicine, also known as rebound headache

An occasional tension headache doesn’t typically require medical attention. Do see your doctor if you experience 15 or more headache days per month.

Migraine

Whether it’s the left side or the right side, one-sided head pain often indicates migraine.

Migraine is a primary headache disorder that causes recurrent attacks. Symptoms of migraine typically include:

• throbbing, pulsating pain
• nausea or vomiting
• aura
• noise, light, and odor sensitivities
• difficulty focusing

Migraine can be caused by a variety of contributing factors, including changes in brain chemicals. In particular, a decrease in serotonin levels.

Many other factors may also trigger an attack, such as:

• loud sounds
• bright or flashing lights
• specific odors
• certain foods
• changes in weather conditions
• lack of sleep
• hormonal changes
• skipping meals
• dehydration

These triggers vary from person to person. It can even be a combination of factors that bring on an attack. It’s not always possible to identify triggers.

Cluster headache

Cluster headache is another primary headache disorder that causes pain on one side of the head.

The pain is often located behind or around one of your eyes. In some cases, the pain may spread to your forehead, side of your head, nose, neck, or shoulders on the same side.

Cluster headaches tend to occur in cycles or, as the name suggests, “clusters.” You may experience headaches for a few weeks or months, followed by a remission period.

These headaches often come on suddenly and the pain usually becomes severe within about 10 minutes of starting.

Some common symptoms of a cluster headache include:

• burning, stabbing pain behind or around one eye
• a red, teary eye
• a smaller, constricted pupil
• a drooping eyelid
• puffiness under or around one or both eyes
• runny or stuffy nose
• facial flushing
• feeling restless

Once you get the right diagnosis, migraine and cluster headaches can be treated and managed.

Medication overuse and head trauma can also cause pain on one side of the head.

A headache behind your eyes and nasal passages can be due to allergies, such as hay fever, which can also produce symptoms similar to that of the common cold.

However, true sinus headaches tend to be rare. These headaches usually turn out to be migraine, which can cause pain over the sinuses.

A headache behind your eyes is rarely related to eyestrain.

If you think you’re having sinus headaches, consider seeing your doctor to get a diagnosis. Your doctor can help determine if your headache is truly caused by allergies, or if it could be migraine.

Pain in the back of your head can be due to arthritis of the neck. Pain tends to get worse when you move.

This type of headache can also be due to poor posture or neck problems such as a herniated disc.

A back of the head headache, often accompanied by neck pain, can also be a sign of a low-pressure headache, otherwise known as spontaneous intracranial hypotension (SIH). It’s caused by low spinal fluid pressure in the brain.

Another sign of SIH is that the pain eases when you lie down, but worsens when you:

• sit upright
• stand
• cough or sneeze
• strain
• engage in physical activity

This type of headache can occur following a lumbar puncture. If you’ve recently had this procedure and develop a headache, see your doctor as soon as possible for treatment.

If you have any type of chronic headache, it’s a good idea to contact your doctor or healthcare provider. Headaches are considered chronic if they happen 15 days or more per month.

By identifying your specific type of headache, your doctor can determine the best type of treatment. Getting the right kind of treatment for your headache may help improve your overall quality of life.

Sometimes, a headache can indicate a more serious medical condition such as:

• aneurysm
• stroke
• meningitis
• encephalitis (inflammation of the brain tissue)
• brain tumor

Signs that you may need immediate medical attention for a headache include:

• sudden onset of severe headache
• a rigid neck
• double vision
• weakness or paralysis on one side of your body
• numbness on either side of the body
• balance and coordination problems
• speech difficulties
• high fever
• lethargy
• reduced or altered consciousness level
• hallucinations

Everyone is different, so it may take some trial and error to figure out what works best for your headaches.

Here are some ways that you may be able to help ease your headache pain with self-care:

• Lie down in a dark, quiet room. Take a nap if you can.
• Apply ice or a cold compress to the area that hurts. Some people find that heat works better.
• Drink water to stay hydrated.
• Do some deep breathing exercises.
• Take over-the-counter (OTC) nonsteroidal anti-inflammatories as directed. Be careful, because taking too many can lead to rebound headaches.
• Drink a little caffeine.

For chronic headaches, your doctor may prescribe medications based on the specific type of headache you have. These medicines include:

• triptans
• ergot derivative drugs
• combination analgesics and caffeine

Preventive medications for chronic headache include:

• anticonvulsants
• beta-blockers
• calcium channel blockers
• calcitonin gene-related peptide (CGRP) antagonists
• onabotulinumtoxinA (Botox)
• selective serotonin reuptake inhibitors (SSRIs)
• serotonin-norepinephrine reuptake inhibitors (SNRIs)
• tricyclic antidepressants

The area of your head that hurts can tell you something about the type of headache you’re having. Other symptoms and the frequency of your headache pain can tell you a lot more.

If your headaches aren’t too severe or frequent, home remedies and OTC medicines may help get you through them.

If you get headaches frequently, or the pain disrupts your daily life, be sure to follow up with your doctor for a proper diagnosis and treatment.

A headache that’s accompanied by certain symptoms can be a sign of a more serious condition. If you have head pain with symptoms such as partial paralysis, high fever, blurred vision, or speech difficulties, call 911 or go to your local emergency room.

What Can It Tell You?

The location of your head pain can be an important clue in determining what type of headache you have and the potential remedies.

Headaches are very common. In fact, it’s estimated that about half to three quarters of adults have experienced some type of headache within the last year.

Chronic headache, which means 15 or more headache days every month, affects between 1. 7 to 4 percent of adults.

Let’s take a closer look at the most common types of headaches based on location, as well as when it’s important to seek medical care.

The whole-head headache can feel like there’s a tight band around your head. This often indicates a tension headache, the most common primary headache disorder.

However, it’s important to point out that there are times when migraine pain can be holocranial. This means the pain can be felt around the head instead of just on one side.

With a tension headache, pain and pressure may extend to your neck, and you may also feel pain and tenderness around your forehead.

Tension headaches are caused by muscle contractions in your head and neck. This type of headache tends to last a few hours, but can linger for days.

A tension headache can be caused by stress or neck problems. However, you might also have an all-over headache from:

• caffeine withdrawal
• physical exertion
• hunger
• hangover
• fatigue
• having a cold or flu
• head trauma
• eye strain or staring at a computer for too long
• using too much headache medicine, also known as rebound headache

An occasional tension headache doesn’t typically require medical attention. Do see your doctor if you experience 15 or more headache days per month.

Migraine

Whether it’s the left side or the right side, one-sided head pain often indicates migraine.

Migraine is a primary headache disorder that causes recurrent attacks. Symptoms of migraine typically include:

• throbbing, pulsating pain
• nausea or vomiting
• aura
• noise, light, and odor sensitivities
• difficulty focusing

Migraine can be caused by a variety of contributing factors, including changes in brain chemicals. In particular, a decrease in serotonin levels.

Many other factors may also trigger an attack, such as:

• loud sounds
• bright or flashing lights
• specific odors
• certain foods
• changes in weather conditions
• lack of sleep
• hormonal changes
• skipping meals
• dehydration

These triggers vary from person to person. It can even be a combination of factors that bring on an attack. It’s not always possible to identify triggers.

Cluster headache

Cluster headache is another primary headache disorder that causes pain on one side of the head.

The pain is often located behind or around one of your eyes. In some cases, the pain may spread to your forehead, side of your head, nose, neck, or shoulders on the same side.

Cluster headaches tend to occur in cycles or, as the name suggests, “clusters.” You may experience headaches for a few weeks or months, followed by a remission period.

These headaches often come on suddenly and the pain usually becomes severe within about 10 minutes of starting.

Some common symptoms of a cluster headache include:

• burning, stabbing pain behind or around one eye
• a red, teary eye
• a smaller, constricted pupil
• a drooping eyelid
• puffiness under or around one or both eyes
• runny or stuffy nose
• facial flushing
• feeling restless

Once you get the right diagnosis, migraine and cluster headaches can be treated and managed.

Medication overuse and head trauma can also cause pain on one side of the head.

A headache behind your eyes and nasal passages can be due to allergies, such as hay fever, which can also produce symptoms similar to that of the common cold.

However, true sinus headaches tend to be rare. These headaches usually turn out to be migraine, which can cause pain over the sinuses.

A headache behind your eyes is rarely related to eyestrain.

If you think you’re having sinus headaches, consider seeing your doctor to get a diagnosis. Your doctor can help determine if your headache is truly caused by allergies, or if it could be migraine.

Pain in the back of your head can be due to arthritis of the neck. Pain tends to get worse when you move.

This type of headache can also be due to poor posture or neck problems such as a herniated disc.

A back of the head headache, often accompanied by neck pain, can also be a sign of a low-pressure headache, otherwise known as spontaneous intracranial hypotension (SIH). It’s caused by low spinal fluid pressure in the brain.

Another sign of SIH is that the pain eases when you lie down, but worsens when you:

• sit upright
• stand
• cough or sneeze
• strain
• engage in physical activity

This type of headache can occur following a lumbar puncture. If you’ve recently had this procedure and develop a headache, see your doctor as soon as possible for treatment.

If you have any type of chronic headache, it’s a good idea to contact your doctor or healthcare provider. Headaches are considered chronic if they happen 15 days or more per month.

By identifying your specific type of headache, your doctor can determine the best type of treatment. Getting the right kind of treatment for your headache may help improve your overall quality of life.

Sometimes, a headache can indicate a more serious medical condition such as:

• aneurysm
• stroke
• meningitis
• encephalitis (inflammation of the brain tissue)
• brain tumor

Signs that you may need immediate medical attention for a headache include:

• sudden onset of severe headache
• a rigid neck
• double vision
• weakness or paralysis on one side of your body
• numbness on either side of the body
• balance and coordination problems
• speech difficulties
• high fever
• lethargy
• reduced or altered consciousness level
• hallucinations

Everyone is different, so it may take some trial and error to figure out what works best for your headaches.

Here are some ways that you may be able to help ease your headache pain with self-care:

• Lie down in a dark, quiet room. Take a nap if you can.
• Apply ice or a cold compress to the area that hurts. Some people find that heat works better.
• Drink water to stay hydrated.
• Do some deep breathing exercises.
• Take over-the-counter (OTC) nonsteroidal anti-inflammatories as directed. Be careful, because taking too many can lead to rebound headaches.
• Drink a little caffeine.

For chronic headaches, your doctor may prescribe medications based on the specific type of headache you have. These medicines include:

• triptans
• ergot derivative drugs
• combination analgesics and caffeine

Preventive medications for chronic headache include:

• anticonvulsants
• beta-blockers
• calcium channel blockers
• calcitonin gene-related peptide (CGRP) antagonists
• onabotulinumtoxinA (Botox)
• selective serotonin reuptake inhibitors (SSRIs)
• serotonin-norepinephrine reuptake inhibitors (SNRIs)
• tricyclic antidepressants

The area of your head that hurts can tell you something about the type of headache you’re having. Other symptoms and the frequency of your headache pain can tell you a lot more.

If your headaches aren’t too severe or frequent, home remedies and OTC medicines may help get you through them.

If you get headaches frequently, or the pain disrupts your daily life, be sure to follow up with your doctor for a proper diagnosis and treatment.

A headache that’s accompanied by certain symptoms can be a sign of a more serious condition. If you have head pain with symptoms such as partial paralysis, high fever, blurred vision, or speech difficulties, call 911 or go to your local emergency room.

questions to the neurologist about the types, causes and treatment of headaches

Important questions for the doctor

30.03.22

Ekaterina Kushnir

asked about headaches

Author profile

Kirill Skorobogatykh

neurologist, cephalgologist

We talked to Kirill Skorobogatykh — neurologist, cephalologist, head of the University Clinic and headaches, author of the book “Knock Your Head. The whole truth about migraines and other headaches.

Cephalgologists specialize in the diagnosis and treatment of various types of headaches. You will find out what headaches are, how they are treated, when you need to go to the doctor, whether an examination is always required and what cannot cause a headache.

What will you learn

• What are the headaches and what are the most common?
• Why do primary headaches occur: migraine, tension headache?
• Can stress and anxiety cause headaches?
• Can a headache be caused by hypertension, osteochondrosis, occluded blood vessels or intracranial pressure?
• When should I see a doctor if I have a headache?
• How does a doctor understand why a person has a headache, what examinations are needed?
• What if a chronic headache interferes with work?
• How is chronic headache treated, is it possible to influence the frequency of attacks?
• How to choose a doctor or clinic for headache treatment?

Go see a doctor

Our articles are written with love for evidence-based medicine. We refer to authoritative sources and go to doctors with a good reputation for comments. But remember: the responsibility for your health lies with you and your doctor. We don’t write prescriptions, we give recommendations. Relying on our point of view or not is up to you.

What are the types of headaches and what are the most common?

Headache is one of the most common symptoms encountered in medicine. There are many types of headaches, about 300. There is an International Classification of Headaches – this is a useful tool for doctors in different countries to speak the same language.

International classification of headaches

All headaches are divided into two large groups: primary and secondary.

Secondary headaches is when the head hurts because of another illness. For example, a person hit his head – this is a secondary headache from an injury, or fell ill with the flu – this is a secondary headache from an infectious disease.

There are many secondary headaches, but they are quite rare. If you take 20 people with a headache, then only one or two of them will have secondary headaches.

Adult Headache Assessment – Uptodate

Primary Headaches – This includes migraine, tension-type headache, or TTH, and a range of other pain conditions. Such pains are much more common than secondary ones. In the case of a primary headache, the head hurts not because there is some kind of disease, problems with the vessels of the neck or something else – it hurts because the brain is not working properly.

According to statistics, migraine affects about 15% of the world’s population. In Russia, about 20% of the working-age population aged 18 to 65 have migraine. Another 30% of Russians suffer from tension headache.

At the same time, every third person has chronic headaches – that is, attacks more often than 15 days a month.

Headache statistics in Russia – International Headache Association

When I lecture doctors, I ask the same question in different audiences: “Have you ever had migraine attacks?” Those who have migraine always turn out to be about 44-55%, that is, about half. This does not mean that migraines are more common among neurologists – I think that they can simply diagnose themselves, understand what kind of headache they have.

When should I see a doctor if I have a headache?

Many people suffer from headaches, not everyone gets to the doctor. However, any person who regularly has a headache should consult a doctor to understand what his diagnosis is and receive appropriate treatment.

When to See a Doctor for a Headache – Mayo Clinic

Unfortunately, many self-medicate and go to the doctor when they are out of control. For example, when the head hurt once a month, and began to hurt every other day, or when conventional drugs stopped helping.

You need to see a doctor urgently if certain symptoms appear, doctors call them “red flags”. They help to suspect secondary headaches.

Such symptoms are grouped into a SNOOP mnemonic rule.

Primary or secondary headache? – American Headache Association PDF, 299 KB

S – systemic symptoms. For example, when a rash appears on the body along with a headache, a temperature or something else.

N – neurological symptoms. That is, not just a headache, but at the same time, for example, vision is lost, an arm or leg is weakened.

O – sudden thunderous pain, when the intensity of the pain increases in a couple of minutes and reaches 10 points on a 10-point scale. This is a serious symptom, it can talk about a brain hemorrhage.

P – change in the pattern of headache, its character. For example, earlier the pain was on both sides of the head and was squeezing, but now it hurts on one side behind the eye. At the same time, it should be taken into account that a change in only the frequency of headache – it hurt once a week, but it became more frequent – usually does not speak of secondary headaches, this is typical for migraine and HDN.

How does a doctor understand why a person has a headache, what examinations are needed?

Headaches rarely require instrumental and laboratory tests, i. e. blood tests, MRI, ultrasound and others.

Migraine – An MSD Physician’s Guide

A diagnostic search is structured like this:

1. A neurologist tries to rule out secondary headaches. They are rare, but this is the first thing to do. It is not necessary to prescribe an examination for everyone – only for those who have threatening symptoms, those same “red flags”. In such cases, an MRI may be prescribed, less often an ultrasound of the vessels of the neck – usually if the doctor suspects their damage as a result of an injury.
2. If there are no red flags, then the headache is primary. Examinations are not needed here, the diagnosis is made according to the patient’s survey. Primary headaches are associated with disruption of the brain, it cannot be assessed by other diagnostic methods.

For example, a diagnosis of migraine is made if there are headache attacks that last from four hours to three days, accompanied by nausea and / or increased sensitivity to light and sound. At the same time, the pain meets any two of the four criteria: the head hurts on one side more than on the other, the pain throbs, it is of moderate intensity or strong, and worsens from movement.

Tension headache has a different set of symptoms. In this case, the pain is not intense, not throbbing, not one-sided, does not increase with physical activity, without nausea, discomfort from light and sound. That is, such an “anti-migraine”.

8 ways to prevent or manage a migraine attack

It’s good for patients to keep a headache diary for a month before seeing a doctor – this helps in diagnosis. The diary can be kept in different applications, there is a chat bot in Telegram called Migrebot.

European and American headache clinics generally do not accept patients who do not keep a diary because it saves time. With a diary, the reception is more efficient, patients can tell how many times and how much their head hurt, what happened before the attack, how long the headache lasted, and so on.

Headache Diary – British Migraine Foundation

Headache Diary Template

Bot helps track headaches

Why do primary headaches occur: migraine, tension headache?

Migraine. The trigeminal nerve is responsible for almost any pain in the head area. All fibers of the trigeminal nerve, like the roots of a tree, gather at one point in the brain, it is called the trigeminal nucleus.

Pathophysiology of Migraine – Journal of the International Association for the Study of Pain

People with migraine experience sudden electrical activity in this area, causing them to feel a headache. Various factors can influence the activity of this zone and, consequently, migraine attacks: hunger, alcohol, lack or excess of sleep, hormone fluctuations due to the menstrual cycle, and others.

Such a feature of the brain is genetically incorporated, such as, for example, eye color. For some, seizures will be rare, for others they will be frequent, they can manifest themselves in different ways, but the general mechanism is the same.

Also, in people with migraine, at the very beginning of an attack, even before the onset of pain, the hypothalamus is activated – this is an important brain area that regulates sleep and wake cycles, eating behavior, mood and much more. It can be assumed that migraines can originate in this part of the brain.

How to treat migraine in children and adolescents

Tension headache. Less is known about the mechanisms of its occurrence. It is believed that rare attacks of tension headache may be associated with incorrect head position, uncomfortable posture, emotional stress.

Mechanisms of chronic tension headache – Journal of the International Association for the Study of Pain

There is also chronic tension headache, when attacks occur more than 15 times a month. In such cases, it is assumed that the problem is that the brain system responsible for pain relief is working worse. Because of this, bouts of pain occur, often associated with concomitant depressive or anxiety disorders.

The branches of the trigeminal nerve are responsible for sensitivity in the head area. Activation of a nerve nucleus in the brain may be the cause of migraine The branches of the trigeminal nerve are responsible for sensation in the head region. Nerve nucleus activation in the brain may cause migraine

Can stress and anxiety cause headaches?

Stress and anxiety often accompany migraines and many other types of primary headaches. Stress can cause tension headaches for the first time or worsen migraines. For example, earlier a person had mild attacks, in which the usual painkiller helped, and against the background of a stressful situation, the attacks became more severe, the pills stopped helping.

Reducing stress prevents headaches – Mayo Clinic

Depressive and anxiety disorders are also more common in people with headaches. Most likely, these conditions have common biological mechanisms within the brain. Perhaps they are associated with the work of neurotransmitters – substances with which the brain cells communicate, or with something else.

It is important for a neurologist at the appointment to assess whether a person has anxiety disorders or depression, and if they do, then treat them in parallel with the treatment of migraine. Both anxiety and depression exacerbate migraine – these are some of the factors that can make a rare migraine frequent, leading to its progression.

Link Between Depression, Anxiety, and Migraine – Migraine Foundation of America

Can a headache be caused by hypertension, osteochondrosis, occluded blood vessels, or intracranial pressure?

Hypertension. High blood pressure can cause headaches in rare cases, when pressure figures are more than 180/120 mm. rt. Art., that is, in a hypertensive crisis.

If the pressure numbers are lower, then the opposite is true: a headache is usually the factor that led to an increase in blood pressure. In principle, it can increase pain in any part of the body.

Hypertension and headaches – Medscape

Intracranial pressure. Intracranial pressure increases for two groups of reasons:

1. Something has formed inside the skull: for example, a tumor or a hematoma. The skull cannot stretch, as a result, the pressure inside grows. This rarely happens. In addition, in addition to a headache, there will be other symptoms, in particular neurological ones: speech, coordination, movement, and sensitivity disorders. In this case, the cause will be visible on the MRI.
2. Idiopathic increase in intracranial pressure – the pressure has increased, but it is not clear why. This is more common in overweight women. In this case, headaches are accompanied by visual impairment: flashes before the eyes, narrowing of the visual fields. These disorders progress rapidly, sometimes to complete blindness. If such a case is suspected, an examination of the fundus by an ophthalmologist is necessary. If intracranial pressure is increased, the doctor will see swelling there, because the fluid that washes the brain also washes the optic nerve – the pressure in the fundus also increases.

Intracranial pressure – NHS

Osteochondrosis. We often use this term to refer to the natural changes in the spine that await everyone in old age. The presence of hernias and protrusions is in no way associated with the occurrence of a headache.

Cervicogenic Headache – Migraine Foundation of America

Extremely rare headache associated with changes in the cervical spine, when there is subluxation of the joint and sprain of the ligament. In this case, the pain will be on one side, it is felt as if in an arc from the neck to the head. And most importantly, it occurs only after neck movements. Such a headache is called cervicogenic.

Vessels of the neck. Headache due to pinched neck vessels is a myth. If blood does not reach the brain, there will be no pain: a person will either faint or develop a stroke with neurological symptoms: speech impairment, facial asymmetry, paresis of the arms or legs.

Changes in the vessels of the neck that are found on ultrasound, such as asymmetry of blood flow, tortuosity, and so on, are variants of the norm, and not the cause of headache.

Neck vessels can sometimes be a source of headache when damaged. In this case, the wall of a large vessel – the vertebral or carotid artery – is exfoliated – an unpleasant pain appears, which can radiate to the back of the head. This is called vessel dissection.

Arterial dissection – Uptodate

This happens after car accidents when there is a sharp movement of the head, or when certain exercises are not performed correctly, for example, a headstand.

When an artery is dissected, the wall becomes stratified, usually after an injury When an artery is dissected, the wall becomes stratified, usually after an injury

What if a chronic headache interferes with work?

Economic losses and reduced quality of life due to headaches are big problems. There is such an indicator as the number of years lived with disability. It is important because it characterizes the burden on the healthcare system.

Global burden of disease: migraine is the second leading cause of disability – Headache Journal

There are many chronic diseases that do not kill a person, but require frequent visits to doctors and treatment. Among these diseases, migraine is in second place in the world in terms of the number of years that a person lives incapacitated, it is only ahead of back pain.

Migraine attacks often start at a young age and usually last a lifetime. If we take a typical example – a 55-year-old woman, suffers from migraine since the age of 15, attacks on average once a week – then in 40 years she spent 5.5 years in an attack. But during an attack, more than half of the people need bed rest, they cannot work.

To this we must add the prevalence of migraine among the working population – in our country it is 20%. It turns out that 20% of employees in any organization suffer from migraines.

At the same time, people with migraine feel stigmatized – “just have a headache, take a pill and go to work.” But this doesn’t always help. A person during an attack thinks worse, cannot analyze information normally, that is, it is almost impossible to work with his head. His condition is aggravated by the office environment, especially in open space: sound, light, conversations. Even if a person comes to work with a migraine, he will be unproductive.

Sick leave can be taken for migraine, especially for migraine status when the attack lasts longer than three days. However, migraine attacks can be frequent – 15 times a month or more, it is difficult to take a sick leave every time. Here we need a different approach, in particular, to choose the right therapy in order to reduce the frequency of attacks and quickly remove them.

How much does it cost to keep a migraine under control

It is better to discuss the problem with the employer and relatives. I call migraine a personal terrorist – attacks are unpredictable, it is impossible to predict when a person will fall out of the work process. It’s good if they understand at work that he missed the day not because he doesn’t want to work, but because it’s impossible to work. Or if the attack occurred at work, then the person needs time to recover.

Employers should make contact with people who have chronic headaches. For example, to equip dark rooms so that you can wait out the attack in silence, allow you to work remotely on the days of attacks or stay at home for a while until the pill works.

How is chronic headache treated, is it possible to influence the frequency of attacks?

Migraine. It is impossible to cure it completely, but it can be treated. There are three approaches to migraine treatment.

The first is the elimination of headache episodes. Common painkillers such as ibuprofen can help here. If they still do not help, then they use special preparations – triptans. Antiemetics may also be prescribed. If attacks are rare – up to four days a month, then such therapy will be enough.

Migraine Treatment – Mayo Clinic

The second option is preventive therapy to reduce the frequency of attacks. It is used if the attacks are frequent – more than four or five times a month, or so severe that nothing helps.

Various drugs are used here: some drugs that affect blood pressure and pulse, in particular beta-blockers, antidepressants, antiepileptic drugs, botulinum therapy. Such treatment reduces activity in the areas of the brain responsible for headache attacks. The mechanism of their action in migraine is not fully understood, but it is a standard therapy in all countries of the world.

Pharmacological prevention of episodic migraine in adults – recommendations of the American Academy of Neurology

There is also the newest group of drugs – monoclonal antibodies that block the action of the CGRP protein. This protein works inside the trigeminal nerve system: the more it is, the more pain. Monoclonal antibodies “turn off” this protein or the receptor for this protein for a long time. Injections should be done once a month or even every three months.

Monoclonal antibodies for migraine prevention – Medscape

Prophylactic therapy is considered effective if the frequency of attacks is reduced by at least half. Sometimes it is possible to remove them completely. The duration of therapy is usually six months to a year. The effect may be in a month, but the treatment needs to be continued longer so that the connections in the brain change.

Elimination of factors that can worsen migraine again. For example, if there is depression and anxiety disorders, they must be treated. Overweight, smoking, snoring, lack of physical activity can also affect. It is also important not to allow uncontrolled use of painkillers – this can cause an abuse headache, when the head hurts because of the drugs themselves. It can occur if you take painkillers more than two days a week. To prevent this, with an increase in seizures, prophylactic therapy should be immediately prescribed.

Tension headache. The most effective drug for chronic tension headache is amitriptyline. This is a weak and old antidepressant, while it is very effective for treating various pain syndromes. Other antidepressants are also used.

Also in chronic tension-type headache, many patients are diagnosed with anxiety disorders or depression. They can affect the chronicity of pain, it is important to treat them – it happens that after the treatment of such disorders, the headache also goes away.

Tension headache – Mayo Clinic

For migraine, botulinum toxin injections are given into points in different parts of the head For migraines, botulinum toxin injections are given into points in different parts of the head

How do I choose a doctor or clinic for headache treatment?

In Russia, people go to a neurologist with a headache, while abroad they go to a therapist, general practitioner or family doctor, because in most cases they can help.

Diagnoses like osteochondrosis or vegetovascular dystonia should be alert – there are no such diagnoses as the causes of headaches. In this case, you should get a second opinion. The same applies to situations where the doctor advised to “clean the blood vessels” or prescribed some kind of “vascular remedy”, of which we have a wagon and a small cart.

Remember

1. Headaches can be secondary, that is, arising from any disease, and primary – associated with disruption of the brain. The latter are much more common.
2. Migraine is thought to be due to activation of the trigeminal nucleus in the brain, while tension-type headache is due to malfunctioning of the analgesic system. It’s genetic.
3. Headaches may first occur or worsen due to stress, and chronic headaches are often associated with depressive and anxiety disorders.
4. Usually a headache causes an increase in blood pressure, and not vice versa. An increase in intracranial pressure can cause headache, if it is suspected, the fundus should be checked. Osteochondrosis and the condition of the vessels of the neck do not affect the headache, except in cases of damage to the walls of the vessels.
5. Many people suffer from headaches, not everyone gets to the doctor. However, any person who regularly has a headache should consult a doctor to understand what his diagnosis is and receive appropriate treatment.
6. Headaches rarely require instrumental and laboratory examinations, i. e. blood tests, MRI, ultrasound and others. Usually, only a patient survey is needed for diagnosis.
7. Employers should make contact with people who have chronic headaches. For example, to equip dark rooms so that you can wait out the attack in silence, allow you to work remotely on the days of attacks or stay at home for a while until the pill works.
8. The treatment of migraine consists in the removal of attacks, their prevention and reduction in frequency. Antidepressants are commonly used to treat chronic tension headache.
9. It is better to consult a neurologist who specializes in the treatment of headaches. The chosen doctor must answer all questions in detail and clearly, as well as make existing diagnoses.

Causes of headaches, headache treatment, making an appointment in Nizhny Novgorod

Quite often, patients who already know why they have a headache get an appointment. Having studied many articles on the Internet, having listened to the opinion of “sympathetic” colleagues and various, sometimes authoritative, specialists, having “fixed” the diagnosis with the results of additional examination methods, such patients have a clear idea of ​​their disease. That’s just the recommended treatment for some reason does not help.

For some reason, vascular preparations do not help with a headache of a compressive nature, due to “vasospasm”. From a constant headache caused by “intracranial hypertension” (and the diagnosis was established in childhood!) Diakarb does not “save”. Yes, and osteochondrosis of the cervical spine, from which the head constantly hurts, cannot be cured in any way …

Despite the lack of effect from previous treatment, it can be very difficult to convince such patients. But what can we say about patients, when even neurologists with many years of experience cannot “get away” from the old ideas about the mechanisms of headache development and “traditional” methods of treating it with vascular, nootropic and diuretic drugs.

The purpose of this article is to dispel the myths about “the most common causes of headaches”.

Why does the head hurt

The brain itself has no pain receptors. That is, the substance of the brain cannot get sick. Headache is caused by irritation of pain receptors located in the following structures:

• meninges;
• cranial nerves;
• neck roots;
• veins and venous sinuses;
• arteries;
• muscles of the base of the skull;
• neck muscles.

Irritation of pain receptors of these structures occurs both in primary and secondary (symptomatic) cephalalgia. In addition, dysfunction of the central (serotonergic, noradrenergic, etc.) systems that affect the perception of pain plays an important role in the mechanism of development of primary headaches.

In 95% of cases, cephalalgia is primary (tension headache, migraine, cluster cephalgia, etc.). At the same time, the most thorough examination does not reveal the cause of the headache. The detected “abnormalities” are “non-specific” and cannot be the cause of cephalalgia. Here are some examples of such “deviations”:

• “single cysts and foci in the white matter of the brain”, “expansion of the subarachnoid cerebrospinal fluid space”, “external replacement hydrocephalus”, “indirect signs of intracranial hypertension”, detected during magnetic resonance imaging;
• “dysfunction of the median structures of the brain” according to electroencephalography;
• “change in the linear velocity of blood flow”, “hypoplasia” or pathological “tortuosity” of the arteries, “violation of the venous outflow”, detected by ultrasound dopplerography;
• “tendency to vasospasm” according to rheoencephalography;
• “degenerative-dystrophic changes in the spine”, detected on radiographs, and much more.

Secondary, or symptomatic, headaches occur as a result of mental, inflammatory, vascular, post-traumatic, tumor, intoxication and other processes. However, serious disorders cause headaches in no more than 5% of cases.

Let’s discuss the most common misconceptions about the causes of headaches

The main cause of headache is cervical osteochondrosis
Cervicogenic headache does exist. However, it occurs much less often than it is diagnosed. At the same time, the degree of severity of degenerative-dystrophic changes in the spine (decrease in the height of the intervertebral discs, protrusions, hernias, osteophytes), detected by X-ray and neuroimaging (MRI), does not correlate with the presence of “neck headache” and its severity.
Cervicogenic cephalalgias are caused by dysfunction of the joints, ligaments of the cervical vertebrae, overstrain of the neck muscles and have certain characteristics (see secondary (symptomatic) headaches). In most cases, tension and soreness of the neck muscles accompanies other, primary forms of headache – tension headache and migraine.

“Clamping of blood vessels in the neck”
An extremely rare, but rather serious problem that occurs mainly in the elderly. In this case, when turning the head, there is a violation of cerebral circulation in the vertebrobasilar basin with all the ensuing consequences – “flies” before the eyes, ringing in the ears, dizziness, speech impairment, weakness and numbness in the limbs, and even loss of consciousness. But that doesn’t make your head hurt.

Arterial hypertension
Hypertension may cause headache if blood pressure (BP) rises to 200/120 mm Hg. Art., or diastolic pressure is kept above 120 mm Hg. Art. Cephalgia, caused by an increase in blood pressure, is usually localized in the back of the head and is stopped by antihypertensive drugs.

Contrary to popular belief, there is no clear relationship between a moderate increase in blood pressure (below the above numbers) and headache. More often, the opposite situation occurs – blood pressure rises as a reaction to a headache, and is not its cause.

“Cerebral vasospasm”
Some patients mistake a headache of a compressive, pressing nature for a “cerebral vasospasm”. However, this is how the most common type of primary headache manifests itself – tension headache.
What causes the effect of antispasmodic No-shpa in this case? If you carefully read the instructions for use of this drug, you can be sure that it is tension headache, and not vascular headache, that is the indication for taking it. In addition to the fact that No-shpa relaxes the smooth muscles of the gastrointestinal tract, biliary tract and genitourinary system, it effectively relieves muscle tension.
As for the short-term relief of headache on the background of taking vascular drugs – the placebo effect, i.e. self-hypnosis, no one canceled.

“Bad vessels”
The concept of “bad vessels” does not exist in medicine. What the layman means by “bad vessels” – hypertensive angiopathy, atherosclerosis of vessels (loss of elasticity, thickening of the walls, formation of atherosclerotic plaques), etc., are risk factors for the development of cerebrovascular accident, i.e. stroke. But it has nothing to do with headaches.

Vegetative-vascular dystonia
The autonomic nervous system is responsible for the work of the heart, vascular tone, thermoregulation, sweating, urination, gastrointestinal tract and much more. An imbalance in the work of the autonomic nervous system leads to fluctuations in blood pressure, “interruptions” in the work of the heart, sweating, diarrhea, and even to autonomic crises (panic attacks). However, vegetative dystonia cannot be the cause of headache. Even such a phenomenon as the lability of vascular tone (narrowing or expansion), which is extremely important for adaptation to environmental conditions, can cause dizziness, but not a headache.

Intracranial hypertension
Ever since Soviet times, “increased intracranial pressure” was considered almost the main cause of headaches. Already from early childhood, the child was diagnosed with such a diagnosis and passed a “sentence” that in the future he would definitely have a headache. The head really hurt, but for a completely different reason, and the ICH label remained.
An increase in intracranial pressure is indeed accompanied by a characteristic headache (see secondary (symptomatic) headaches). But is intracranial hypertension so common in practice? Luckily, it’s extremely rare!

Intracranial hypertension is always caused by serious causes: intracranial masses (tumors), intracranial infections (meningitis), traumatic, ischemic or toxic cerebral edema, etc. Intracranial hypertension threatens with serious complications – from loss of vision to death due to compression of the brain in the closed space of the skull.

The main research methods confirming the diagnosis of ICH are neuro-ophthalmological examination (examination of the fundus) and measurement of CSF pressure (lumbar puncture). “Indirect signs of intracranial hypertension” in the form of “enhanced digital impressions” detected during skull radiography or “expansion of the perivascular spaces of the optic nerves” during magnetic resonance imaging have no clinical significance. Also not related to increased intracranial pressure “external replacement hydrocephalus”.

Another mythical cause of headache is a traumatic brain injury.
Headache is post-traumatic if it occurs within the first 14 days after injury (see secondary (symptomatic) headaches). Post-traumatic headache is characterized by a gradual disappearance. If the headache persists for more than 3 months after the injury, then most likely it is not associated with the injury, and you need to look for another cause of the headache, incl. mental disorders (anxiety, depression).

Let’s stop attributing all headaches to bad blood vessels, osteochondrosis and intracranial hypertension. Modern science has long found out that in the vast majority of cases, these causes have nothing to do with headaches.