How do certain activities impact headache relief. What role does orgasm play in alleviating pain. Which types of headaches respond best to alternative treatments. How can lifestyle changes contribute to headache prevention. What are the latest FDA-approved medications for migraine management.

The Surprising Link Between Sex and Headache Relief

For years, the notion that sexual activity could alleviate headaches was dismissed as mere hearsay. However, recent scientific studies have shed light on this intriguing phenomenon, revealing a genuine connection between sexual activity and headache relief. This discovery has opened up new avenues for those seeking alternative methods to manage their pain.

In 2006, two groundbreaking case studies emerged, bringing this topic into the realm of clinical research. Both subjects had endured cluster headaches for decades and had independently discovered that sexual activity provided swift and consistent relief. This initial research paved the way for more extensive studies, challenging long-held assumptions about headache management.

The 2013 Survey: A Broader Perspective

A comprehensive survey conducted in 2013 significantly expanded our understanding of the relationship between sexual activity and headache relief. The study involved 400 participants, including 304 individuals with chronic migraine and 96 with cluster headaches. The results were compelling, demonstrating that a substantial number of respondents experienced pain relief through sexual activity.

Is orgasm necessary for headache relief through sexual activity? While sexual activity in general can be beneficial, research suggests that reaching orgasm is particularly important for maximizing pain relief. Both case studies mentioned earlier specifically identified orgasm as the crucial moment when pain began to subside.

The Science Behind Sexual Headache Relief

Why does sexual activity, particularly orgasm, help alleviate headaches? While the exact mechanisms are not fully understood, many experts point to the role of endorphins. These naturally occurring substances are released during orgasm and are well-known for their pain-reducing properties. Endorphins help the body manage discomfort and promote a sense of well-being, which may explain their effectiveness in headache relief.

Can masturbation provide the same headache relief as partnered sex? Absolutely. The key factor in headache relief appears to be reaching orgasm, regardless of whether it’s achieved through partnered sexual activity or masturbation. In fact, a 2015 case study specifically highlighted the relationship between migraine relief and masturbation, further supporting the idea that self-stimulation can be just as effective as partnered sex in managing headache pain.

Types of Headaches Most Responsive to Sexual Activity

While the connection between sexual activity and headache relief is promising, it’s important to note that not all headaches respond equally to this approach. Current research indicates that migraine episodes and cluster headaches are the types most likely to benefit from sexual activity and orgasm.

How effective is sexual activity for other types of headaches? Unfortunately, little is known about the impact of sexual activity on other headache types. More research is needed to determine its effectiveness across a broader spectrum of headache disorders. However, individuals experiencing different types of headaches may still find it worthwhile to explore this method, as personal experiences can vary.

The Potential Downsides: When Sex Triggers Headaches

While sexual activity can provide relief for many, it’s crucial to acknowledge that for a small subset of individuals, sexual activity can actually trigger headaches. These are known as orgasmic and pre-orgasmic headaches, occurring either during or after sexual activity.

Why do some people experience headaches from sexual activity? The exact cause remains unclear, but some theories suggest it may be related to muscle tension in the back and neck during sexual activity. Another possibility is that the post-orgasm spike in blood pressure causes blood vessels to dilate, which is associated with headache onset in some individuals.

If you consistently experience headaches during or after sexual activity, it’s important to consult a healthcare professional. There may be treatments available to address this specific issue and allow you to enjoy sexual activity without the associated pain.

Alternative Approaches to Headache Management

While sexual activity can be an effective method for some, it’s not always a practical or desirable option for everyone. Fortunately, there are numerous other approaches to managing headaches, ranging from lifestyle changes to medical interventions.

Migraine Management Strategies

For those dealing with migraines, a multi-faceted approach often yields the best results. Some effective strategies include:

• Keeping a migraine journal to identify and avoid triggers
• Regular exercise routines tailored to individual tolerances
• Exploring acupuncture and acupressure massage techniques
• Engaging in cognitive behavioral therapy (CBT) to manage stress and pain perception
• Investigating the potential benefits of essential oils (with proper guidance)

What are the latest advancements in migraine medication? Recently, the FDA approved a new class of drugs called calcitonin gene-related peptide (CGRP) monoclonal antibodies. These medications represent a significant breakthrough in migraine prevention and treatment, offering hope to many who have struggled with traditional therapies.

Holistic Approaches to Headache Prevention and Relief

Beyond specific treatments for different headache types, there are several holistic strategies that can contribute to overall headache prevention and management. These approaches focus on improving general health and well-being, which can have a positive impact on headache frequency and severity.

Stress Management Techniques

Stress is a common trigger for many types of headaches. Implementing effective stress management techniques can significantly reduce headache occurrence. Some proven methods include:

1. Mindfulness meditation
2. Deep breathing exercises
3. Progressive muscle relaxation
4. Regular physical exercise
5. Adequate sleep hygiene

How does mindfulness meditation help with headache management? Mindfulness meditation can reduce stress, improve pain perception, and enhance overall well-being. Regular practice has been shown to decrease the frequency and intensity of headaches in many individuals.

Dietary Considerations for Headache Prevention

Diet plays a crucial role in headache management for many people. While triggers can vary widely between individuals, some common dietary factors to consider include:

• Staying hydrated by drinking adequate water throughout the day
• Limiting or avoiding known trigger foods such as aged cheeses, processed meats, and artificial sweeteners
• Maintaining regular meal times to prevent blood sugar fluctuations
• Moderating caffeine and alcohol intake
• Incorporating anti-inflammatory foods into your diet

Can certain foods actually help prevent headaches? Yes, some foods may have protective effects against headaches. Foods rich in magnesium, such as leafy greens, nuts, and seeds, have been associated with reduced headache frequency in some studies. Additionally, foods high in omega-3 fatty acids, like fatty fish and flaxseeds, may help reduce inflammation and prevent headaches.

The Role of Sleep in Headache Management

Quality sleep is fundamental to overall health and plays a significant role in headache prevention and management. Poor sleep patterns can trigger headaches or exacerbate existing conditions. Implementing good sleep hygiene practices can make a substantial difference in headache frequency and intensity.

Strategies for Improving Sleep Quality

To enhance sleep quality and potentially reduce headache occurrences, consider the following strategies:

1. Maintain a consistent sleep schedule, even on weekends
2. Create a relaxing bedtime routine to signal your body it’s time to wind down
3. Ensure your sleeping environment is dark, quiet, and cool
4. Limit screen time before bed to reduce exposure to blue light
5. Avoid caffeine and heavy meals close to bedtime

How does sleep deprivation contribute to headaches? Sleep deprivation can lead to increased production of proteins that cause chronic pain. It also affects the body’s ability to manage stress and regulate pain-controlling neurotransmitters. By prioritizing sleep, you’re giving your body the best chance to prevent and manage headaches effectively.

The Impact of Physical Activity on Headache Management

Regular physical activity is not only beneficial for overall health but can also play a crucial role in headache management. While intense exercise can sometimes trigger headaches in some individuals, moderate, consistent physical activity has been shown to reduce headache frequency and severity for many people.

Exercise Recommendations for Headache Sufferers

When incorporating exercise into your headache management strategy, consider the following recommendations:

• Start with low-impact activities such as walking, swimming, or yoga
• Gradually increase intensity and duration as your body adapts
• Stay hydrated before, during, and after exercise
• Pay attention to your body and stop if you experience pain or discomfort
• Consider working with a physical therapist to develop a tailored exercise plan

How does exercise help prevent headaches? Regular physical activity can reduce stress, improve sleep quality, and promote the release of endorphins – natural pain-relieving compounds. Additionally, exercise can help improve overall cardiovascular health, which may contribute to reduced headache frequency in some individuals.

Emerging Therapies and Future Directions in Headache Treatment

The field of headache research is continuously evolving, with new therapies and treatment approaches emerging regularly. Staying informed about these developments can provide hope and new options for those struggling with chronic headaches.

Promising Areas of Research

Some of the most exciting areas of current headache research include:

• Neuromodulation devices that use electrical or magnetic stimulation to interrupt pain signals
• Gene therapy approaches targeting specific proteins involved in migraine pathways
• Personalized medicine strategies based on genetic profiles and biomarkers
• Advanced imaging techniques to better understand headache mechanisms
• Novel drug delivery systems for more effective and targeted treatments

What role might artificial intelligence play in future headache treatments? AI has the potential to revolutionize headache management by analyzing vast amounts of patient data to identify patterns and predict optimal treatment strategies. It could also assist in early detection of headache disorders and help personalize treatment plans based on individual patient characteristics.

The Importance of Ongoing Research

As our understanding of headache disorders continues to grow, so too do the possibilities for more effective treatments. Ongoing research is crucial for developing new therapies, refining existing treatments, and ultimately improving the quality of life for millions of people affected by headaches worldwide.

How can individuals contribute to headache research? Many research institutions and headache clinics offer opportunities for patients to participate in clinical trials. By volunteering for these studies, individuals can not only potentially access cutting-edge treatments but also contribute to the advancement of headache science and help future sufferers.

Does Sex Help with Headaches? We Read the Research to Find Out

With so many totally unsubstantiated rumors floating around the interwebs, you’d be forgiven for rolling your eyes at the idea of sex being used as headache relief.

But we’re here with some rare news: The rumors are true! Research has found that having sex — with yourself or a partner — can help with some types of headaches, especially migraine episodes and cluster headaches.

Stick with us to learn what the research says, what orgasm has to do with it, and how to know if this sexy health hack will work for you.

Fast facts

• Sex works as headache relief for some people, especially for migraine episodes and cluster headaches.
• Reaching orgasm appears to be important for finding relief.
• Experts don’t know why but think it has to do with endorphins.
• Though this is rare, sex can trigger migraine episodes or headaches in some people.

Was this helpful?

For a long time, sex as a headache remedy was purely anecdotal lore. Plenty of folks knew it worked for them, but there wasn’t any clinical evidence backing it up.

Then, in 2006, two case studies emerged that brought the subject into the clinical space. Both people assessed had lived with cluster headaches for decades, and both had come to learn that sex was a quick and reliable route to relief.

Following that publication, a 2013 survey collected evidence on a much larger scale. According to responses from 304 people with chronic migraine and 96 people with cluster headaches, a significant number of people found that getting busy did, indeed, ease their pain.

If you’re a fan of Greatist, you know that we usually don’t advocate for making orgasm the goal of sex. But when it comes to headaches, it appears that reaching climax is important for relief.

In both case studies mentioned above, people explicitly cited orgasm as the point at which the pain would ease. How come? While we can’t say for sure, some experts point to endorphins.

Endorphins are substances your body serves up when you have an orgasm. They’re also famously known for their ability to minimize pain and help us manage discomfort.

Yes, this includes masturbation!

Sorry to be Captain Obvious, but we want to make it extra clear that masturbating is included in this definition of sex.

Regardless of which route you take, finding relief is all about making it to the land of O. In fact, one case study from 2015 specifically highlighted the relationship between migraine relief and masturbation.

Was this helpful?

As exciting as the above research is, we want to be clear that sex is by no means a headache cure-all.

There are tons of different types of headaches. According to the available research, sex and orgasm are most likely to work for migraine episodes and cluster headaches. But even if you have those types of headaches, there’s no guarantee it’ll work for your unique body.

However, little is known about how sex affects other types of headaches. (Of course, feel free to do your own research next time you wake up after wine night.)

Yes, sadly, this is true. Although it’s rare, some people experience orgasmic and pre-orgasmic headaches — headaches that come on either during or after getting frisky.

Experts aren’t entirely sure why these sexual headaches occur, but some think they’re related to the tightening of muscles in your back and neck when you have sex. It’s also possible that the post-orgasm spike in blood pressure causes blood vessels to dilate, which is associated with headaches.

If sex regularly brings on headaches, mention it to a healthcare professional. It’s likely there’s a treatment out there that can bring you some relief.

Depending on who you are and how severe your headache is, sex may be the last thing on your mind. (In fact, according to research from 2015, many people who live with migraine also report being disinterested in sex.)

And last time we checked, it’s pretty hard to force yourself to get in the mood when you’re not feeling it. Luckily, there are other routes you can take for headache relief.

But first a caveat: There are A TON of different types of headaches and treatments to go along with each. Below, we’ve listed some common treatments for common types of headaches, but this is not an exhaustive list. For more info, check out our guide to treating every kind of headache.

For migraine

• journaling to identify triggers and avoiding those triggers
• prescription medications, including a class of drugs recently approved by the FDA called calcitonin gene-related peptide (CGRP) monoclonal antibodies
• exercise
• acupuncture and acupressure
• massage
• cognitive behavioral therapy (CBT)
• essential oils

While research suggests there are health benefits, the FDA doesn’t monitor or regulate the purity or quality of essential oils. It’s important to talk with a healthcare professional before you begin using essential oils and be sure to research the quality of a brand’s products. Always do a patch test before trying a new essential oil.

For cluster headaches

• prescription medications, including triptans
• inhaling pure oxygen
• journaling to identify triggers and avoiding those triggers
• verapamil and corticosteroids (for prevention)

For sinus, menstrual, dental, sexual, and other headaches

• over-the-counter pain relievers
• caffeinated beverages
• exercise
• cold compresses
• essential oils
• acupressure and acupuncture
• B vitamins
• 100 milligrams of CoQ10 supplements

Talk with a pro if headaches are interfering with your life

We can’t stress this enough. Headaches and migraine episodes can take a brutal toll on quality of life. A professional will be able to help identify the cause of your headaches and find treatment options that make the most sense for you.

Was this helpful?

Sex — namely orgasm — appears to work as headache relief for some people, especially for migraine episodes and cluster headaches. Experts don’t know why, but it could be related to the release of endorphins, which are known pain relievers.

Sex doesn’t work as headache relief for everyone, and in some cases it can actually trigger a headache. If headaches are interfering with your life, making it hard to work or enjoy yourself, consult a professional.

FDA approves new fast-acting nasal spray for migraines

Health news

Zavzpret, also known as zavegepant, was approved for the treatment of acute migraine with or without aura in adults.

Pfizer is hoping to gain a competitive edge with Zavzpret, and Biohaven has pitched it as the “Epipen of migraine.”Pfizer

March 10, 2023, 9:05 PM UTC

By Reuters and Marina Kopf

The Food and Drug Administration on Friday approved Pfizer’s nasal spray for migraines, giving patients access to a potentially fast-acting pain relief option.

The drug, Zavzpret, also known as zavegepant, was approved for the treatment of acute migraine with or without aura in adults, the company said. Aura refers to any neurological disturbance that appears shortly before or during the development of migraines.

Pfizer gained the drug, as well as the FDA-approved oral migraine pill Nurtec ODT, through its $11.6 billion buyout of Biohaven Pharmaceuticals last year.

The drug, whose pricing will be revealed at its launch in July, is “expected to be comparable in price to other FDA approved migraine medicines” which belong to the same class, Pfizer told Reuters.

Zavzpret belongs to a class of drugs called calcitonin gene-related peptide inhibitors and will compete with other therapies from AbbVie, Eli Lilly, Amgen and Teva Pharmaceutical.

Pfizer is hoping to gain a competitive edge with Zavzpret’s quick speed of action, and Biohaven has pitched it as the “Epipen of migraine.”

The new drug isn’t the first nasal spray for migraines, although Dr. Emad Estemalik, a headache specialist at the Cleveland Clinic, said the quick, 15-minute relief gives the drug an advantage over the existing oral treatments.

“A lot of patients, when they have migraines, they’re throwing up, for instance, so they may not be able to hold oral medication,” he said.  “That’s where an intranasal comes as an advantage.” 

Dr. Rashmi Halker Singh of the Mayo Clinic in Phoenix had a similar opinion.

“Migraine is more than head pain,” the neurologist said in an interview.

People with migraines often have many other symptoms, such as light sensitivity and nausea, and can benefit from a medication that’s not a pill, she said.

Halker Singh, who is also on the board of the American Headache Society, is excited about the new medication, although she notes that about 20% of patients in the clinical trial experienced an altered sense of taste, compared to about 4.7% of patients who were given a placebo.

The FDA approval is based on data from a late-stage study that showed the drug, when compared to a placebo, proved superior in 13 of 17 goals, including pain relief in 15 minutes, normal function at 30 minutes and return to normal at two hours.

The drug, when compared to a placebo, failed to show statistically significant difference in one of the secondary goals of returning to normal function at 15 minutes.

The drug’s label includes a warning advising patients to stop taking it in case of hypersensitivity reactions, such as facial swelling and skin rashes.

Migraine affects 39 million people in the United States, according to the Migraine Research Foundation.

Reuters

Marina Kopf

Marina Kopf is a production assistant with the NBC News Health and Medical Unit.

prices for a doctor’s consultation at the medical center “TN-CLINIC”

In the treatment of headaches , the most important thing is to find the cause that caused it.

In our clinic, the treatment of headaches of various origins is handled by the doctor of the highest category Ambardaryan Anahit Henrikovna. For more than 35 years, she has been effectively solving the problems of her patients suffering from headaches, migraines, dizziness, etc. She uses kinesiology and osteopathy for treatment. Its work is based on the necessary set of clinical and instrumental tests. The choice of treatment methods, drugs is carried out on the basis of research data, taking into account the state of the body, and the individual characteristics of the course of the disease.

What does headache indicate?

Headaches – well-known to everyone, unpleasant, painful sensations that usually occur in the brain projection area. They can be different in time – from very short to very long, they can have variable intensity – from weak to unbearable, they can be localized both in one area and be “blurred” – all over the head. Headaches strongly depend in their manifestations on the cause that causes them.

Headaches are not a specific disease, they are one of the symptoms of a person’s ill health, and often patients tend to treat them superficially, eliminating discomfort by taking widely advertised painkillers. However, it is worth knowing that the presence of a headache can be a signal for the development of many pathologies – spinal lesions, vascular problems in the form of acute circulatory disorders in the brain or strokes, neurological disorders, infectious and ENT diseases, endocrine and metabolic changes in the body, injuries and others. brain damage.

Headache affects people of all ages, its intensity is measured from very moderate – like a feeling of pressure, to simply unbearable, such as migraine or increased intracranial pressure. Headache can occur in quite healthy individuals with overwork or sudden changes in the weather, but such pains quickly disappear after rest and without the use of medications, or with a single dose of painkillers. But if you suffer from repeated attacks or prolonged pain in the head, it is very important to consult a neurologist in order to find out their true causes and eliminate them as quickly as possible.

The most common types of headaches

Migraines – acute throbbing pains that form as an attack, lasting from several hours to several days. Often such pains originate in one of the halves of the head, accompanied by light and sound fear, nausea with bouts of vomiting. In such situations, the usual painkillers do not help, and the causative factors are not fully understood. They can be triggered by hormonal fluctuations, acute stress, prolonged fasting, bright flashes of light and smells, foods, and weather changes. Predisposition to migraine tends to be inherited.

Headaches due to pressure fluctuations cerebrospinal fluid (CSF) inside the cranial cavity occur as a result of trauma or hemorrhage, hematomas or brain tumors. With such pain in the head, vomiting, bouts of dizziness, severe drowsiness or agitation, general malaise, and visual disturbances are also characteristic. Pain is localized in the area of ​​the temples, on the surface of the forehead, in the back of the head or throughout the head, provoked by stress, overwork or changes in the weather.

Headaches after injuries of the skull tend to last several months from the moment of injury and may be accompanied by anxiety, reduced concentration and distracted attention, irritability and dizziness, depressive moods.

Tension headaches may be accompanied by a feeling of fatigue and muscle spasm, they are caused by physical or mental tension, can be provoked by muscle spasm in the neck, severe emotional experiences or stress.
Cervical headaches can be moderate or severe, localized from the neck to the back of the head, temples and eyes, while the person experiences nausea, dizziness and staggering when walking. May occur as a result of sudden movements in the neck, overwork and colds, osteochondrosis

Diagnosis and treatment of headaches at the TN-Clinic

Any patient with a headache needs a medical examination and examination to identify the cause of the pain. The complex of examinations, depending on the patient’s complaints, may include:

• reception of a neurologist, therapist, osteopath, kinesiologist;
• Ultrasound of neck and head vessels;
• general and advanced blood tests.

After the examination, the doctor will be able to develop a treatment program. In each case, the method of treatment and the choice of drugs is carried out taking into account the individual characteristics of the course of the disease, research data and the state of the body. Methods in the treatment of headaches can vary significantly, include the use of: drugs, manual therapy, reflexology and other methods of influencing the body. An individual treatment program is developed for each patient.

Osteopathy is a great help in curing headaches, which will eliminate both the pains themselves and their most common causes – spasm and muscle clamps. At the same time, an experienced doctor, through special manipulations, performs a smooth and accurate removal of spasm and restoration of full-fledged muscle work, which relieves pain and normalizes range of motion. Doctors of the TH-Clinic treat such conditions quite effectively. Another well-established method of treating headaches is lymphotropic therapy.

Neurologist Anahit Henrikovna Ambandaryan talks about what kind of headaches are and in what cases the help of a neurologist is required.

Abusive headaches. Ordinary classic tension headache may be complicated by a second drug-induced headache if a person takes painkillers more than twice a week for more than 2 pieces. In this case, it is necessary to treat already two headaches

Muscle pains

Considering that often the head hurts precisely because of a spasm of the neck muscles, it is worth dwelling on this problem in more detail. Due to prolonged exertion, pain in the neck and back often occurs, which is felt by patients as spasms or tension, or may go unnoticed for a long time. These muscle spasms interfere with normal circulation in the neck, spine, and head, which can lead to feelings of fatigue, tension, and headaches, impair performance, and reduce activity.

Spasmodic muscles require increased energy consumption, they compress nerve fibers and blood vessels, because of which metabolism and the functioning of internal organs suffer, pain and stiffness in movements occur. The causes of their occurrence are:

• osteochondrosis with protrusions and disc herniation,
• injuries and bruises of the spine, muscle injuries,
• long-term static loads with incorrect posture, prolonged sitting, carrying bags on one shoulder,
• emotional stress with increased muscle tone.

In this case, there are zones of pain, tension and spasm in the area of ​​the trapezius muscle, rectus muscles of the back, raising the scapula and others. There are pains of a pressing, aching or boring nature, they are unstable, they can intensify and fade, give to the shoulder, eyes or head. Sometimes, due to muscle pain, the full range of motion of the limbs or head turns is disturbed.

Cost

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Price

Duplex scanning of brachiocephalic arteries with color Doppler blood flow mapping

3300 r.

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Appointment with a neurologist, kinesiologist, osteopath

5500 r.

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Appointment with a neurologist

3300 rub.

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Acupuncture session

3850 r.

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Ultrasound examination of the spine

RUB 2420

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Svetlana Tkachenko

Specializes in the diagnosis and treatment of acute and chronic pain syndromes

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When to treat a headache

Headaches are the most common causes of feeling unwell. Almost everyone faces this problem: children, adults, men and women. Strong painful sensations occur in the temples, on the back of the head or inside the head. Intense pain is sometimes accompanied by nausea, intolerance to light and harsh noise. Each movement of the body causes an increase in the attack. Such symptoms are indicative of migraines – chronic attacks of headaches.

MedikCity, multidisciplinary clinic

st. Poltavskaya, 2

— Why does my head hurt?

Pain is caused by impaired cerebral circulation. Pain indicates vasospasm. The causes of discomfort and pain are different for everyone. Experts conventionally divide headaches into:

• tension pains that occur during prolonged compression of the head muscles;
• psychological, caused by stress factors, anxiety, strong excitement;
• migraines, in which the duration of the attack sometimes reaches 48 hours.

— What most often provokes a headache?

There are many factors that cause prolonged or short-term attacks:

• stress, nervous exhaustion;
• physical fatigue;
• hormonal changes;
• atmospheric pressure surges;
• alcohol abuse;
• violation of the regime of the day;
• smoking;
• overeating.

At the same time, there are a number of diseases, which are indicated by pain in the head:

• osteochondrosis;
• tumors;
• hypertension;
• sinusitis;
• diseases of the dental nerve;
• SARS.

— How often do people go to the doctor for help with headaches?

Patients are reluctant to seek medical attention when headaches occur. Most simply take a painkiller pill. Even if the seizures become more frequent or the pill does not give a positive effect, people are afraid or do not consider it necessary to turn to a neurologist or therapist. But self-medication only exacerbates the situation. Incorrectly selected drugs cause irreparable harm to the body. In this case, the main cause of pain is not eliminated. This only increases the negative impact on the general condition.

— What are the consequences of an uncontrollable headache? What happens if no action is taken?

Intense pain in the head brings physical and psychological suffering to a person. The situation is uncomfortable. Often painful sensations are repeated, become more frequent. An attack comes upon us suddenly or increases gradually. This is stress for the whole organism, worsening the quality of life. It is difficult to work productively, relax, and do everyday activities. There is no need to endure headaches, which often disrupt the habitual way of life. It is necessary to consult a neurologist to determine the cause of the problem.

— How to determine the causes of a headache?

It is possible to determine exactly why the head hurts in a particular case after passing a complete examination.