Headaches - symptoms, diagnosis, treatment 

When to see a doctor urgently?

The most important aspect is whether the headache is the current manifestation of a pre-existing or recurring headache or a completely new or changed complaint. Many adults have already suffered headaches since adolescence or childhood, with headaches up to several times a week, but in so far as the usual pain occurs, it is unlikely that the headache would pose an extra danger beyond the usual discomfort.

When should we take symptoms seriously?

• If you do not generally suffer with headaches but start experiencing one.
• If you get headaches or migraines but experience a different headache than usual.
• If you suddenly have a very severe headache with the following symptoms:

- Sudden, shock-like neck pain begins, as if you had received a blow to the head, accompanied by nausea, vomiting, possibly drowsiness, dullness, confusion, and epileptic seizures - this could be a sign of intracranial hemorrhage, for example. In this case, consult a doctor immediately.

- Headaches with a high fever and possibly seizures should also be taken seriously, as these symptoms may be signs of meningitis or encephalitis.

• Patients with cancer may develop distant metastases in the brain. In the case of a known cancer, even if it is classified as cured, an unusual or hitherto unknown headache may be a symptom of a tumor.

A lot of people have headaches, but only a small percentage living with this pain has a disease that causes their headaches which can lead to more serious consequences, even death, without treatment or intervention. In these cases, a headache is just a symptom of another disease, the discovery and treatment of which over time can mean the patient's survival.

What are the types of headaches?

• In one group, some underlying disease causes a symptomatic headache. These are called secondary headaches. In such cases, the underlying disease needs to be identified and treated, which usually eliminates the headache.
• Another group of headaches are what we call primary headaches: there is no detectable structural lesion of any organ that is causing the patient’s headache. In such cases, it is a headache syndrome that is largely genetically inherited and manifests itself in a characteristic clinical syndrome. The most common form is migraine.

However, headaches can arise from more than just neurological causes. What are the most common non-nervous system diseases that cause headaches?

• Several types of ophthalmic disease can cause headaches. One of the most serious is glaucoma, and it is very important that the patient sees an ophthalmologist urgently in such a case.
• Otolaryngological diseases such as sinusitis, frontal sinus inflammation, and infections of the middle ear (otitis media) can also cause headaches.
• Shingles can also cause headaches, and its dermatological symptoms are often more difficult to notice on the scalp.

What do we need to know about migraines?

In the case of a migraine headache, there is no detectable structural lesion of any organ that is causing the patient's headache. The headache in migraine sufferers has a very characteristic clinical syndrome. Migraine headaches can affect up to 10-20% of the population and often begin in childhood. Among migraine sufferers who see a doctor, the proportion of women is much higher. This is probably because the disease is more common in women and that men are less likely to see a doctor with a headache, although if they did, they would spare themselves and those around them a great deal of suffering.

What are the symptoms of migraine?

A characteristic symptom of migraine is a recurrent seizure-like headache, usually occurring once or twice a week and lasting 4 to 72 hours. Migraine headaches typically fall into this time range, are usually spasmodically throbbing, often with very severe pain on one side, making daily activities impossible. In the case of a migraine attack, the patient is unable to do their job and cope with everyday life.

The characteristic accompanying symptoms of migraine are nausea, possibly vomiting, an increased sensitivity to external stimuli, and the sufferer is unable to tolerate strong lights, sounds and odors during the attack. Physical activity intensifies the headache, while resting in a dark quiet place, and sleeping if possible, may improve or even rid the sufferer of the migraine.

Migraine diagnosis and treatment

In many cases, migraine patients fear that their complaints are caused by a serious disease of the organs or nervous system, such as a brain tumor. Fortunately, during the medical examination’s interview with the patient, we can make a safe diagnosis which can convince the patient that it is not a secondary headache, but a primary headache disease: migraine. The characteristic connection and typical coexistence of symptoms and complaints give the diagnosis of migraine.

A typical migraine patient does not necessarily require any further examination, but a CT or MRI scan is often performed to reassure the patient, with the goal that the patient accepts that their headache has no serious cause stemming from an organ but is a genetic disease characterized by recurrent headaches. We cannot cure a migraine, but it can be treated very well with the medications already available.

With proper specialist care, it is possible to effectively treat a migraine attack, on the other hand, we can administer medications that in some cases reduce the frequency or duration of migraine attacks. This is a great help for migraine sufferers who have frequent seizures, several times a week, lasting a day or two, and are thus unable to work. In such patients we usually recommend long-term medication, which can reduce the frequency of migraines by half, a third, or a quarter. Nevertheless, individual seizures can be treated very effectively with completely different prescription medications that can be prescribed by a neuropathist or a neurologist.

What are the most common misconceptions about headaches?

There are many misconceptions about headaches in the public consciousness. One typical example is that the headache is caused by narrowing of the blood vessels in the neck, or cerebral atherosclerosis, but this is a false assumption.

Patients often think that cervical spine disease is the cause of their headaches, but mostly the cause of the pain lies elsewhere.

Effective treatment of migraine begins with an accurate diagnosis, and medications prescribed by a specialist can also reduce the severity, frequency and duration of migraine attacks.

For further information and to make an appointment, phone: +36 1 377 6737.