Main types of headaches
Tension headaches are the most common: they are bilateral, compressive, like a hoop or helmet, of moderate intensity, do not get worse with normal activity, and are rarely accompanied by nausea. Migraine is usually unilateral, pulsating, of moderate to severe intensity, worsens with movement, is accompanied by nausea, intolerance to light and sound, and is sometimes preceded by an aura in the form of visual disturbances. Cluster pain is rare, mainly in men: it is extremely intense unilateral pain in the eye area with redness of the eye and lacrimation, attacks are repeated in series.
- Tension headache - compressive, bilateral
- Migraine - throbbing, often unilateral, with photophobia
- Cluster pain - very intense, around the eye
- Abuse pain from painkiller abuse
- Cervicogenic neck pain
- Secondary pain due to other diseases
Causes and provoking factors
Primary headaches are associated with the functioning of the brain's pain systems and increased sensitivity to triggers. In tension headaches, the main provocateurs are stress, prolonged work in an uncomfortable position, lack of sleep, tension in the muscles of the neck and shoulders. For migraines, the list is wider: irregular eating and skipping meals, lack of sleep or excess sleep, dehydration, alcohol, hormonal fluctuations in women, bright light and strong odors. Secondary pain is caused by sinusitis, glaucoma, neck diseases, high blood pressure during a crisis, infections, and also some medications.
- Stress and muscle tension
- Lack of sleep and irregular routine
- Skipping meals and dehydration
- Alcohol and selected products
- Hormonal fluctuations in women
- Abuse of painkillers
- Sinusitis, glaucoma, neck diseases
- A sharp increase in blood pressure
When is an examination needed?
Most people with typical recurrent headaches and a normal neurological examination do not require an MRI: the examination does not change management and often reveals incidental findings that only raise alarm. An examination is necessary if there are alarming signs: sudden severe pain, a change in the usual nature of pain, the appearance of pain for the first time after 50 years, pain due to cancer or immunodeficiency, neurological symptoms, pain after injury. An examination is also prescribed for pain that increases in the morning, intensifies with coughing and is accompanied by vomiting.
- Examination by a neurologist with assessment of neurological status
- Headache Diary
- Blood pressure measurement, 24-hour monitoring if necessary
- Complete blood count and ESR
- MRI of the brain and blood vessels for warning signs
- Examination by an ophthalmologist for eye pain and blurred vision
- Consultation with an ENT doctor for suspected sinusitis
Treatment of attacks
For occasional tension headaches, simple painkillers, rest, airing, and relaxing the neck muscles are usually sufficient. For migraines, it is important to take the drug as early as possible, at the beginning of the attack: the later, the worse the effect. In addition to conventional analgesics, special medications are used for migraines, which are selected by the doctor taking into account concomitant diseases. The key limitation is the frequency of use: if painkillers are required more than 10–15 days a month, an overuse headache develops, in which the pills themselves maintain daily pain. In this case, you need the help of a neurologist.
- Taking the drug at the beginning of an attack
- Simple analgesics for tension pain
- Specific medications for migraines as prescribed by a doctor
- Dark quiet room and sleep with migraines
- Limiting how often you take painkillers
- Refusal to independently combine drugs
- Contact a neurologist if attacks become more frequent
Prevention and lifestyle
If attacks are frequent or severely disruptive, your doctor will prescribe a preventative treatment that you take daily for several months to reduce the frequency of attacks. Non-drug measures are no less important: regular sleep with a constant time of getting up, eating without long breaks, drinking enough, moderate physical activity, working with stress. It is useful to keep a diary, noting days with pain, medications taken and possible provocateurs: it helps both the patient and the doctor. Neck exercises and workplace adjustments work well for tension headaches.
- Preventive therapy for frequent attacks
- Constant sleep pattern
- Eating regularly and drinking enough
- Moderate aerobic exercise
- Stress management and relaxation techniques
- Headache Diary
- Workplace correction and neck exercises
- Limiting alcohol and caffeine
