The headache can be prevented; that’s good news! What good could do a diary of painful episodes? How do we manage triggers? From stress, the great enemy of mental and physical health, to an innocent pickle that accompanies a tasty meal, they are all triggers for a headache! Yes, yes, you heard well… a common pickle!

The World Health Organization says 1 in 20 people in developed countries suffers a daily headache episode.

It brings us a complex approach to this condition, internal medicine specialist Dr Ioana Vescan, so you don’t have to worry!

Headache is described as localized pain in the head or upper neck and includes a cumulation of symptoms that can sometimes be difficult to describe.

Most of the time, it is located in a certain part of the head: frontal, occipital, temporal, but it can also be in the form of hemicrania (half-head pain). Hemicrania is also the most common form in migraine, sometimes generalized, encompassing the whole head. Headache can be installed acutely, suddenly, usually connected with stress or intense physical exertion, but it can also be chronic.

The nature of the pain can be in the form of stings (sharp), in the form of pressure (tension) or “deaf”. As for duration, it can be constant or intermittent.

The World Health Organization says 1 in 20 people in developed countries suffers a daily episode of tension headache.

Classification of headaches and main symptoms

Headache is of 3 types: primary, secondary and neuralgic (facial pain).

Primary headache includes tension headache, migraine and “cluster” headache.

Tension headache

It is the most common form of headache, found mainly in women. It is of moderate intensity and does not affect the daily activity of the patient. It is usually not accompanied by nausea or vomiting, and the specialist’s neurological examination is always normal.

Migraine

It can occur in both adults and children. In adults, it is more common in women than in men.

The most common symptoms of accompaniment are photosensitivity, sensitivity to noise, nausea and vomiting. The most common (80%) migraine form is the “no aura”, but you may also encounter the “aura” migraine variant. Migraine “with aura” (prodroma) means mood changes (irritability, depression), changes in taste or smell and excessive drowsiness or state of tension.

Triggers are described in migraine (situations that trigger the painful crisis): bright flashes (a TV image that appears and disappears very quickly), fluorescent light, reflected sunlight. Other triggers are stress and fatigue, hormonal changes, and certain foods: soy sauce, matured cheese, pickles, etc.

“Cluster” headache

Is a type of headache less common and mainly affects younger men. This occurs cyclically, with painless periods and is described as unilateral pain, usually above or behind the eye. The affected eye may be red, warm, tear, and be accompanied by nasal congestion or rhinorrhea. It’s very intense pain. The pain usually occurs twice a day, and each painful episode lasts about 30-90 minutes. It usually occurs at the same time of day and may even wake the patient from sleep.

Secondary headache

It occurs due to other conditions such as tooth infections, sinusitis, otitis, the ocular Zoster area or forehead, and life-threatening infections (meningitis or encephalitis) or head or neck trauma. This category also includes headache as an adverse drug reaction given by drug abuse as well as headache given by excess alcohol (hangover).

Neural headache

It means nerve pain. The most common facial neuralgia is trigeminal neuralgia. The pain is severe, lancinant, triggers and intensifies when the patient chews or speaks, may be accompanied by fever or subfebrility and loss or permanent or temporary reduction of vision in one or both eyes may occur.

Treatment of headache

Tension headache is treated primarily with analgesic or anti-inflammatory medication. I draw attention to the fact that all medicines can have side effects and have drug interactions. If the headache is severe and becomes repetitive, it is important to seek a specialist’s advice to guide you on the following steps: clinical investigations, paraclinical and treatment.

There are also methods of non-pharmacological treatment: stress management, massage, breathing and relaxation techniques.

Treatment of “cluster” headache is the preserve of the neurologist specialist, as it is a complex treatment for both acute episodes and prevention of recurrence of painful episodes. It is essential to change the lifestyle, and the most important measures are quit smoking, reduced alcohol consumption and sleep hygiene.

The most important recommendation is for the patient to keep a personal diary to write down all his painful episodes and under what conditions they were triggered in trying to avoid them.

Ongoing studies have shown that some dietary supplements have beneficial effects on the prevention of migraine attacks. These are magnesium, vitamin B2, walnut root extract and soft grass extract.

Treatment of migraines is determined according to the severity of painful seizures, their duration, and the impact on daily activity. It starts with common analgesic drugs. New studies demonstrate the effectiveness of monoclonal antibody therapy and other neuromodulation therapies.

Headache caused by drug abuse is treated by eliminating the causative factor: analgesic drugs.

When do we have to call a specialist?

It is important to call a specialist as soon as possible when the following alarm signs and symptoms appear:

new pain or change in the character of the pain;
new headache in a patient over 50 years of age or in children before puberty- may signify a brain tumor or neuralgia;
evolutionary pain, which increases in intensity, becomes more frequent and affects life and ordinary activity;
headache arising from a head injury or accident;
sudden, intense pain with a “split” character – may suggest a subarachnoid hemorrhage;
atypical “aura” migraine, lasting more than 60 minutes or accompanied by neurological phenomena (paresis or paresthesia in the limbs, balance disorders, vision), or loss of consciousness;
headache accompanied by fever or subfebrility, rash, stiffness in the neck and cervical spine and confusion- may indicate encephalitis or meningitis;
intense eye pain accompanied by redness and tear of the eye – may signify the onset of the ocular Zoster Zone or “cluster” headache;
headache accompanied by nausea and vomiting important and difficult to control at home;
headache associated with neurological phenomena: reduction or loss of sensitivity or control of a limb, balance disorders, speech inconsistency, difficulty concentrating, inappropriate behaviour, convulsions, double vision disorders, blurred vision.

Specialist recommendation

If you work a lot of time in the office, take breaks to get up and do stretching and muscle relaxation exercises.

Pay attention to hydration, healthy nutrition and sleep hygiene.

Be aware of the warning signs of a severe condition and contact a specialist (internal medicine or neurologist) as soon as possible. Most types of headache can be diagnosed by anamnesis (discussion with the patient). If time or conditions do not allow you to go to a doctor’s office, this can also be done through telemedicine. Your doctor will be able to tell if you should get a consultation and whether you need to have other investigations too.

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