Headache: A headache?

A headache is one of the most frequent reasons for consultation in our society, it is estimated that approximately 90% of the population suffers at some point in their life a headache.

Almost all types of a headache are more frequent in women, it is a disease with great implications in terms of quality of life, school and work absenteeism, with a great economic cost for incapacities, medications, and a decrease in the overall performance of the patient.

This pain can compromise the entire head or parts of it, and according to the characteristics described by each patient is classified and a management plan is made.

Primary headaches

Migraine (hemicranias means half of the skull) or migraine is a constitutional disorder with a hereditary basis characterized by recurrent episodes of a headache. It is located in one part or in the whole head, has a palatial nature (with the sensation of beat) and is accompanied by nausea and occasionally vomiting, as well as an exaggerated discomfort by lights (photophobia) and by noises (photophobia). Usually the pain is triggered by various stimuli such as stress, menstruation, certain drugs or foods, climatic changes or physical effort. It is a pain that usually worsens with physical activity and improves with rest.

A tension-type headache occurs in the form of pain that occurs in the occipital (posterior) region of the head or forehead, sometimes reaching the cervical (neck) region. The pain is of moderate intensity (less than a migraine) and is not usually accompanied by nausea, photophobia or phonophobia. It also does not get worse with exercise. It is usually present all day and usually does not prevent the person from developing his usual physical activity.

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Some patients with episodic headaches begin to develop pain symptoms more frequently and intensely, to the point of presenting them daily or most days. This situation is generally associated with a high consumption of analgesics, which is favored by the wide and easy access that facilitates the consumption of these drugs, usually taken without a prescription.

Chronic daily headache, represents a group of headaches characterized by the almost daily frequency of pain. They present headache more than 15 days a month for at least 6 months. In most cases, it is a case of patients who previously had a migraine or a tension headache. The vast majority of these patients self-medicate and abuse analgesics.

Symptom

• The pain can be located in one part, or it can affect the whole head. The intensity of pain is often variable, depending on the sensitivity of each patient to pain, and can often be disabling, forcing them to lie down and suspend all their activity.
• The frequency of episodes is variable, ranging from one to four or five per month, with increased stress, consumption of certain foods, alcohol consumption, menstruation, fatigue.
• The duration of a migraine crisis usually does not exceed 24 hours, although they can be very brief (3-4 hours) or very long (up to 3 days).
• Visual disturbances (black spots, bright lights, visual distortion, etc.), alterations of sensitivity (tingling), strength (weakness) or language. More exceptionally, the migraine crisis can occur with alterations in a coordination of balance and double vision.

Related Factors

Heredity: a large majority of migraine patients have parents or siblings with a migraine. Although the form of inheritance is not fully established, in some special forms of a migraine (familial hemiplegic migraine) the gene that transmits it has already been identified.

Age: There migraine in childhood, although less frequent. At these ages, migraine occurs equally in boys and girls. From puberty and due to hormonal changes, the incidence of a migraine in women is increased. In the elderly patients, tension-type headache predominates.

Food: chocolate, cocoa, vanilla, banana (banana), nuts, citrus, food additives “junk”, sausages, fermented cheeses and spicy have been implicated as triggers of migraine headaches.

Alcohol: regardless of type, however, red wines often trigger migraines more frequently.

Hormonal changes: the incidence of a migraine is markedly increased in women after the onset of menstruation. A migraine often worsens with ovulation and menstruation, as well as taking oral contraceptives. Pregnancy usually transiently improves a migraine and many women improve dramatically when menstruation disappears.

Missing or excessive sleep can make the pain worse.

Drugs used in the management of heart disease (vasodilators), oral contraceptives, asthma drugs can trigger, or increase pain.

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Diagnosis

To define a diagnosis, it is recommended that the person who suffers a headache, inform the doctor, as detailed as possible, the manifestations of pain, duration, number of crises, response or not to analgesics, what improves it? What makes it worse?

• Characteristics of pain (stabbing, burning, oppressive).
• The location (the whole head, parts, unilateral, ocular).
• The time of evolution of the pain (minutes, hours, days).
• Factors that trigger or aggravate it (menstruation, stress, food).
• The factors that relieve it (rest, vomit, sleep, darkness, analgesics).
• Symptoms associated with pain (nausea, vomiting, photophobia, phonophobia).
• The symptoms that precede the pain, like alterations of the vision (bright lights, black spots, defects of vision, alterations of the sensitivity, etc.).
• Information about family history, in case you have a family member with headaches similar to yours (usually there is some antecedent).

Alarm Signs

The presence of any of the conditions listed below indicates an immediate consultation with the emergency department, where appropriate measures will be taken, as it is very possible that diagnostic tests such as imaging tests (CT, resonance, lumbar puncture, Other studies based on examination findings):

• A headache (a recent headache) (patient without a history of previous headaches).
• If you feel you have the worst headache in your life.
• A headache that has changed its characteristics (intensity, duration, symptoms, etc.).
• A headache associated with neurological deficit (loss of strength, sensitivity, vision, coordination, seizures).
• A headache and fever.
• A headache and meningeal signs (difficulty in mobilizing the neck, suspicion of meningitis).
• A headache and debilitating disease (cancer, AIDS).
• A headache and disturbance of consciousness.

Treatment

The basis of treatment is in the exact diagnosis of the type of a headache, which should only be done by the physician.

Since it is a multifactorial disease it is impossible to give a recommendation that applies to a whole population, the treatment must be individualized according to the characteristics of each patient, age, associated diseases, risk factors, family history.

Please do not self-medicate, because we not only delay a necessary medical consultation, we confuse the characteristics of the disease and delay the diagnosis but also, there are serious risks of poisoning and life-threatening adverse effects. Finally we suggest you to visit this blog to know related reviews.