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  • Writer's pictureJugoslav Erceg

A comprehensive guide to headaches: causes, diagnosis and treatment


Welcome to our comprehensive guide to headaches. In this article, we will take a detailed look at this widespread complaint.


Young man holds his hand to his forehead because of a headache.
man with headache

The classic definition of headache refers to a painful sensation in the head or head region. This is a subjective experience that can vary in intensity and duration. Headaches can occur in different areas of the head, such as the forehead, temples, back of the head or in the entire head region. They can be short-lived or chronic and vary in severity.


There are two main categories of headaches, primary and secondary headache syndromes. Primary headaches are disorders in their own right, such as migraines, while secondary headaches result from an underlying cause, such as an injury, infection, or other medical condition.


 

The most common primary forms include:


Tension headaches: This type of headache is often described as aching or aching. They can be episodic or chronic and are often associated with muscle tension in the neck and shoulder area.


Migraine: A migraine is characterized by paroxysmal headaches, which are often localized on one side and can be accompanied by strong accompanying symptoms such as nausea, vomiting, and sensitivity to light and noise.


Cluster headaches: Cluster headaches are extremely painful headache episodes that occur in what are called clusters. They are usually localized on one side and are accompanied by additional symptoms such as red eyes, tearing and nasal congestion. These attacks typically occur over weeks or months, followed by longer symptom-free periods.


In addition to these common types of headache, there are also rare headache syndromes that require specific diagnosis and treatment. Some of these less common primary headache types are:


Hemicrania continua: Hemicrania continua is a persistent, unilateral headache that is constant and may be accompanied by accompanying symptoms such as tearing, nasal congestion, and sweating. The pain is usually moderate to severe. Typically, the symptoms respond to a specific treatment with the drug indomethacin.


Paroxysmal hemicrania: Paroxysmal hemicrania is a rare form of headache that occurs in brief but frequent attacks. The pain is unilateral and typically occurs in the eye and temple area. Accompanying autonomic symptoms such as lacrimation, redness of the eyes or blocked nose can occur.


SUNCT syndrome: SUNCT syndrome (Short-lasting Unilateral Neuralgiform headache attacks with Conjunctival injection and Tearing) is characterized by extremely short but very painful attacks. These seizures usually last a few seconds to two minutes and often occur during the day. They are accompanied by reddening of the eyes, tears and a blocked nose.


 

Here are some common causes of secondary headaches:


Meningitis: Meningitis is inflammation of the lining of the brain and spinal cord caused by an infection. Headache is one of the main symptoms, accompanied by neck stiffness, fever, nausea and sensitivity to light. Meningitis is a medical emergency that requires immediate medical evaluation and treatment.


Head trauma: Headaches can occur after a head trauma, such as a fall, an accident, or a sports accident. These can be a sign of a concussion, brain hemorrhage, or other injury. After a relevant head trauma, a medical examination should always be carried out to rule out serious injuries.


High blood pressure: Uncontrolled high blood pressure (hypertension) can cause headaches. These headaches are often throbbing and usually occur in the morning. It is important to monitor blood pressure regularly and initiate treatment with medication if necessary to reduce the risk of complications.


Sinusitis: Inflammation of the sinuses, known as sinusitis, can lead to facial pain and headaches. The pain is usually due to pressure and swelling in the sinuses. Treatment involves relieving the inflammation and underlying causes, such as a bacterial infection.


Glaucoma: Glaucoma, also known as glaucoma, is an eye disease in which the pressure inside the eye is increased. Headaches can be one of the symptoms, especially when the increased intraocular pressure is acute and markedly high. Early diagnosis and treatment are important to prevent vision loss.


Medication side effects: Some medications can cause headaches as a side effect. These include certain blood pressure medications, hormonal drugs, nitrates, antidepressants, and others. If headaches occur after starting a new medication, this should be discussed with the treating physician.


In the case of secondary headaches, it is important to quickly identify the underlying cause and initiate specific treatment. When taking the anamnesis, certain red flags should be observed, which can indicate possible serious causes or diseases. These include sudden and extremely severe headaches, neurological deficits, changes in consciousness, fever, or headaches that occur after trauma.


If secondary headaches occur, an early medical examination is advisable in order to rule out serious illnesses and to initiate adequate therapy. Self-medication should be avoided as it can mask the underlying cause and symptoms.


 

But it is also important to take a good history (anamnesis) for all other headaches. Here are some important questions to consider:


  1. Type of headache: What is the type of headache? Is it a dull ache, a throbbing pain, or a stabbing pain. Are the symptoms acute or are they chronic headaches?

  2. Localization: Where is the exact localization of the headache? Is it unilateral or bilateral? Is it more noticeable in the forehead area, the temples, the back of the head or the entire head area?

  3. Intensity and Duration: How intense is the headache on a scale of 1 to 10 and how long does each episode typically last?

  4. Accompanying symptoms: Are there any accompanying symptoms such as nausea, vomiting, sensitivity to light (photophobia), sensitivity to noise (phonophobia) or visual disturbances? Neck stiffness, dizziness or neurological symptoms can also be important.

  5. Triggers: Have you noticed typical triggers such as stress, certain foods, hormonal changes or environmental factors that could be associated with the occurrence of the headache?

  6. Frequency: How often does the headache occur and how long does it usually last? Have the symptoms, frequency, or pattern of headaches changed over time?

  7. Pre-existing conditions and medication: Do you have any pre-existing conditions, medication or known allergies? This information can be important for diagnosis and selection of appropriate treatment options.


In addition, keeping a headache diary or headache calendar can help to better understand the course of the headache and identify possible triggers.


Here are some reasons why a headache diary can be helpful:


Recognize patterns: By regularly recording headache episodes, possible patterns can be identified and connections are recognized. They can determine if certain activities, foods, hormonal fluctuations, or environmental factors are related to the occurrence of the headache.


Identify triggers: A headache diary allows you to identify potential triggers identify. They can determine if certain foods, stressful situations, weather changes, or other factors are associated with the occurrence of the headache.


Assess treatment effect: You can check the effect of certain treatments or medications by documenting the frequency and intensity of headaches before and after use. This can help assess the effectiveness of your treatment and make adjustments if necessary.


Support doctor consultation: A headache diary can also be used when communicating with the be helpful to the doctor. By keeping a journal, you can provide accurate information about your headache and assist in the diagnosis and treatment processes.


When keeping a headache diary, note the following:

  • Date and time of headache episodes

  • Type and intensity of headache

  • Duration of headache

  • Concomitant symptoms and their severity

  • Possible triggers such as food, stress or weather changes

  • Medications or treatments taken

  • Actions that have contributed to the relief (e.g. rest, relaxation techniques)


 

The physical examination takes various aspects into account in order to make an accurate diagnosis. This includes examining the head/scalp to rule out injury, inflammation or abnormalities, and examining the cervical spine for possible tension or postural changes.


The diagnosis of headaches can involve different procedures, depending on the suspected cause. These include:


  1. Blood tests: Tests for inflammatory markers, hormone levels or hemoglobin levels, for example.

  2. Liquor puncture: This examination of the liquor (nerve or cerebrospinal fluid) can be carried out if inflammatory diseases of the central nervous system such as meningitis are suspected.

  3. Neurological examination: This can be used to assess the neurological condition and to identify or rule out neurological causes of headaches.

  4. Imaging tests: MRI or CT scans are used to detect structural changes in the brain, injuries, or other abnormalities.


 

The therapy of the most common headache syndromes is based on an individual treatment strategy that is tailored to the needs of the patient.


A holistic therapeutic approach to the treatment of headaches includes looking at the patient as a whole and taking physical, psychological and social aspects into account. Here are some key components that can be included in a holistic therapy approach:


Medical Treatment: A neurologist can make an accurate diagnosis and prescribe medical treatment options tailored to the specific headache type and individual needs of the patient. This may include the use of acute pain relief medication and/or prophylactics to reduce the frequency and severity of headache attacks.


Lifestyle changes: A healthy lifestyle can help reduce headaches. This includes adequate sleep, regular physical activity, a balanced diet and stress management techniques such as relaxation exercises or meditation.


Trigger Management: Identifying and avoiding potential headache triggers. This can include certain foods, environmental factors (e.g. noise, bright lights), hormonal changes, certain smells or emotional stressors. Avoiding or managing these triggers can reduce the frequency and severity of headaches.


Psychotherapy and behavioral therapy: In the case of chronic headaches, the support of a psychologist can be helpful. Improvement can be achieved by addressing stressors, learning stress management strategies, and identifying emotional or psychological factors that can trigger or worsen headaches.


Complementary therapies: A holistic approach can also include the use of complementary therapies such as acupuncture, massage, physical therapy exercises, or relaxation techniques such as yoga or tai chi. These techniques can help reduce pain and improve overall well-being.


Patient Education and Self-Management: Educating the patient about the underlying headache disorder, trigger factors, coping strategies, and the importance of medication, rest, and self-care is critical. The patient is encouraged to monitor their headaches, keep symptom diaries and learn to listen to their body to help manage their headaches independently


A dog with a hot water bottle on its head.
Animal pain

Digital health applications (DiGA) are medical apps that can be used to prevent, diagnose, monitor or treat diseases. They can also play a supporting role in the treatment of headaches. There have recently been various DiGAs specifically designed for the treatment and management of headaches.

In Germany, the DiGA must be approved by the Federal Institute for Drugs and Medical Devices (BfArM). The BfArM checks the quality, safety and effectiveness of the applications before they are approved on the German market. It is important to ensure that the DiGA you are using has a valid approval to ensure adequate quality and safety.

When using DiGA to help with headaches, it is advisable to follow the recommendations of your doctor. They can help you identify suitable DiGAs tailored to your specific needs. A combination of conventional treatment methods and digital health applications can enable a holistic and individual approach to headache management.

It is important to note that while DiGA can be helpful, it should not be used as a substitute for medical advice or treatment. If the headache is persistent or severe, it is important to see a specialist for an accurate diagnosis and appropriate treatment.


 

A healthy diet can also have a positive effect on headaches. However, there is no universal dietary recommendation that applies equally to all headache syndromes. Still, certain nutritional principles can help reduce headaches.


Here are some recommendations:


  1. Regular Meals: Skipping meals can trigger headaches. It is important to eat regularly and avoid blood sugar fluctuations. Eat balanced meals rich in nutrients.

  2. Hydration: Staying hydrated is important to avoid dehydration, which can trigger headaches. Drink enough water throughout the day.

  3. Identify trigger foods: Some people have specific foods that can trigger headaches. Common trigger foods include alcohol, caffeinated beverages, chocolate, cheese, nuts, citrus fruits, and artificial sweeteners. If you find that certain foods give you headaches, try to avoid them.

  4. Balanced diet: Eating a diet rich in fruits, vegetables, whole grains, lean protein, and healthy fats can help reduce inflammation in the body and promote overall health. This can also help reduce headaches.

  5. Trigger avoidance: In addition to certain foods, other triggers such as artificial additives, monosodium glutamate (MSG) or certain preservatives can also cause headaches. It can be helpful to check the ingredients list of processed foods and avoid such triggers.


 

Special case of headaches during pregnancy:

Headaches are not uncommon during pregnancy and the peripartum period, i.e. around the time of birth. However, there are certain aspects to consider as treating headaches in pregnant women requires special care.


During pregnancy, hormonal changes, increases in blood volume, and other physiological factors can affect the onset of headaches. Many women report tension headaches caused by muscle tension in the neck and shoulders. Migraine attacks may decrease during pregnancy, but there are also cases where migraine symptoms worsen or new migraine attacks appear.


During pregnancy, certain medications are avoided, especially in the first trimester, to minimize the risk to the unborn child. In such cases, alternative measures such as rest, relaxation techniques, massage, or physical therapy may be considered. Medications are also avoided at the end of pregnancy as they can negatively affect labor activity.


Headaches can also occur in the peripartum period, which can be due to hormonal changes, fluid shifts and lack of sleep. Especially after giving birth, women can suffer from headaches due to the abrupt drop in hormones and exhaustion. In these cases, adequate pain relief is important to support the mother and enable positive bonding with the newborn.


During pregnancy and the peripartum period, however, rare but potentially serious causes of headache such as sinus and cerebral vein thrombosis (SVT) also need to be considered. These conditions can be associated with a headache, but are rare and require immediate medical attention.

Sinus or cerebral vein thrombosis occurs when blood clots form in the venous sinus canals in the brain. This obstructs the flow of blood from the brain. This can lead to increased pressure in the brain and cause headaches. Pregnant women have a slightly increased risk of sinus or cerebral vein thrombosis due to changes in the blood clotting system during pregnancy. Typical symptoms are severe and persistent headaches, which are accompanied by neurological symptoms such as visual disturbances, epileptic seizures, changes in consciousness and neurological deficits.


If sinus or cerebral vein thrombosis is suspected, medical attention should be sought immediately.


A precise diagnosis usually requires imaging methods such as magnetic resonance imaging (MRI) or computed tomography (CT) in combination with a vascular display, a so-called venous angiography, as well as specific blood tests. Treatment usually involves blood-thinning therapy with drugs to break up the clots and prevent further complications.


 

Special case of lack of liquid:

Headaches can be a common symptom of dehydration. Insufficient fluid intake can lead to thickening of the blood, which in turn can impair blood flow to the brain and cause headaches. It is important to drink enough fluids to keep the body hydrated and avoid possible dehydration headaches.


Recommended daily fluid intake may vary based on individual needs, but in general an intake of around 2 liters of fluid per day is recommended. This can include water, unsweetened beverages, herbal teas, or fresh fruit juice. In hot temperatures, physical activity or certain illnesses, the need for fluids can be increased.


Pay attention to body signals and drink fluids in good time before you feel thirsty or have a headache. Drink regularly throughout the day and make sure you stay hydrated. Adequate hydration can not only help prevent dehydration headaches, but also promote overall health and well-being.


 

Special case of hot temperatures and prolonged exposure to the sun:

Sufficient fluid intake is extremely important, especially in hot temperatures in Germany, to protect the body from dehydration and prevent heat problems. Sweating causes the body to lose more fluid, and dehydration can lead to dehydration, which can cause serious health problems.

Insolation, also known as heat stroke, occurs when the body overheats and fails to regulate itself normally. This can lead to serious health complications and requires immediate medical intervention. Symptoms of insolation can include headaches, dizziness, nausea, confusion, increased heart rate and changes in consciousness.


To prevent heat problems, people should take the following measures in hot temperatures:


  1. Drink enough fluids: Drink water regularly to ensure proper hydration. Avoid alcoholic beverages and caffeinated beverages as they can be dehydrating.

  2. Keep cool: Go to cool places like air-conditioned rooms or shaded areas. Avoid direct sunlight and wear light, airy clothing to protect the body from overheating.

  3. Heat protection in the house: Ensure good ventilation in your premises, use fans or air conditioning to keep the room temperature comfortable.

  4. Light Meals: Eat light, easily digestible meals to reduce the burden on the body of digestion.

  5. Sun protection: Wear a hat, sunglasses and use sunscreen to protect your skin from harmful UV rays.

  6. Adapt activities: Avoid intense physical activity during the hottest hours of the day. Plan outdoor activities in the cooler mornings or evenings.


It is important to heed your own body signals and to seek rest and cool down in good time if you notice signs of heat problems such as headaches, dizziness or nausea. If symptoms persist or are severe, medical attention should be sought immediately.

The current recommendations and warnings from national health authorities and weather services should be followed for the latest on heat stress and precautionary measures.


A young woman fans her face with a fan.
Cooling down is good

 


Conclusion: Headaches are a complex problem that requires a thorough diagnosis and individually tailored therapy. Our neurology specialist practice is on hand to help you diagnose, treat and relieve your headaches. Please note that this post contains general information and does not replace personal medical advice. Always consult a health care professional to discuss your specific symptoms and needs and receive appropriate treatment.



Your neurology practice,


NEUROLOGY GALLUSWARTE


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