Headache: causes, symptoms, remedies

What is it

The common headache, in medicine defined as “headache”, is a very common disorder and characterized mainly by pain localized at the level of the skull or the upper part of the neck.

In fact, it affects the female sex more than the male sex and represents one of the most important health problems on a global scale since it affects such a large number of people (including children), sometimes even in a disabling way.

It generally manifests itself with acute and sporadic attacks, of variable duration, but can also become chronic with recurrent attacks.

To relieve or control a headache, especially if frequent or if the intensity is high, it is essential to immediately identify the type of headache in question by making a correct diagnosis in order to intervene with the most appropriate therapy, often pharmacological.

The term headache, headache, in fact contains over 150 different types of head pain. This term of common use is too generic to allow us to understand what the exact disorder is present.

The distinction between primary or essential headaches (where headache is the actual disease) and secondary headaches, in which head pain is only one of the symptoms that accompany other conditions (for example a sleepless night, a large meal, a glass too much) or a different pathology (such as a flu, a head injury, depression) can however be difficult given the complexity and variability of the cases.

Usually, to “catalog” them, reference is made to the International Classification of Headaches (ICHD) approved by the World Health Organization and based on the symptoms presented by the patient and, for secondary headaches, on the identified etiology.

Primary headaches

Primary headaches tendto recur periodically, with varying frequency and intensity and spontaneously or solicited by specific triggers. If not treated properly, they tend to get worse over time, attack after attack, and recur more and more often. Generally, they affect people who have a particular predisposition to develop them. Migraine, for example, mainly affects women of childbearing age (affected four times more than men). And the main culprits are hormones and their periodic fluctuations. The three most common are:

• migraine, which causes recurrent attacks, lasting from 4 to 72 hours, often anticipated by warning signs (such as irritability or depressed mood), which can also be serious. The typical pain is pulsating, concentrated on only one side of the head, not always the same. In the case of migraine with aura may be accompanied by nausea, vomiting, hypersensitivity to light and noise. Typically, it gets worse with physical activity;
• cluster headache, affecting men between 25 and 50 years of age. It is so defined for the grouped trend of attacks, it is certainly the worst form to bear. The pain is located on one side of the forehead, around and behind the eye, presents as stabbing pangs and may be accompanied by eye irritation and a feeling of stuffy nose and/or runny nose. The duration of a single attack can vary from a quarter of an hour to three hours, but during the day you can have more than one;
• muscle-tension headache, which gives rise to a more bearable pain, similar to a weight or a vice, spread to the whole head, dull and of constant intensity. More equal, by age and gender distribution, tension headaches can be occasional (if its manifestations occur for less than 15 days a month) or chronic (if, on the contrary, they occur for more than 15 days) and depends on an excessive contraction of the muscles of the neck, face and skull, often induced or favored by emotional stress, from orthodontic problems or incorrect postures. It can last from half an hour to a few days.

Secondary headaches

We speak of secondary headaches when the cause is well determined, as happens in the case of a strong trauma to the head or a further medical condition in progress.

Headache manifests itself is, for example, sinusitis, an inflammation of the paranasal sinuses due to allergy or a simple infection of the upper airways and often accompanied by symptoms similar to those of colds (nasal congestion, secretion of yellowish mucus, tenderness and swelling of the face, reduced ability to perceive odors and cough).

Pharyngitis, an inflammation of the pharyngeal mucosa of viral origin, is also manifested by headache, associated with sore throat, fever, malaise, gastrointestinal disorders (etc.), while in certain ear infections, such as otitis, this symptom arises only in the most severe cases.

Cervicalgia of a muscular nature (a pain localized in the nape area, neck and shoulders, generally associated with a sedentary lifestyle or a traumatic episode such as whiplash) can be accompanied by a tension-type headache, if emotional tensions cause stiffening of the neck and shoulder muscles.

Headaches are also frequent in systemic diseases such as hypertension, in some brain tumors, in cerebral aneurysm and in the consequent intracerebral hemorrhage; An event, the latter, characterized by a particular form of headache called “thunderclad” and caused by the rupture of atherosclerotic blood vessels.

In addition, toothache and headache, bruxism (or teeth grinding), jaw pain and headache are often associated or headache or headache can appear at night for example due to sleep disorders (in this case we speak of night headache) or it can be one of the symptoms of the flu (fever and headache are often associated).

Finally, it is possible to include in the category of headaches also:

• a cranial neuralgia, different in localization according to the nerves involved;
• facial pain called central or primary;
• other types of minor headaches.

Secondary forms can affect anyone at any time. They may be occasional or return frequently. It depends on the cause that triggers them. And their treatment, in fact, targets the very problem that generated them.

A particular secondary form to which it is good to pay attention is medication headache: at its origin, as the term says, there are medicines used to treat other diseases, such as opiates, non-steroidal anti-inflammatory drugs (NSAIDs), triptans but also over-the-counter drugs such as paracetamol. Excessive use of analgesics containing butalbital to try to quell an insistent headache can also cause it.

Diagnostic tests in many cases are useless, and are limited to cases of secondary headaches in which the underlying cause is to be confirmed.

Valid methods of diagnosis include:

• the physical examination, during which the doctor assesses the general condition and investigates, among others, the possible presence of vasodilation in the temporal zone and the correct functioning of the jaw joint;
• blood tests sometimes accompanied by a lumbar puncture (called spinal cord) in case of suspicion of an ongoing infection, such as an inflammation of the meninges (meningitis));
• computed tomography (CT) or magnetic resonance imaging, to exclude any structural abnormalities or tumor masses, especially if the onset of headache is sudden and of strong intensity
• The neuroimaging study.

Causes

Headaches in general are caused by the alteration of the mechanisms of activation and transmission of the painful stimulus in the areas affected by the symptoms; To date, however, it has not yet been fully clarified why these processes change, but it seems that both endogenous mechanisms and environmental or exogenous triggers are involved.

There are also some conditions that favor the onset of the attack, called “triggering factors” that create a concentration of irritating and inflammatory stimuli in the brain that affect the nerve endings causing pain. These include:

• Stress;
• difficulty falling asleep, and sometimes insomnia;
• environmental pollution both acoustic with too loud noises and atmospheric with exposure to the sun during the hottest hours or humid climate;
• certain foods such as aged cheeses or chocolate;
• alcohol abuse (which causes so-called hangover headaches) and caffeinated products;
• cigarette smoke;
• a drop in sugar due to prolonged fasting;
• certain medications;
• incorrect posture;
• a too sedentary life or, on the contrary, an excessive sporting activity.

In addition, driving headaches, fever and stiff neck may appear, especially if you suffer from muscle-tension headache.

In women, even the fluctuation of hormone levels during the different phases of the cycle, in particular at the menstrual flow would seem to affect the appearance especially of migraine. In fact, most women report that the frequency of attacks increases immediately before, during or after menstruation. To date, the mechanism linking estrogen and progesterone levels with migraines has not yet been fully explained. In addition, some women observe a significant improvement in headache during pregnancy or with the arrival of menopause, which for others is the triggering event.

Common symptoms

As far as migraine is concerned, the main symptom is represented by an acute throbbing pain, of medium-intense degree and often recurrent with variable timing and severity. Especially at the beginning it tends to affect a specific point of the head in particular in the frontal region and at the level of the temples. In advanced stages it can involve both sides of the head.

The sensation of pain may be associated with other symptoms such as:

• general malaise;
• nausea;
• vomit;
• photophobia (sensitivity to light), phonophobia (sensitivity to sound) and/or osmophobia (sensitivity to odors), which often require periods of rest in dark and quiet environments.

Migraine can also appear with “aura“, i.e. characterized by the passing manifestation of visual and speech disturbances prior to the actual migraine attack and by sensory symptoms also in other parts of the body (such as legs or arms). In recent years it has been seen that those who suffer from migraine have a higher risk of developing more serious diseases affecting the nervous system, such as stroke or cerebral hemorrhages.

Tension headache is instead characterized by a pain of lesser intensity, very often on both sides of the head and not pulsating, defined as the classic “circle to the head”. It can often be a consequence of periods of stress, anxiety or depression. Although less debilitating than migraine, it is the most common form of headache in the population, the one that most people around us have experienced at least a few times in their lives.

In the case of cluster headache, the pain is usually unilateral and always strikes from the same side. It can also be associated with:

• lachrymation;
• conjunctival redness;
• drooping of the eyelid;
• rhinorrhea and nasal congestion.

All of these symptoms commonly manifest on the same side where pain is felt. Only rarely is it associated with nausea or vomiting.

Below is a table that summarizes the main characteristics of the forms of headache just described.

In secondary forms, pain may be accompanied by different symptoms depending on the triggering factors. For example, if there are stressful situations at the base of the headache, tachycardia (increase in the number of heartbeats) or a feeling of muscle tension may also appear, particularly in the shoulder muscles, which can lead to incorrect postures.

If, on the other hand, the disorder is due to changes in blood pressure, dizziness and nausea may occur.

Complications

Persistent pain that becomes frequent and very acute is already in itself a non-negligible complication since it negatively affects the quality of life and prevents the performance of normal daily activities. Headaches, migraine in the first place, can go from occurring occasionally to having a scheduled and therefore chronic appearance. Excessive use of symptomatic drugs is one of the possible causes of the process of chronicization.

Early diagnosis and appropriate therapies are generally recommended to control symptoms.

Treatment

It is not always easy to fight headaches. There are different medicines depending on the headache, medicines for severe headaches and others for milder cases. For example, for sporadic and mild forms in general, analgesic drugs for self-medication such as NSAIDs (acetylsalicylic acid, ibuprofen, naproxen) or antiemetics, better if they are fast-acting preparations, such as products in granular format that dissolve in the mouth and quickly enter the circulation, or specific formulations for rapid absorption.

This therapeutic approach is in fact symptomatic and is recommended only in case of a headache that occurs with medium-low frequency (no later than 8-10 days a month).

How to cure migraine instead? For this form of headache, your doctor may decide to prescribe a tryptane. In general there is no triptan better than another as they all demonstrate comparable effectiveness not only on pain, but also on the symptoms that usually accompany an attack of headache (photophobia and phonophobia, nausea and vomiting) with positive response rates of about 70-80%. However, it is important to take into account the side effects related to them: these drugs are not indicated for subjects with cardiac or vascular problems in general.

When headache episodes occur with a certain frequency, specific prophylactic treatments should be evaluated. These do not replace the analgesic during times of pain, but taken daily lead to a reduction in the number of days in which the headache is present. Drugs belonging to the following pharmacological classes are usually used:

• beta-blockers;
• calcium channel blockers;
• Serotonin antagonists;
• Antidepressants;
• antiepileptics,
• botulinum toxin.

Recently in the United States and the European Union new biological drugs are being approved, directed against a peptide involved in the processes of triggering migraine. However, these treatments will be reserved for patients in whom other prophylactic drugs have not proven adequately effective.

Even the observance of some daily habits, such as having lunch or dinner at the same time and practicing regular physical activity, going to bed and getting up at the same time even during the weekend and sleeping an adequate number of hours, would seem to have a positive effect in preventing or reducing the appearance of attacks. In the same way it also seems useful to perform daily exercises for the cervical (even in the office) or undergo specific shiatsu massages for headaches. In addition, it is good to include in the daily menu large portions of fruits and vegetables, foods rich in vitamin C and antioxidants. A positive correlation was also observed between dark chocolate intake and headaches and between migraine and coffee.

Finally, some people also benefit from non-conventional medical techniques such as acupuncture.

Other tips to treat headaches

If the frequency of attacks remains high for more than three months, the headache is considered chronic. In these cases, in order not to see the quality of life significantly reduced, it is advisable to consider a preventive therapy, whose purpose is to reduce the number of episodes and mitigate their severity, restoring sensitivity to analgesics that may have become ineffective in the meantime.

Prevention may involve taking several medications. For example, against migraine are often indicated beta-blockers, calcium channel blockers, long-acting ergotamines. In addition, it seems that for migraine sufferers it is better not to drink from plastic bottles as they may contain a substance (bisegol A) capable of increasing the frequency and intensity of attacks.

Against cluster headaches, calcium channel blockers are mostly used which, if taken from the first attacks, are able to substantially attenuate its frequency and intensity, allowing to maintain a good quality of life.

Many tension headaches are associated with muscle contractures: preventive treatment with muscle relaxant drugs associated with physiatric interventions and local massages that help to release tension and normalize muscle tone can therefore be effective.

Identifying the most effective drug for prophylactic purposes in each individual case is not easy: it takes time, commitment and patience, as well as the willingness to collaborate with the doctor.

The white coat, which is responsible for the choice and prescription of these drugs, must be referred to the characteristics and duration of the attacks, the response to the therapies taken and all the factors that tend to trigger or aggravate the attack (stress, changes in time zone or habits, intake of particular foods or drinks and so on). It is very useful to compile a “headache diary” where you can write down all the characteristics of your condition.

Prophylactic therapy should be followed for several months, often over a year. It is long, but usually brings a good degree of improvement.

When to consult your doctor

If the episodes of headache recur several times in a month or if the prescribed medication, for example a painkiller, does not work, it is necessary to consult the doctor so that the causes and the most appropriate treatments can be identified. In order to be able to adequately assess the frequency with which you suffer from headache, it is advisable to regularly compile a headache diary (there are some that can be downloaded free of charge from the network).

In addition, you should always contact your doctor both when the pain occurs suddenly and is very intense and if fever, tiredness or exhaustion, visual disturbances, difficulty speaking, pain or stiffness in the neck or following a strong trauma appear.