Headaches and flu

Headache (headache) is present in eight out of ten cases of influenza, but it can also be a sign of a different problem.

If the headache lasts more than five days, is severe or is accompanied by vomiting or visual disturbances, it is good to contact your doctor.

Also, if headache is the only symptom, it is not necessarily due to flu or an infection of the paranasal sinuses (sinusitis). In these cases, the causes must be carefully investigated.

Many possible causes

In general, headaches are divided into primary and secondary. Among the first the most frequent are:

• tension headache
• migraine
• cluster headache

Primary headaches are diseases in their own right, while secondary headaches are the symptom of other disorders such as:

• Neck and head trauma
• overexertion
• hypertension
• eye or dental disorders
• infections (such as influenza).

Primary headaches

According to the World Health Organization, headache is the most common disorder affecting the nervous system. In Italy, according to the most recent estimates, about 26 million people suffer from it, especially in the age group between 18 and 65 years.

Tension headache

Tension headache is the most common form of headache: about 75 percent of the population suffers from it, with preference for the female sex.

Its causes have not been fully clarified, but it seems that it is linked to disorders, such as anxiety and stress, which induce a continuous contraction of the muscles of the head and neck. It would be the latter to cause the pain in the head.

Tension-type headache can be:

• occasional, when it occurs less than once a month
• frequent, when one to fifteen episodes occur per month
• chronic, if it occurs more than 15 times a month.

The pain is constrictive, or the classic circle to the head, and can last from half an hour to a few hours. In the most disabling and chronic forms, headaches can appear upon waking up and continue until the evening, causing considerable discomfort. The pain is not typically associated with nausea or vomiting and is not aggravated by movement.

Migraine is a type of headache that affects only one area of the brain, usually the frontal, orbital or temporal lobe, and presents with throbbing pain that increases if you make sudden movements. Its causes are not yet clear. However, what is now evident is that it occurs more frequently in women and that there is a certain familiarity Migraine attacks, in addition to intense throbbing pain, often only on one side of the head, are also characterized by gastro-intestinal symptoms, in particular nausea and vomiting, as well as by increased sensitivity to light (photophobia), to noises, smells and movement (with possible dizziness).

Sometimes these disorders may be preceded by warning symptoms, such as mood changes (depression, tension, irritability, etc.) or increased appetite. During a migraine attack, it can become difficult to carry out daily activities and especially physical activity. It is therefore a very disabling disease, even more so if headaches are associated with the so-called auras (or typical visual disturbances, such as vision of spots in the visual field), falling asleep or tingling of an arm and / or half of the face and sometimes difficulty in speaking (inability to find the words to express themselves) that last on average 20-30 minutes and precede the headache (which in rare cases can also do not appear). Hence the distinction between migraine without aura and with aura, fortunately less common. In both cases, migraine crises are typically favored by some triggers of different nature and variable from individual to individual including:

• Stress
• consumption of certain foods or alcohol
• cigarette smoke
• hormonal changes (as can happen in pregnancy, during menopause or menstruation)
• environmental factors (climatic variations, excessive sun exposure, etc.)
• noises and smells.

As for the link with food, headaches can arise because, for example, digestion is made tiring and slow by fried or fatty foods, or because in some subjects the consumption of foods rich in tyramine (eg aged cheeses), a particular amino acid, triggers pain.

Cluster headache is one of the worst pains you can experience. Fortunately, this form of headache is quite rare: it is estimated that 50 to 300 people per 100,000 people are affected.

The causes are not well known, but it is evident an involvement of an area of the brain called the hypothalamus, which regulates the sleep-wake rhythm. The pain is excruciating, it arises suddenly and reaches its maximum intensity in a few minutes. It affects only one side of the head, always the same, and is located around and behind the eye, but can radiate to the forehead, temple and jaw. During attacks, the person suffers so much that they cannot sit still. The characteristic pain can then be associated with other typical symptoms, only on the affected side. The most common are tearing, runny nose, pupil twitching, eye redness, sweating on the forehead, swelling or sagging (ptosis) of the eyelid.

Secondary headaches

Secondary headaches account for about 20 percent of all forms of headache. They are secondary to other conditions, sometimes very serious, for example a head injury or the rupture of an intracranial aneurysm: for this reason they should not be neglected, especially if they are associated with other symptoms. Making a correct diagnosis is the first step to setting the most appropriate therapy.

Secondary headaches include headaches related to infections, such as sinusitis or influenza. In the first case, the headache occurs in association with stuffy nose, discharge of phlegm from the nose and, depending on the inflamed paranasal sinus, sense of pressure to the face when bending down, pain in the forehead, especially in the area of the cheekbones and / or the upper dental arch.

In the case of influenza, the typical headache that many feel is related to fever, which causes a dilation of blood vessels and an increase in cranial pressure.

Secondary headaches are also often linked to a contracture of the cervical muscles (only sometimes cervical hernias) that causes localized pain in this area and headache.

Different symptoms, depending on the cause

Let’s see together how the symptoms change depending on the cause of the headache.

Therapies

For primary headaches, there are generally two therapeutic strategies:

• counteract pain with analgesics
• prevent attacks.

In most cases, paracetamol and NSAIDs such as acetylsalicylic acid, naproxen and ibuprofen are used to counteract pain. You can then resort to other specific drugs (called triptans) in the case of migraine or cluster headache, or non-pharmacological measures (antalgic gymnastics, relaxation techniques, etc.) in the case of tension headache.

The treatment of migraine attack, in particular, is based on the use of analgesics, anti-inflammatories, ergotamines and triptans. In cases where migraine is such as to significantly compromise the quality of life, preventive therapy can be considered: there are various drugs that can be used for this purpose and the doctor can identify the most suitable for the individual case. In addition, to prevent crises it may be useful to review your eating habits, avoiding those foods that can act as triggers (in this regard there is no solution that works for everyone, but everyone will have to identify the foods that, avoided, reduce the frequency of headache). Improving sleep quality can also help fight some forms of headache and migraines.

When headaches are frequent (more than once a week), in addition to the therapy of the acute phase, it is important to set, as soon as possible under the guidance of a doctor, a preventive treatment, especially in the most serious and disabling cases.

In the case of flu, symptomatic drugs, such as analgesics and non-steroidal anti-inflammatories, relieve headaches, including through the reduction of fever. Always useful rest and drink a lot to avoid dehydration, while you do not need to fast, which in itself is a trigger for headaches.

In case of sinusitis, if the infection is bacterial, antibiotics are used which, by solving the cause, also eliminate the symptoms.