Headache • Recognize the causes & relieve pain

Headaches have many faces. The pain can be dull, pressing or pulling, affect the entire head or only occur on one side. In addition, headaches can be acute or chronic.

As diverse as the headache symptom itself are the types of headache that experts differentiate. The International Headache Society (IHS) has described a large number of different types of headache in its classification. Tension headache is by far the most common type of headache and migraine is the second most common. Together they make up around 90 percent of all headache cases.

Primary and secondary headaches

With regard to the type of headache, a basic distinction is made between primary and secondary headaches. Primary means that the headache occurs for no apparent reason or without an underlying disease. Secondary headaches, in turn, are headaches that occur as a symptom of an underlying disease.

Primary headache (without underlying disease):

• Migraine: Attack-like, periodic headaches, typical are side effects such as sensitivity to noise and light, nausea and vomiting

• Tension headache: Clinically there are no special features, often mild to moderate headache with a dull, oppressive character, often affects the entire head

• Cluster headache: Seizure-like, one-sided headache in the eye or temple area

• Other primary headaches: Clinically very heterogeneous group, the causes of which are so far little known. This includes, for example, hemicrania continua – a persistent, strictly one-sided headache that responds to the non-steroidal anti-inflammatory drug (NSAID) indomethacin.

In principle, headaches can also be a symptom of an underlying illness such as. Most of the time, this secondary headache does not occur on its own and other symptoms can be observed.

• Head and cervical spine trauma

• Vascular disorders in the head and neck area, for example a stroke

• Non-vascular intracranial disorder, such as changes in pressure in the cerebral and cerebrospinal fluid (CSF)

• Substances or their withdrawal, for example alcohol, drugs, medication

• Infections, for example meningitis (inflammation of the meninges)

• Food, for example histamine intolerance

• Impaired homeostasis, for example high blood pressure (hypertension)

• Diseases of the skull and of the throat, eyes, ears, nose, sinuses, teeth, mouth

• Mental illness

Causes of Headache

The causes of headaches are just as different as the pain is pronounced. Headaches can be the result of illnesses, but certain foods such as cheese, which contains biogenic amines or nitrates in meat and sausage products, can also lead to headaches. In addition, stress and pollutants are considered possible causes of a painful head. Even sex or exercise that is believed to have a relaxing effect and recommended for the prevention or treatment of headaches can do the opposite. Too frequent use of pain or migraine medication for acute complaints can also turn episodic headaches into chronic ones.

Recognize symptoms correctly

There are a wide variety of headaches that have specific symptoms. Depending on the type of headache, the pain in the head area can express itself differently:

• stabbing
• dull
• pulsating
• oppressive
• cramping
• pulling
• convulsive

Forehead, back of the head, temple: localization of headache

The symptoms can last a few seconds up to several days and vary in severity. The headache occurs either at individual points, over larger areas of the head, on one side or in both halves of the head.

Typical localization of headache:

• forehead
• temple
• Back of the head

Headache can be a sign of serious illness

If the headache persists for several days, if it worsens or if the symptoms are also accompanied by dizziness, visual disturbances, nausea, vomiting, paralysis and / or impaired consciousness, a doctor should clarify the exact cause of the headache. In these cases, it is possible that the headache is a symptom of a serious medical condition, such as meningitis or inflammation of the facial nerves.

It is also advisable to consult a doctor if the headache recurs or persists and noticeably affects the quality of life of those affected. Sudden, very severe headaches should also be clarified by a doctor in order to rule out a serious cause or to be able to treat it quickly if necessary.

Correct diagnosis is crucial

An essential part of the diagnosis by the doctor is the detailed discussion with the patient (anamnesis). The doctor records the type, intensity and duration as well as the temporal course of the headache and asks where exactly the pain is perceived. The accompanying circumstances are also important:

• Are the headaches related to certain events (stress)?

• Do they typically occur in phases of relaxation, for example on the weekend or on vacation?

• Are the headaches only noticeable in certain weather conditions?

• For women: is there any connection with the cycle?

• Does exercise worsen the pain?

• Are the headaches associated with nausea, vomiting, visual disturbances (aura), sensitivity to light, fever or other accompanying symptoms?

In addition, the doctor asks about the patient’s habits and daily routine as well as previous illnesses and family medical history. The use of pain relievers or other medication is also important. From this it can possibly be deduced whether a pain reliever-related headache could be present. Often times a relieved Pain diary the diagnosis, in which the patient enters the mentioned factors over a longer period of time.

Physical examination

Further examinations serve to rule out or identify physical causes of the headache. The doctor first records the general state of health and, as part of the physical examination, checks whether, for example, there are sensory and perceptual disorders, neck stiffness, coordination disorders or symptoms of paralysis. These symptoms could suggest a neurological cause (a disease of the nervous system such as meningitis or cerebral haemorrhage).

Further examinations for headaches

Depending on the initial findings, further laboratory tests and imaging procedures may be necessary to reliably prove the cause of the headache. These include:

• Computed tomography (CT) scan of the head

• Magnetic resonance imaging (MRI) of the brain

• Blood tests

• Examination of the cerebrospinal fluid (using a lumbar puncture)

• Ultrasound examinations (sonography)

• Examinations to show the blood vessels in the brain (angiography)

• Recording of brain waves (electroencephalography, EEG)

• X-rays of the cervical spine

• Examinations by the ophthalmologist

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Home remedies, medication, lifestyle: what helps against headaches?

Which therapy is the right one depends on the cause of the headache. A first step can be various home remedies or behavior changes before drug treatment is considered – as long as there are no serious illnesses behind the symptoms.

Home remedies and lifestyle changes

• Fresh air, sleep and exercise
• Daily fluid intake of at least 1.5-2 liters
• Relaxation exercises
• Refrigeration applications
• Light massage of the forehead, neck and shoulders
• For colds: nasal rinsing and inhalation to clear the airways again

Using medication properly yourself

Active ingredients such as acetylsalicylic acid, paracetamol, ibuprofen or diclofenac are suitable for treating headaches. However, these medications should not be taken over a long period of time and only in accordance with a doctor’s recommendation or package insert. This is particularly important for children, as some drugs are not approved for children at all or only approved for use from a certain age.

When the headache gets worse

In many cases, walks in the fresh air, sleep, physical exercise, adequate hydration, relaxation exercises or light massages can reduce the discomfort. If respiratory infections, colds or flu infections are the cause of the headache, nasal rinsing and inhalations can help. The topical application of a peppermint oil solution can also relieve tension headaches and as a herbal alternative to medication.

For the treatment of migraine attacks that cannot be managed with conventional painkillers, migraine-specific agents, such as the selective serotonin agonist triptans, are available, which are only available on prescription. In the case of cluster headaches, oxygen inhalation or the intake of triptans can alleviate the excruciating headache in consultation with a doctor.

When to see a doctor if you have a headache

In particular, chronically recurring and permanent headaches should always be clarified by a doctor. Painkillers should also not be taken permanently and not taken without consulting a doctor, as they can have side effects. In addition, the regular use of painkillers can lead to headaches (drug-induced headache) and thus exacerbate existing symptoms and make diagnosis more difficult.

Visit a doctor if you have the following headaches or accompanying symptoms:

• If headache occurs within seconds to minutes and is excessively severe (annihilation pain)

• For headaches of previously unknown intensity

• If there is also a fever

• If there are also signs of meningitis, such as stiff neck or drowsiness

• In the case of additional epileptic seizures

• When impaired consciousness (vigilance disorders) and neurological deficits (paralysis, speech disorders, visual field deficits) occur

How to prevent a headache

The occasional headache can be prevented by adopting a healthy lifestyle. In addition, the following measures can relieve headaches caused by serious medical conditions.

• Drink at least two liters of liquid (unsweetened tea, water) throughout the day

• Adequate stay in the fresh air and ventilate regularly

• Do endurance sports (jogging, cycling, swimming) regularly and integrate exercise into everyday life

• Strengthen the muscles of the cervical spine and shoulders

• Stretching exercises for the neck and back muscles

• Avoid or reduce stress

• Incorporate regular recovery periods

• Relaxation techniques against everyday stress

• Make sure you get enough sleep

• Avoid nicotine and alcohol if possible or limit consumption

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