Mr Dimitrios Anastasopoulos, MD, MSc, Pathologist and Deputy Director of the 7th Pathology Clinic of the Metropolitan General, explains the different forms of headaches and how they are treated.
Headaches are among the most common health problems, affecting the majority of the population at least once in their lifetime. Depending on their characteristics and etiology, headaches are divided into primary and secondary—more than 90% are primary headaches.
Primary headaches
Tension headache is the most common form of headache. It is characterised by the feeling that something is pressing bilaterally on the patient's head. Stress, hormonal changes, weather changes, various visual stimuli, alcohol, fatigue, fasting, sleep disorders, poor posture, aspartame, and reduced water intake have been implicated as triggers.
Common analgesics are given as treatment for tension headaches, such as paracetamol 1,000mg every 6 hours or ibuprofen 600mg every 8 hours after eating for more severe symptoms.
Aspirin is effective in relieving symptoms but is not recommended. It is also recommended that the above triggers be avoided or resolved.
Migraine is the most common headache for which patients seek help in primary health care. It occurs more often in women and concerns a disorder of intense, recurring, usually episodes of pain in one half of the head (contralateral) that is frequently accompanied by nausea, photophobia and phonophobia.
There are cases when a migraine attack lasts 3-5 days.
Different types of migraine are:
1) Migraine without aura, which is mainly accompanied by nausea and photophobia
2) Migraine with aura. Aura is characterised by specific symptoms that usually precede the pain. Examples are visual aura (bright lines or dull spots in the visual field) and sensory aura (numbness in a specific part of the body)
3) Migraine aura without headache. In this case, the patient experiences the aura for a period of time without experiencing a headache
4) Chronic migraine, which refers to migraine attacks with a frequency of 15 or more days per month.
"Therapeutically, in addition to common analgesics, non-steroidal anti-inflammatory drugs, triptans and ergotamine derivatives are administered. As a prophylactic treatment, it is recommended to avoid potential triggers and to take propranolol, amitriptyline and topiramate always after medical assessment and evaluation," Anastasopoulos emphasises.
Cluster headaches involve contralateral, recurrent severe pain episodes with accompanying autonomic symptoms, such as lacrimation, conjunctivitis, rhinorrhea, facial sweating, and nasal congestion.
Although they are sometimes rated as dangerous, they are usually transient and disappear within 3 hours. Their urgent treatment involves administering oxygen through a nasal cannula and injectable analgesics.
Secondary headaches
Secondary headaches are related to very serious disorders and require urgent investigation by a doctor. Miscellaneous, accompanying headache, signs and symptoms such as paresis of half of the body, eye pain with visual disturbance, headache in a specific location or after exercise, cough or sexual intercourse, or accompanying neck pain, as well as taking anticoagulant or antiplatelet medications should be evaluated by a pathologist or neurologist immediately to exclude the possibility of secondary headache.
Possible causes of secondary headaches include brain tumours, infections, autoimmune diseases, ruptured brain aneurysms, and subarachnoid hemorrhage.
The most accurate diagnostic test is an MRI of the brain and is recommended, especially when:
• A very severe headache occurs for the first time
• The headache has some special characteristics, such as worsening when lying down
• It is a new headache in a person aged >50 years or a pregnancy period
The treatment of secondary headaches is also the treatment of the underlying cause.
Headache is primarily a transiently intense but usually innocuous symptom that most people experience during their lifetime.
"Any change from its usual appearance or the appearance of accompanying symptoms should be a reason to seek a doctor for a valid and timely evaluation", concludes Mr Anastasopoulos.
Dimitrios Anastasopoulos MD, MSc, is a Pathologist and Deputy Director of the 7th Department of Pathology at the Metropolitan General. Translated by Paul Antonopoulos.
