Headache is one of the most common neurological symptoms and can occur at any age. Pain may be located in the forehead, temples, around or behind the eyes, at the back of the head, or in the neck region.
Headaches can vary considerably in their intensity, duration, frequency, and associated symptoms. Correctly identifying the type of headache is important for establishing an accurate diagnosis and selecting the appropriate treatment.
Primary and Secondary Headaches
Headaches are generally divided into two main categories:
Primary headaches: The headache itself is the disorder and is not caused by another underlying medical condition. The most common types include migraine, tension-type headache, and cluster headache.
Secondary headaches: The headache occurs as a result of another disease or medical condition. Depending on the individual case, it may be associated with infections, head injury, vascular disorders, medications, or other medical conditions.
Distinguishing between primary and secondary headaches is an important part of the neurological assessment.
Migraine
Migraine is a common neurological disorder that causes recurrent episodes of headache. The pain is often throbbing or pulsating, moderate to severe in intensity, and may affect one side of the head, although this is not always the case.
A typical untreated migraine attack can last from 4 to 72 hours and is often aggravated by routine physical activity.
The headache may be accompanied by:
- Nausea
- Vomiting
- Sensitivity to light (photophobia)
- Sensitivity to sound (phonophobia)
- In some patients, sensitivity to strong smells
Some patients experience migraine with aura. An aura may include temporary visual, sensory, language, or other neurological symptoms that usually precede or accompany the headache.
Various factors may act as migraine triggers in susceptible individuals. These may include:
- Psychological stress
- Lack of sleep or changes in sleep patterns
- Intense physical fatigue
- Hormonal changes and menstruation
- Bright lights or strong smells
- Changes in daily routine
- Alcohol
- Certain foods in susceptible individuals
Migraine can occur at any age and is more common in women. Genetic predisposition also plays an important role, as migraine often runs in families.
Cluster Headache
Cluster headache is a primary headache disorder characterized by extremely severe, one-sided pain, usually located around or behind the eye and in the temple region.
Attacks characteristically occur during specific periods, known as cluster periods, during which they may recur daily for several weeks or longer. These periods are often followed by symptom-free periods of remission.
The pain may be accompanied by symptoms on the same side, including:
- Tearing of the eye
- Redness of the eye
- Nasal congestion or runny nose
- Drooping or swelling of the eyelid
- Facial sweating
Unlike migraine, people experiencing a cluster headache attack often become extremely restless and may find it difficult to remain still.
Attacks typically last between 15 and 180 minutes and may occur from once every other day to several times within the same day. In some patients, attacks characteristically occur at approximately the same time of the day or night.
During an active cluster headache period, alcohol consumption may trigger an attack in some patients.
Tension-Type Headache
Tension-type headache is the most common type of primary headache.
The pain is usually mild to moderate in intensity, affects both sides of the head, and has a pressing or tightening quality. Many patients describe the sensation as a tight “band” or “vice” around the head.
Unlike migraine, tension-type headache usually:
- Is not pulsating or throbbing
- Is not significantly aggravated by routine physical activity
- Is not accompanied by vomiting
- May be associated with photophobia or phonophobia, but usually not both simultaneously
An episode may last from approximately 30 minutes to several days.
Factors such as stress, fatigue, and sleep disturbances may be associated with the development or worsening of episodes in some patients.
Diagnosis of Headache
The diagnosis of headache is based primarily on a detailed medical history and neurological examination.
Particular attention is given to characteristics such as:
- The age at which the headaches began
- Their frequency and duration
- The location and nature of the pain
- Headache intensity
- Associated symptoms
- Possible triggering factors
- The use of painkillers or other medications
- Any recent change in the pattern of a previously established headache
In many cases of primary headache, brain imaging is not required. However, when specific clinical findings or features raise suspicion of a secondary cause, further investigation with Brain Magnetic Resonance Imaging (MRI), Computed Tomography (CT), laboratory tests, or other investigations may be required depending on the individual case.
Treatment of Headache
Headache treatment depends on the type of headache, the frequency and severity of the episodes, associated symptoms, and the individual needs of each patient.
For primary headaches, the treatment approach may include:
Acute treatment: The aim is to provide rapid relief from pain and associated symptoms when a headache attack occurs.
Preventive treatment: Patients experiencing frequent, prolonged, or particularly disabling attacks may benefit from preventive treatment aimed at reducing the frequency, duration, and severity of headache episodes.
Identification of triggers: Keeping a headache diary can help identify possible factors associated with the onset of attacks.
Lifestyle modifications: Maintaining a regular sleep schedule, adequate hydration, regular meals, physical activity, and stress management can be important components of overall headache management.
Treatment should be individualized, particularly when headaches are frequent or there is excessive use of pain-relieving medications. Frequent use of acute headache medication can, in some cases, lead to medication-overuse headache.
Signs That Require Immediate Medical Assessment
Most headaches are not caused by a serious underlying condition.
However, a new or unusual headache requires particular attention when it:
- Appears suddenly and is extremely severe
- Is accompanied by weakness, numbness, speech difficulties, or visual disturbances
- Is associated with confusion or loss of consciousness
- Occurs together with fever and neck stiffness
- Develops following a head injury
- Represents a significant change from the person’s usual headache pattern
- Occurs for the first time at an older age or in a person with a significant underlying medical condition
Accurate identification of the type of headache and an individualized treatment approach can significantly reduce the frequency and severity of headaches and improve daily functioning and overall quality of life.