#Headaches: Common, usually harmless, frequently bothersome

Almost everyone has headaches on sometimes. In general, they are harmless and resolve themselves soon.

Headaches that reoccur regularly without a clear cause are known as “primary headaches” and are treated as distinct disorders. They account for approximately 90% of headache maladies. Migraine, tension, and cluster headaches are some of the most frequent types of headaches.

Less than 10% of headaches are caused by a variety of conditions, including hypertension, colds, or skull and brain traumas. These are known as “secondary headaches.”

Symptoms — How to distinguish Headache Types

Headaches don’t always feel the same. They can be dull and pressing, sometimes stabbing, drilling or pulsating. Sometimes the whole head hurts, sometimes just one side of the head or just the temples. Headaches can occur briefly and severely or persist subliminally for days. Depending on the type of headache, additional symptoms may also occur.

Tension headaches

Almost everyone is familiar with tension headaches. This headache symptoms

• can last from half an hour to several days,
• are mild to moderate,
• are pressing, dull or pulling,
• are noticeable on both sides of the head,
• do not cause nausea,
• do not get worse with physical activity and
• do not usually interfere with everyday activities.

Migraine

Headaches are classified as migraines if pain attacks with the typical migraine symptoms have occurred more than five times. These headaches

• are pain attacks that last at least four hours and up to three days (at least two hours in children),
• are moderate to severe
• are felt as pulsating, hammering or throbbing
• are particularly noticeable in the front of the head,
• often only occur on one side, whereby the side can change,
• are also characterized by sensitivity to light, sound or smell,
• are sometimes preceded or accompanied by visual disturbances, flashes of light, skin discomfort or dizziness (“aura”)
• are often accompanied by nausea and vomiting
• are intensified by physical activity.

Cluster headaches

We speak of cluster headaches (cluster = group, accumulation) when the symptoms accumulate over a certain period of time and exhibit typical characteristics. Cluster headaches

• last between 15 minutes and three hours,
• are very severe,
• are described as burning, stabbing or drilling,
• can occur more frequently (in episodes) over days or weeks and at the same times, usually in the early hours of the morning
• only affect one side of the head in the area of the temple and around the eye, usually always the same side in subsequent episodes,
• are accompanied by symptoms such as a blocked nose, red eyes, sweating on the forehead or watery eyes,
• are sometimes eased by movement.

The Course of Headache — acute or chronic?

Headaches can be sporadic (occasional), episodic (occurring more frequently over a certain period of time) or chronic (hardly any or no pain-free phases).

There are defined guidelines for the various types of headaches. Tension headaches, for example, are considered chronic if they occur 180 days a year and last for several hours at a time.

What Causes Headaches?

Why some people have primary headaches such as migraines, cluster headaches or tension headaches has not yet been clearly explained. A genetic predisposition may play a role. However, triggering factors such as a change in the day-night rhythm, skipping meals or stress are known. Other known triggers for cluster headaches are alcohol or being at high altitude.

Secondary headaches usually have harmless causes such as a cold, muscular tension or a hangover after drinking alcohol. In women, hormonal fluctuations during the menstrual cycle can trigger secondary headaches. Certain medications such as hormone preparations, heart medication, blood pressure medication and sexual enhancers can also cause headaches.

Only rarely are illnesses requiring treatment behind the headache symptoms, such as pronounced high blood pressure, increased intraocular pressure (glaucoma), inflammation of the teeth, ears, sinuses or teeth, meningitis, a brain tumor or injuries to the head or spine.

Paradox and Little Known: Pain Killers Cause Headache!

People who take painkillers or migraine medication very frequently can also get more headaches as a result. They often mistakenly assume that their headache has worsened and continue to increase their dose of medication — a fatal fallacy. “Excessive use of painkillers” is not defined by the single dosage, but rather by the number of days on which the medication has been used within the last three months.

In the case of painkillers such as paracetamol, acetylsalicylic acid (ASA) or ibuprofen, excessive use is defined as having been taken on 15 or more days per month.

In the case of migraine medications such as triptans and ergotamines, even 10 days of use per month is considered excessive.

Diagnosis of Headaches

A detailed discussion with a doctor about the headache symptoms and the general health condition is usually sufficient for a diagnosis. Important questions include

• What exactly does the headache feel like?
• Where does it hurt, when did it start and how long does it last?
• Have such complaints occurred in the past?
• Are there any other complaints?
• Are you taking any medication, and if so, what kind and how frequently?

The consultation is usually followed by a thorough physical examination. If there are still uncertainties after this, further measures may be appropriate in rare cases, such as a magnetic resonance imaging (MRI) scan of the head.

Prevalence of Headache

Headaches are generally widespread and affect all age groups. However, there are differences in frequency depending on the type of headache:

Tension headaches — more than 300 out of 1000 people

Migraine — about 100 to 150 out of 1000 people

Cluster headaches — around 1 in 1000 people

Women suffer from migraines more often than men, while cluster headaches occur more frequently in men.

Prevention and Treatment of Headaches

If you are suffering from primary headaches you can try to identify and avoid possible triggers with the help of a pain diary.

If a headache occurs, it usually goes away on its own. Some people find cold compresses on the forehead, the smell of peppermint, a walk in the fresh air or rest in a cool, dark room helpful.

Anyone who feels severely affected by acute headaches can take short-term painkillers such as acetylsalicylic acid (ASA), ibuprofen or paracetamol. So-called triptans are suitable for migraines and cluster headaches.

If you take pain killers for headache, make sure to document the use of medication in a calendar. Be aware that too frequent use of pain medication may enforce headaches. You may prevent headaches caused by excessive medication use by reducing the monthly days of medication intake.

For chronic headaches, a combination of different forms of treatment can also be useful — for example, medication and behavioral therapy. There are telemedical therapy programs that may help to reduce headache days and thus improve quality of life through optimal attack medication, drug and non-drug prophylaxis, psychological support, guidance on a healthy lifestyle and diet as well as innovative therapy methods.

Ask your doctor about your individual appropriate therapy!