Headaches

"Tension headache is characterized by crises that last from a few minutes to several consecutive days, with localized pain throughout the head. It does not get worse with physical activity".

DR. MARGARITA SÁNCHEZ DEL RÍO
SPECIALIST. NEUROLOGY DEPARTMENT

There are more than 300 types of headaches, which can be divided into two main groups:

  • Primary headaches, among which are migraine, tension headache, headache in accumulation, chronic daily headache and trigeminal neuralgia. They represent 95% of the headaches.
  • Secondary headaches: They suppose only 5% of the headaches. After a medical study, it is possible to identify the cause that produces them. Generally, they are of sudden establishment, by some cranial or cerebral upheaval (hemorrhages, infarcts, tumors...), although also they can be caused by infections or excessive use of analgesic medication.

The key to solve the headaches is to arrive at the exact diagnosis of the type of headache and for it the experience of the neurologist is crucial. Once identified, the most appropriate pharmacological treatment and periodic controls will be established in order to eradicate the pain.

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What are the symptoms of different headaches?

In tension headache, the symptom is pain of mild or moderate intensity that appears episodically and can last several days. It hurts all the head. It is not in the habit of associating with other symptoms like nauseas or vomits, that are more own of the migraine.

In the case of the migraine or migraine headache, the pain is unilateral (it hurts half of the head), of pulsatile character (like a beat) and can be accompanied by nauseas, vomits and intolerance to the light and the noise. It can present "aura", a set of generally visual neurological symptoms (flashing lights or blurred vision) that usually precedes the headache.

The symptoms of cluster headache are intense pain, always unilateral and of short duration (less than 3 hours), repeated several times a day during some months of the year. It can present ocular redness, tearing, nasal congestion, facial swelling, eyelid edema and rhinorrhea (transparent liquid as a moqueo) on the same side where the head hurts.

Do you have any of these symptoms?

It may be necessary to study your headache

What are the causes of headaches?

The causes of migraine are not well known, although 70% of the patients who present this problem have a family history, so it is possible to think of a genetic cause of the disorder.

The attack of migraine begins of unexpected form, although a series of factors exist that can cause it. These factors vary for each person, reason why each patient must identify his or her own and try to avoid them. Some of those factors desencadenantes reside in: alcohol ( coverall wine ), intense scents, shining lights, changes of time, alterations of the rate of dream, hormonal variations (menstruation, ovulation) and stress.

In the case of the secondary headaches, after a medical study, a cause can be identified that produces them. Generally, they are of sudden establishment, by some cranial or cerebral upheaval (hemorrhages, infarcts, tumors...), although also they can be caused by infections or the automedication.

Types of headaches

Primary headaches

Headache of unknown cause in which no structural or metabolic alteration can be demonstrated to justify the headache.

The most frequent are:

  • Tension headache: It affects more women and starts at any age. The pain, mild or moderate, is episodic and can last several days. It hurts all over the head, is described as pressure, and does not get worse with physical activity.
  • Migraines (headaches): Repeated headaches of great intensity, which prevent the patient from carrying out his/her activities. It can last several days. There is usually a family history and it can be triggered by various stimuli. It hurts half the head and feels like a heartbeat. Sometimes it leads to nausea, vomiting, and intolerance to light and noise.
  • Cluster headaches: Rare. It affects young men more. They are very intense, unilateral and brief (less than 3 hours), repeated in the day and a few months a year. They usually wake up the patient. They can also present ocular redness, tearing, nasal congestion, facial swelling, eyelid edema and rhinorrhea on the side where the head hurts.

Secondary headaches

They represent 5% of headaches. A medical study can identify their cause. Generally they are of sudden instauration, by cranial or cerebral upheaval, or can be caused by infections or the automedication.

How are headaches diagnosed?

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In the evaluation of a patient with headache, the most important thing is the clinical history, the description of the symptoms. For this reason it is fundamental that the patient himself observes with detail the characteristics of the pain: where it hurts, how it hurts, duration of the pain, moment of the day in which it appears, and it is accompanied of other symptoms: the light, sounds or smells are uncomfortable, the movement of the head worsens the pain, nauseas, vomits, ocular redness, nasal congestion, visual alterations or of the sensibility in a part of the body, problems of mobility.

With all the data provided by the patient, as well as the observation of symptoms and signs in the consultation, a detailed physical and neurological exploration should be carried out. With all of this, the neurologist must make a diagnostic judgment and decide if medical tests are necessary.

Treatment of headaches

It is important to be evaluated by specialists with great experience in the diagnosis and treatment of this type of problem.

How are headaches treated?

The treatment of headaches has three parts:

  • Identifying and avoiding triggers.
  • Treating pain crises adequately.
  • To initiate preventive treatment when necessary.

Treatment of the crises of pain

The selection of the drug must be done individually for each patient. Analgesics fall into two main groups: non-specific anti-inflammatory type analgesics or paracetamol and specific analgesics such as ergotamines and triptans. 

Sometimes it is necessary to use drugs to control nausea and vomiting.

How to prevent headaches?

When migraine attacks occur more than three times a month, last too long or do not respond to medication, it is advisable to carry out preventive treatment. The objective is to reduce the frequency and intensity of the attacks to at least the half, and to improve the answer to the analgesics. However, this treatment is not a cure.

The vast majority of treatments have to be taken daily for a period of time and take effect several weeks after starting it.

Antihypertensive drugs, calcium antagonists, antidepressants and antiepileptic drugs can be used. In the case of chronic migraine the injections of botulinum toxin every 3 months represent a treatment option. In any case, the expert neurologist will decide together with the patient which is the best option in each case, carrying out an individualized treatment.

More recently, anti-CGRP antibodies have been incorporated into the market. This treatment is applied once a month in the form of a subcutaneous injection.  As general indication, this treatment is used in patients with frequent migraine episodes ( at least 8 a month ) and who have failed at least 2 preventive treatments.

Other preventive drugs are: magnesium, vitamin B2 at high doses

Techniques for headaches: neurostimulation and neuromodulation

Almost 7% of patients suffering primary headaches such as migraine or cluster headache do not respond to any medication. For these people especially we are working on other alternatives that are more effective and better tolerated.

It is a therapy that is carried out through devices that induce an electrical discharge or a magnetic field on certain nerves or areas of the head.

There are two techniques to perform it:

  • An invasive technique that consists of the implantation of electrodes in the occipital nerves or at maxillary level and that is used fundamentally in cluster headache. The implantation of the device requires surgery and therefore can lead to a series of adverse effects such as risk of infection or risk of bleeding, which although not frequent, must be taken into account.
  • The other alternative is a non-invasive technique through the use of portable neurostimulation devices. This technique, called non-invasive stimulation of the vagus nerve, is used for the treatment of patients with migraines and cluster headaches. The non-invasive stimulation of the vagus nerve acts on a series of structures of the central nervous system that are involved in the process of generating headaches.
    This technique does not require surgery and it is the patient who self-administrates the treatment through the portable neurostimulation device, applying it for about 10 minutes and every 8-12 hours, in the area of the carotid artery where the pulse is located and the area where the vagus nerve runs.
    Its effect is headache prevention, although it can also be administered when the patient has a headache crisis. According to the most recent studies, there are no serious adverse effects and mild ones are reasonably well tolerated.

Where do we treat it?

IN NAVARRE AND MADRID

The Department of Neurology
of the Clínica Universidad de Navarra

The Neurology Department has extensive experience in the diagnosis and multidisciplinary treatment of neurological diseases.

We offer a diagnosis in less than 72 hours, along with a proposal for personalized treatment and post-consultation follow-up of the patient by our specialized nursing team.

We have the most advanced technology for an accurate diagnosis with cutting-edge equipment such as HIFU, deep brain stimulation devices, video EEG, PET and epilepsy surgery, among others.

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Why at the Clinica?

  • State-of-the-art diagnostic assistance with great work in research and teaching.
  • Specialized nursing team.
  • We work together with the Sleep Unit.

Our team of professionals

Neurology specialists with experience in the treatment of headaches

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