Headache and migraine: how to recognize and treat

Headaches fall into two broad categories:

• primary, or forms that do not have an organic cause, and which include tension headache, migraine and a rare cluster headache;
• secondary, includes all forms of headache with organic causes, such as tumor masses, aneurysms, abscesses, meningitis, encephalitis, glaucoma, otitis, sinusitis, head or neck trauma.

There are different types of chronic headaches, but the best known and most frequent are tension headache and migraine.

Tension headache

"Tension headache is generally characterized by a dull and severe pain that can last several hours or even days. Pain is not well localized, but usually affects the whole head and may be accompanied by nausea.

Tension headache is certainly the most frequent and due to the emotional tension linked to stress. The latter causes a tension in the neck muscles (in particular the trapezius muscle) which can cause pain that, from the nape of the neck, can reach the forehead up to the eyes.

Women suffer more often than men, in a ratio of 3 to 1,” explains Dr. Bassi.

Migraine

Migraines, on the other hand, mostly affects half of the skull and causes throbbing pain of variable intensity and can last for several days. In migraines familiarity has a high importance: people who suffer from migraine often have relatives, mostly women, who are affected by the same disease.

Migraine can initially manifest itself with neurological symptoms that precede the headache, including:

• visual symptom with partial loss of vision;
• appearance of the so-called scintillating scotomas, or glows, lasting a few minutes;
• rarely tingling or loss of strength in one part of the body.

There are also other related symptoms, such as phonophobia and photophobia (annoyance due to intense sound and light respectively), almost always accompanied by nausea and more rarely by vomiting. In this case, a patient prefers to stay in a quiet and dark environment.

Compared to tension headache, the cause of migraine is well-known: there is a change in a brain neurotransmitter, for which the crisis is triggered by the cascade of serotonin, causing a vasoconstriction with symptoms mainly at the visual level (ophthalmic aura) and then a vasodilation with the onset of the actual headache.

The headache symptom is very generic: the diagnosis can be made clinically and it is very important to carry out a very accurate anamnesis, that is:

• ask the patient about the type and frequency of the headache;
• any other illnesses he/she may have;
• his/her lifestyle habits;
• the sleep-awake rhythm;
• nutrition, as it has been shown that some foods (chocolate, cheese, dried fruit, sausages, red wine) can sometimes trigger headache attacks in predisposed subjects.

Once a complete clinical picture of the patient has been made, a neurological physical examination is carried out. In any case, to exclude important intracranial pathologies, it is advisable to resort to more accurate diagnostic tests such as magnetic resonance.

The tension headache frequently becomes chronic, that is persistent over time and not episodic, and it is necessary to resort to a therapy composed of tranquilizers or antidepressants, in low doses, which allow the person to respond to stress in a better way. It is important that the therapy is followed to the letter and for as long as indicated by the specialist.

In the case of episodic tension headache, the adopted therapy is symptomatic, with the use of drugs (anti-inflammatory, painkillers) at the time of symptoms.

In migraines, when the crises are less than 3-4 times a month, triptans are used. If the crises are more often than 4-5 per month, we usually switch to prophylactic drugs: there are different types, but the most used and effective are beta-blockers.

Dr. Bassi concludes:

“It is difficult to talk about real prevention. Usually we invite the patient to keep a headache diary in which he/she describes:

• frequency of headaches;
• duration;
• intensity;
• drug taken to get him/her through it.

By doing this, it is possible to better frame the patient to learn about his habits, in order to avoid as much as possible, the factors that could favor the onset of headaches such as stress, some drugs and some foods.”

It is important, especially in patients suffering from chronic headache, to rely on specialists and expert centers, such as the Headache Diagnosis and Treatment Center of Palazzo della Salute-Wellness Clinic, for an early diagnosis and specific and targeted treatments and not to undertake do-it-yourself therapies that can make the situation worse rather than improve it.