The headacheany type of headache, affects approximately 50% of the adult population in the world. The headache It is produced in the meninges, the membranes that surround the brain, where the sensitive endings of the trigenous nerve are located. When activated, among other stimuli, by stress, hunger, food or ingredients, odors or muscular overloads, it sends messages to the thalamus, the brain nucleus. , which connects with areas that activate pain awareness. There is more of 150 types of headaches and according to a study published in 2015 by the World Health Organization, it is the sixth leading cause of disability worldwide.
Causes of headache
Headache triggers can be diverse. Although each specific type of headache may have its own triggers, the general reasons are usually: lack or excess of sleep, medication use, hormonal changes, obesity, mental overexertion due to low educational level at school, alcohol consumption, food intake or additives, stress or family history.
Headaches can be grouped into primary, with their own characteristics, and secondary, which are usually the consequence of another disease.
– Tension headache. It is common and is usually mild. It is produced by muscular tension in the head. A pressure is felt on both sides of the head, forehead and neck. It can last a day or several and even become chronic.
– Migraine or headache. Pain of variable intensity that can become very strong. It can be episodic or recurrent, becoming chronic. It starts on one side of the head and spreads to the rest. It is usually pulsatile and may be accompanied by nausea and vomiting as well as photophobia, phonophobia, and osmophobia (phobias of light, noise, and smell, respectively). It improves with rest and is usually caused by stress, although its origin is usually hereditary.
– Cluster headache. Very intense episodes that manifest between one and eight times a day, including at night, with durations of 15 to 180 minutes. Does not improve with rest but produces restlessness. It is more frequent in men and begins around the age of 30.
– Hemicrania headache. Episodes of very intense pain lasting from two to thirty minutes more than five times a day. It can be paroxysmal or chronic. It affects only one side of the head.
– Unilateral neuralgiform headache with conjunctival injection and lacrimation (SUCNT). It is very rare and usually affects men over 50 years of age with episodes of moderate to severe intensity between five seconds and a few minutes but many times a day. They have been added up to 200 times.
– Cough headache. Pain that lasts between one second and thirty minutes with discomfort that lasts for hours after an episode of coughing, sneezing or lifting weights among other efforts.
– Headache due to physical exertion. Pain produced by practicing high-intensity exercise. It is pulsatile and lasts between five and 48 hours.
– Headache associated with sexual activity. It usually occurs when reaching orgasm on both sides of the head and lasts from minutes to hours.
– Cold stimulus headache. Caused by cold that is felt in the head: by contact, because it is inhaled or because it is ingested. It is usually unilateral, throbbing and of short duration,
– Hypnic headache. It appears in the dream and causes an awakening. It lasts between 30 and 180 minutes and may be accompanied by nausea.
– Trigeminal neuralgia. Sharp, stabbing pain with unexpected onset and end that appears on the face or one side of the face. It lasts a few seconds and is triggered by the activation of a “trigger zone” when chewing, talking, blowing your nose or shaving.
– Trauma headache. Produced by a blow to the head or an explosion with foreign bodies entering the head.
– Headache due to cerebral vascular pathology. Produced by an occlusion, an arteriovenous malformation, a stroke, cerebrovascular accident or an aneurysm.
– Substance headache. The cause is substance abuse such as drugs or alcohol or frequent exposure to carbon monoxide or nitric oxide.
– Due to infections such as sinusitis, meningitis or encephalitis. It usually presents with a fever.
– Due to psychiatric pathology such as anxiety or depression.
– Due to high blood pressure.
– Due to a tumor or increased intracranial pressure. The pain worsens when lying down and sudden vomiting occurs.
– Due to hypotension of the cerebrospinal fluid after a lumbar puncture, epidural anesthesia or a head injury.
– Due to Chiari malformations, a structural problem at the base of the skull.
– Due to dehydration.
– Due to dental problems.
– For glaucoma.
Frequent, disabling headache in part or all of the head of moderate to severe intensity. The pain can be: throbbing, like a cramp, explosive, like a drill, or oppressive. Other symptoms may be: almost closed or drooping eyelids, nausea or vomiting, pupils with different dilation (anisocoria), red eyes, tearing or vertigo.
You should see a doctor urgently if there are changes in vision such as black spots, distortion, double vision or bright lights, speech problems, facial twitching, tingling in the arms and legs, weakness in a limb, skin rash, fever or neck stiffness.
Medical history, neurological examination and tests
To obtain a diagnosis, the first step is to prepare a clinical history that will include the type of pain, its location, habits, possible triggers and associated symptoms. The neurologist will examine your head, eyes, ears, throat, and neck.
He will also request a blood test and imaging tests such as x-rays of the paranasal sinuses, cranial computed tomography, cranial magnetic resonance imaging, computed tomography or magnetic resonance angiography, and lumbar puncture. Exceptionally, an isotopic cisternography or a CT-myelography can be ordered to study the hypotension of the cerebrospinal fluid.
Headache medication and treatment
Adapted to headache type
Each case or type of headache will require a specific approach, but there are usually some lifestyle guidelines that usually include good sleep habits, avoiding tobacco, alcohol, following a healthy and balanced diet rich in fiber to avoid constipation, and exercising. moderate.
Within the pharmacological options for migraines, rapidly absorbed non-steroidal anti-inflammatory drugs are usually prescribed in the event of an outbreak and if there is no response with triptans (selective serotonin agonist drugs). The order can be reversed in moderate-severe crises. Hemicrania headache is treated with indomethacin; and cluster headache with triptans such as subcutaneous sumatriptan or intranasal zolmitriptan.
Good habits and orderly life
The prevention guideline for headaches is a healthy and balanced diet that is low in fat and rich in fiber. Perform moderate exercise on a regular basis. Sleep well and enough hours. Avoid alcohol and tobacco. Do not consume too many pain relievers and do not consume too much caffeine.
To control a crisis it is recommended to rest in a quiet and dark room, place a cool cloth on the head and apply relaxation techniques.
In the event of a crisis, it is convenient to write down the beginning, type of pain, duration, the food that was eaten, the hours of sleep, as well as the reason for the cessation of the outbreak. Any change in the usual pattern of headache, change in mood, or motor or visual abnormalities should prompt us to request immediate medical attention.