What should you know about headaches and migraines?

Dr. Genís is a prestigious neurologist in Girona specialized in migraines and headaches. Through the following article the reader will be able to solve some doubts such as, for example, what kind of symptoms characterize migraines or what are the risk factors of headaches.

Headache (Cephalea)

Headache, as is well known, is a very common symptom. They are pains that affect any area of the skull, face or neck.

Causes

The most frequent headaches are tension headache (due to muscle tension and generally secondary to a situation of anxiety or stress) and migraines. There are many other causes. Many patients fear that the headache is the symptom of a brain tumor, but these when they give headache usually give different symptoms from the usual headaches.

Symptoms and diagnosis

Surprisingly for people, most headaches are diagnosed by clinical history, i.e. by what the patient says, but imaging tests (CT or MRI) are used to rule out very specific pathologies, but they can never diagnose a migraine or tension headache, and in these, as in most headaches, there are no visible alterations in the skull or in the brain. The symptoms and clinical patterns of most headaches are very well established.

Migraine

Affects about 15% of the population, especially women. They often begin at puberty and their activity decreases with age.

Causes

They are only known for some subtypes of migraine. It has an important genetic influence and this has made it possible to identify some genes related to very specific subtypes, but not those of the most common types. In these cases, mutations have been shown to affect the function of channels that transport ions across the membrane of neurons, but it is not known how this leads to the development of migraine attacks only from time to time.

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Triggers of the attacks

Often the attacks start after an event that appears to be the trigger for the attack. These include sleep disturbances, changes in daily activity (weekend), hormonal changes, especially during the menstrual cycle, certain foods, emotional disturbances and others. In many occasions a specific trigger is not detected.

What happens during a migraine?

At the onset of a migraine, there is a decrease in brain activity that extends from the back of one cerebral hemisphere forward for minutes. This anomaly is what leads to some of the symptoms of migraine: irritability, general malaise, external stimuli, sounds, light and sometimes smells are felt as unpleasant, when they become intense the patient seeks to be in a place with little light without strong environmental sounds, and if the process is intense, he/she seeks to go to bed, he/she loses appetite and often there is nausea and sometimes vomiting.

Shortly after the onset of this phenomenon, painless but unpleasant and disabling when intense, there is a release of substances in the nerve endings in contact with cranial vessels that generate a sensation of pain and dilation of arteries which induces the sensation of pulsation in the head.

Symptoms

Unilateral headache, sometimes bilateral, throbbing (a throbbing in the head) of moderate to severe intensity, worsens with daily activity, there may be nausea, vomiting, photophobia (excessive sensitivity to light) or sonophobia (excessive sensitivity to sound). Often the patient isolates himself and if possible goes to bed. If sleep is achieved, in many occasions the headache has disappeared upon awakening.

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Some people have sensations prior to the headache that are known as “auras”, the most frequent are visual with partial loss of vision, phosphagenes that consist of the vision of bright images, sometimes flashing, in the form of a saw, and other varied visual symptoms. In other cases the patient has symptoms that indicate some cerebral dysfunction, tingling in the hand and face, speech difficulties or others. The aura is usually short and lasts a few minutes. The process generally lasts from 4 to 72 hours, and can be repeated several times a month.

Treatment

It is individualized based on the characteristics of each patient. Depending on the age, frequency, duration and severity of the migraine. In most cases the analgesic treatment is optimized if there are few crises, adding triptans, drugs that have the ability to reverse the changes produced by migraine, especially if taken at the beginning of the headache. Nonsteroidal anti-inflammatory drugs of various types, or paracetamol, are also used, sometimes combined with other drugs. If the number of monthly attacks is high, drugs are added to reduce the recurrence of attacks. In cases refractory to pharmacological treatment, botulinum toxin can be applied with considerable success with about 15 seizures per month.

In all cases, treatment is assessed according to age, frequency and severity of crises, most important triggers, risks of some drugs, some increase weight, others alter ovarian function, i.e. treatment must be individualized based on the characteristics of each patient. Diets are of no therapeutic use.

Tension headache

It is the most common headache, it affects more women and although it can occur at any age, it is more frequent in adolescence and early adulthood. It can last from hours to days.

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Causes

By far the most common causes of tension pain are anxiety and stress; lack of physical activity, skipping meals, noise can be triggers for a tension headache. Excessive and continuous tension of the muscles and other structures of the skull are what generate the pain. In chronic forms it seems that the neural mechanisms that inhibit pain are altered and are not able to fulfill their function.

Symptoms

The pain is oppressive, like a helmet or a band around the head. The areas where the pain is most commonly felt are usually the nape of the neck and the temporal and frontal areas, and behind the eyes, although it can occur in other areas, it is almost always bilateral.

Treatment

In cases of short duration an analgesic may be sufficient, but when it becomes very frequent the most effective treatment is the reduction of its cause, stress and anxiety. The change of personal and work habits, the reduction of alcohol intake, the various relaxation techniques help to improve the picture. Chronic cases have a more complex treatment with not so good results.

Other headaches

There are many other types of headache, some very severe such as trigeminal neuralgia (although it usually has a good response to treatment), cluster headache that affects the orbital area and usually appears seasonally, or dysfunction of the temporomandibular joint secondary to bruxism (excessive clenching of the teeth) are some relatively common causes of headache. Most headaches can be resolved, not always in the short term, but almost all are usually relieved with drugs or other techniques.