Definition and Overview
Headache is the most common neurological symptom worldwide. Each year, approximately 52% of adults around the world experience at least one headache. The World Health Organization (WHO) ranks headaches at the top of the burden of major diseases based on years lived with disability.
The International Classification of Headache Disorders, Third Edition (ICHD-3), published by the International Headache Society, divides headaches into three categories.
- Primary headache: When the headache itself is a disease without any other underlying disease
- Secondary headache: When caused by a disease such as trauma, infection, or vascular disease
- Cranial neuralgia and other headaches: trigeminal neuralgia, occipital neuralgia, etc.
Primary headaches account for more than 90% of all headaches.
primary headache
migraine
Migraine is a moderate to severe pulsating headache that occurs on one side of the head. It is accompanied by nausea and hypersensitivity to light and sound, and a single attack lasts 4 to 72 hours. About 12-15% of the world's population suffers from migraines, and it is about three times more common in women than in men.
tension headache
Tension-type headache is the most common primary headache type, with a prevalence of approximately 38%. It is characterized by mild to moderate pain in the form of tightening or pressing on both sides of the head. Unlike migraines, nausea or light sensitivity are not evident, and they do not worsen with daily physical activity.
cluster headache
A cluster headache is a headache that causes severe pain around one eye that lasts for 15 to 180 minutes. It is accompanied by autonomic symptoms such as tears on the same side, nasal congestion, and conjunctival congestion. The prevalence is about 0.1%, which is rare, but the pain intensity is so extreme that it is sometimes called ‘suicide headache.’
Other primary headaches
There are primary cough headaches, primary exercise headaches, and primary stabbing headaches. Although the frequency is low, differentiation of secondary causes is necessary.
secondary headache
Secondary headaches are headaches caused by an underlying disease. The characteristic is that headaches improve when the causative disease is treated.
Drug overuse headache
Medication-overuse headaches occur when you take excessive amounts of painkillers. The risk increases when regular painkillers are used more than 15 days a month, and triptans or combination painkillers are used more than 10 days a month. It occurs in 50-80% of chronic migraine patients.
Cervicogenic headache
Cervicogenic headaches are headaches that occur due to structural abnormalities in the cervical spine (neck bones) or musculoskeletal problems. Headaches are triggered or worsened by neck movement and tend to start on one side of the head and spread to the eyes or forehead on the same side.
cerebrovascular headache
It is a headache caused by cerebrovascular diseases such as subarachnoid hemorrhage, cerebral vein thrombosis, and arterial dissection. Severe headaches (thunderclap headaches) that occur suddenly require immediate imaging tests because there is a possibility of subarachnoid hemorrhage.
Other secondary causes
Infections (meningitis), changes in intracranial pressure, head trauma, and exposure to substances (alcohol, carbon monoxide) can cause headaches.
Signs of Dangerous Headaches
Headaches accompanied by the following signs require immediate medical evaluation:
- Thunderclap headache: A headache that reaches extreme intensity within seconds to minutes.
- Fever and neck stiffness: Possibility of meningitis or encephalitis.
- Altered consciousness, convulsions: Possibility of intracranial lesions such as cerebral hemorrhage and brain tumor.
- New neurological abnormalities: decreased vision, double vision, hemiparesis, and speech impairment.
- New headaches occurring after age 50: Secondary causes such as temporal arteritis need to be determined.
- New headache in patients with immunosuppression or a history of malignancy
- Headaches that worsen with changes in posture: Possible intracranial pressure abnormalities
A list of these warning signs organized under the abbreviation SNNOOP10 is used in clinical practice.
diagnosis
The basis for headache diagnosis is taking a detailed medical history. Systemically check the location, pattern, duration, frequency, accompanying symptoms, aggravating and alleviating factors of pain.
Headache diaries are a useful tool for diagnosis and treatment monitoring. Record the date and time of headache occurrence, intensity, duration, whether medication was used, and triggers.
For typical primary headaches with no abnormal findings on neurological examination, imaging tests are not necessary. However, if there are dangerous signs, there are abnormal findings on examination, or the patient does not respond to treatment, brain MRI or CT scan is performed.
Autonomic function tests (heart rate variability analysis) are used to evaluate the relationship between headaches and abnormalities in autonomic nervous system function.
life guide
Maintain a regular sleep-wake time. Both lack of sleep and too much sleep can cause headaches.
Drink 1.5 to 2 liters of water a day and do not skip meals. An empty stomach itself acts as a headache trigger.
Regular aerobic exercise for more than 30 minutes, 3 to 5 times a week, helps prevent both migraines and tension-type headaches.
Limit caffeine intake to less than 200 mg per day (1-2 cups of coffee) and avoid sudden withdrawal.
It is recommended to use painkillers less than twice a week to prevent medication overuse headaches.