Migraines & Headaches

Overall, more than 200 different types of headaches can be distinguished today, which are defined in the classification of the International Headache Society (HIS) and are delimited according to fixed criteria. A distinction is thereby made between primary and secondary headaches.

Primary Headache
There is no known cause for primary headaches. Primary headache is a disease in its own. These include migraines, tension headaches, cluster headaches and headaches without structural lesions, e.g. caused by coldness, cough or great exertion.

Secondary Headache
A cause is always known when it comes to secondary headaches. Secondary headaches occur as a result of other diseases, for example after head injuries, meningitis or after alcohol consumption.

Migraine plays a particular role among headache disorders. Approximately 15-18% of the female and 5-7% of the male population are affected by migraines. A migraine occurs paroxysmal, not symptomatic, it typically involves side effects such as nausea, vomiting, light sensitivity (photophobia), noise sensitivity (phonophobia) and odour sensitivity (osmophobia). Typically, it’s an intense headache that affects one half of the head and is described as pulsating and throbbing.

About 20% of migraines have migraines with aura. On this occasion there are neurological irritation or failure symptoms before or rarely during the headache. The most common form is the visual aura with impaired vision, flickering and visual field defects. In addition to these visual symptoms, there may also be half-sided sensory disturbances, paresis and speech or language disorders.

Migraine attacks often make themselves noticeable days before the actual migraine attacks by heralds, so-called prodomi, having a red head, diarrhoea, tiredness, sweating, euphoria, depressive moods or food cravings.

Cluster headache is one of the most severe headache disorders ever and affects more often men and boys aged from 25 to 65 years of age. Cluster headache typically only ever occurs in the same half of the face, around the eyes, forehead and temples.

Cluster headache typically only ever occurs in the same half of the face, around the eyes, forehead and temples. Sometimes the pain even goes down to the throat and neck. There are hardly any worse pains. The pain is accompanied by at least one of the following symptoms: Red eye, tearing, nasal congestion, runny nose, swollen eyelid or increased face sweating.

The pain attacks can last between 15 and 180 minutes and occur recurrent. It’s therefore called cluster. Between these cluster phases, many sufferers are headache-free. Some patients, however, suffer from chronic cluster headaches with ongoing pain attacks which last from months up to years.

A tension headache is one of the primary headaches, i.e. it has no known cause. The pain is not pulsating and not as severe as migraines; it is much more described as pressure. It furthermore won’t be enhanced by physical activity like headaches or migraines. Nausea and vomiting are untypical for this type of headache. These characteristic differences make it possible to distinguish migraines and tension headaches.

Often, but not always, tension headaches can be a response to stress. They can be mitigated with sports, relaxation exercises and pain medications. If the patient suffers from chronic tension headaches it is necessary to look for other causes.

Similar to low back pain, everybody has a different extent of neck pain, it’s because the area of the initial curvatures of the cervical and lumbar spine (lordosis) have, so-to-speak, weak points in the mechanical stress on the spine in the upright walking and standing of the human body. Furthermore, wear and tear can manifest early. It is not uncommon for intervertebral disc damage or small vertebral joints to occur, which then lead to changes in the soft tissues and muscles in the affected zones. Headaches around the skull are often associated with it. Acute complaints mostly improve within a short time by themselves.

A warning sign is a very sudden severe neck pain, which may be a reflection of acute cerebral haemorrhage (subarachnoid haemorrhage) or neck pain, respectively neck stiffness with a fever and severe feeling of illness or worsening of the general condition, which may be symptoms of meningitis.

Another warning sign is a pain with a striped radiance in the arm, especially if they are accompanied by sensory disturbances or even paralysis of the arm. Neck pain and a gangrene or bladder disorder are also acute warning signs. In that case, as with chronic complaints, a more extensive medical examination over several weeks is required.

Compared with the number of patients affected by the pain, very few operations on the cervical spine are required. By the short-term use of pain and anti-inflammatory or muscle relaxants, as well as physiotherapy, physical measures (heat, cold, electricity) there can often be a pain relief. Regular physical activity and avoiding overweight can be preventively effective.

Traumatic brain injuries after a head impact, beating or falling occur in adolescence as well as in old age. Bleeding may occur at different locations in or around the brain, increasing the pressure inside the skull and can be the cause of death in the worst case. Therefore, even after a mild craniocerebral trauma with loss of consciousness of only a few minutes (brain concussion) a detailed clinical examination and possibly monitoring is required.

After craniocerebral trauma or a cranial surgery most patients’ common headaches disappear within a few weeks but it can happen that headaches persist even over a very long period of time. Many cases of severe traumatic brain injury can also cause damage to the cervical spine, which may initially go unnoticed in the acute situation. Therefore, all consciousness patients with head injuries are first provided with a rigid cervical to immobilize the cervical spine.

A need for clarification of the headache exists in particular if one or more of the listed points apply to you:
Migraines or headaches worry me
Migraines or regular headaches hinder my everyday life and work
I don’t receive the desired information from the doctors
I have never heard of triptans
Various treatments have so far been unsuccessful
I still have headaches despite the daily use of medication

Since there’s no study that can confirm the diagnosis of a migraine, it is useful to keep a headache diary: When and under what circumstances do you have headaches? What side effects do you have (nausea, vomiting, sensitivity to light, noise, odour, blurred vision, ect.)? With a detailed description of your headaches you can help the doctors with the diagnosis. The headache diary also helps you track down your own personal headache triggers, so you can avoid them better in the future.

Headache Diary (annual calender)

Headache Diary (quarterly period calender)