Other headache disorders

Over 300 different types of headaches can be distinguished. For example, headaches can occur as a result of a trauma or injury to the head and/or neck or can also be caused by overuse of medication, so-called medication-overuse headache (MOH).

Headache after head impact, blows or falls can occur both in adolescent and up to old age is usually associated with traumatic brain injury. Bleeding can occur in different places in or around the brain, which can increase the pressure inside the skull and, in the worst case, lead to death. Therefore, even after relatively mild traumatic brain injury with a loss of consciousness of only a few minutes (concussion), a detailed clinical examination and, if necessary, monitoring is required.

While in most patients with traumatic brain injury or skull surgery, the initially common headache disappears after a few weeks, it can happen that headaches also persist for very long periods of time. It should also be borne in mind that in many cases of severe traumatic brain injury, damage to the cervical spine (c-spine) can also occur, which can even go unnoticed in the emergency situation. Therefore, all unconscious patients with head injuries are first treated with a rigid neck collar for immobilisation of the cervical spine.

When taking one or more medication for the acute treatment of headaches on more than 10-15 days per month, over a period of at least 3 months, there is a risk that the painkillers themselves will cause even more frequent and severe headaches. If such a permanent or chronic headache persists, it is called medication-overuse headache, or MOH for short.

The probability of occurrence of MOH can be determined by means of self-testing. If two of these three questions are answered with «yes», the diagnosis of medication-overuse is likely according to the classification of the international Headache Society (IHS):

  1. Are you taking medication on more than 10-15 days per month to treat acute headaches?
  2. Are the headaches becoming more frequent and stronger?
  3. Do the headaches occur on more than 15 days per month?

Self-testing serves as an orientation aid as to whether MOH is present or not. However, it does not replace the medical diagnosis. If MOH is confirmed by a neurologist, the most important measures are the complete withdrawal of acute medication and the start of a prophylaxis (a therapy for the prevention of headaches).

This withdrawal can be performed on an outpatient or inpatient basis, depending on the personal situation of the person concerned. After withdrawal, further care by a headache specialist is necessary since this improves the therapy success on a long-term basis.

Neck as well as lower back pain occur in almost every person to varying degree, since there are in the area of the pre-curvatures of the cervical and lumbar spine (lordosis), so to speak, built-in weak points in the mechanical load on the spine. Therefore, signs of “wear and tear” manifest themselves very early on. Frequently, intervertebral disc damage or “wear and tear” of the small vertebral joints happen here, which in turn lead to changes in the soft tissue and muscles in the affected areas. Often, this can be the cause for headaches. In most cases, acute pain improve on their own after a short time.

Warning signs are very sudden and severe neck pains, which can be an expression of acute extra and intra cerebral haemorrhage as well as subarachnoid haemorrhage.

Also, neck pain or neck stiffness with fever and strong feeling of illness or worsening of the general condition can be symptoms of meningitis. Once meningitis is considered, immediate emergency evaluation is absolutely necessary.

Other warning signs are pains with stripe-shaped radiance in the arm, especially if it is accompanied by sensory disturbances or even paralysis of the arm. Neck pain with gait disorder or disorder of the bladder is also an acute warning sign. In this case, as with chronic pain over several weeks, further medical examination is required.

Compared to the number of patients affected by neck pain, operations on the cervical spine are very rarely required. Often, relief can be provided by the short-term use of medication such as anti-inflammatory or muscle relaxing drugs. Physiotherapy and physical measures (heat, cold, electricity) also improve the condition. Regularly performed sporting activity and avoidance of obesity are preventative measures that can be very effective.

Chewing dysfunction, for example due to surfaces of the grinding teeth that do not exactly match, is primarily a domain of maxillofacial surgery. However, it can lead to pain in the entire head area due to the impairment of the temporomandibular joint and tension of the masticatory muscles. Since part of the masticatory muscles start in the temporal area, this can disturb the balance of the muscles in the head, face and neck and may lead to painful tension in the occipital area or dull pain affecting the entire head.

Increased muscle tension in the temporomandibular joint area can also occur in the context of other neurological and psychological disorders, sometimes with the main symptom of teeth grinding. The cause must then be determined in collaboration with other medical specialists and the therapy can range from mechanical measures such as a bite splint, the injection of Botulinum toxin or psychotherapeutic treatment.