Headaches are one of the most frequent and disabling neurological disorders. It is essential to achieve a proper diagnosis to design a tailored treatment and to improve the patient.
In the following link you can access specific questions answered through the newspaper patients 20 minutes
Most headaches are primary, that is not due to any injuries, so we can rest easy. However in case of headaches that wake up at night to the patient, appearing with (cough, do belly, …) efforts that are like an explosion inside the head, appear with fever, in older patients than ever them has hurt the head, gradually increase intensity or showing neurological symptoms (unable to speak, loss of strength, etc.) should consult our primary care physician or neurologist.
We should also worry if our primary headache (migraine for example) is becoming more common and need many painkillers that can be becoming chronic and it is important to specific treatment
We have compiled the following guide to counsel patients about this important disease.
When a patient has a headache first thing we do it is try to distinguish whether it is a primary headache, ie, headache is the disease and not due to tumors or other abnormalities. Or if it’s high, the patient has a disease that causes the headache. For them are important warning signs that we summarize in the image.
PRIMARY HEADACHE
Migraine is one of the most common and disabling headaches. Migraine is a recurrent and episodic headache characterized by a combination of neurological, gastrointestinal and autonomic symptoms. It is a picture that is not the same in every patient, varying attacks intensity, duration and frequency among people and each person over time.
The typical migraine headache is the one side and changing a pain crisis to another, (although it may be bilateral or unilateral start later generalized), throbbing like a heart in most patients. Episodes with moderate or severe intensity, and increases with physical activity or simply nod. It can occur at any time of day, but more often occurs at dawn. The onset is usually gradual, reaches its peak and then decreases in intensity and usually disappears between 4-72 hours. The pain of migraine is invariably accompanied by vegetative manifestations.
Anorexia is common but can be seen craving for food. Nausea occurs in almost all patients while vomiting occur in one third of them and diarrhea can 5%. More than 75% of patients report during crises hypersensitivity to sensory stimuli expressed as sensitivity to noise, lights and intolerance to olfactory stimuli. Often the skin paleness and alterations in body temperature.
The treatment is complex and must make a suit to avoid side effects in our patients.
Type strain or tension headache is the most common. The pain is described as a tightness or «weight» cephalic without pulsatile character in most patients. The location of the pain is all over the head in most patients but could fluctuate over the coming days to present unilaterally in some patients. Striking is the absence of worsening physical activities characteristic finding of migraine headaches. The intensity of pain is mild to moderate although there is a greater severity in patients with chronic daily.
Accompanying symptoms of migraine are absent in most subjects except for occasional gagging sensation. Symptoms are often associated with fatigue, sleep disturbances or feeling unsteady gait
For patients with inflammatory get occasional headaches, if they are frequent preventive we prescribed.
Autonomic trigeminal headaches are a set of entities that are characterized by pain always located on one side of the head or face, usually the same and corresponds to the territory innervated by the trigeminal nerve and occur in association with cranial autonomic symptoms
Cluster headache is the most common type of headache trigeminal autonomic. Other names with which it is also known to this Horton headache or cluster are even been given the nickname «suicide headache» due to the high intensity of pain of suicidal ideation in those who suffer. The location in most patients is around the eye. It affects young adults being the debut for approximately 30 years. It is often accompanied by nervousness, closed eye, red and crises last about 1-2 hours and usually coincides at the same time and wake the patient. It is essential to start treatment early and there are treatments that can shorten the outbreak. Interesting website of the association.
Paroxysmal hemicrania is a rare trigeminal autonomic headache. Patients present unilateral short attacks of severe pain, accompanied by eyelid droop or change the pupils. There are very effective and specific as indomethacin treatment.
The SUNCT headache is an uncommon but increasingly diagnosed more. Is characterized by a cluster headache location is around the eye, moderate intensity, being sharp or throbbing and characteristics as indicated by its acronym is accompanied by conjunctival injection and tearing the same eye.
Hemicrania continua is a unilateral headache not only changing sides. Although fluctuating, it is continuing with great intensity exacerbations during which autonomic symptoms may occur. It should be studied to rule out intracranial lesions. The response to indomethacin is complete and maintained.
Headache associated with myofascial pain is a muscle located in the area of pain can be intense and referred to other areas of the head or neck box. It is diagnosed with proper palpation cranial
Primary cough headache is a headache triggered by a cough or Valsalva maneuvers. Sudden onset and short duration, usually from seconds to half an hour. Looking ahead to a proper diagnosis is essential to urgently go to the neurologist to rule out serious conditions.
The sharp primary headache is characterized by pain of short duration, usually less than a second puncture type. It consists of twinges or fleeting, isolated or in salvos, a fingertip punctures.
Effort headache is a headache of variable duration, from 5 minutes to two days, which occurs only during exercise. It can be hemicranial, bilateral or diffuse, of variable location. In these cases we consult a neurologist or an emergency to rule out serious illnesses.
Orgasmic headache is a headache explosive characteristics that coincides with the arrival of orgasm. It is of great intensity, as in other explosive headaches in the first crises must exclude extremely serious pictures.
Hypnic headache is a headache exclusively nocturnal, waking the patient, who usually appears above the 5th decade of life. In most cases it is bilateral, mild or moderate intensity (may be severe in up to 20% of cases), deaf in his quality and usually lasts more than 15 minutes and less than 180 minutes. You always have to go to a neurologist to rule out intracranial injury. Some patients improve with a coffee before bedtime, others need medical treatment.
Continuous headache from the start is a continuous headache since its inception, in which there are no periods without headache. It is bilateral, oppressive and not aggravated with activity.
There are multiple causes of secondary headache, which headache is produced by another process, such as problems in the temporomandibular joint, drugs, idiopathic intracranial hypertension, in these situations we must act early to eliminate the causative element.
