Headache or migraine?3 most common types of headache

Having a headache is almost normal; It is estimated that about 14,000 people go to the doctor every month for this reason. But, when headaches recur too often, or are of an intensity difficult to bear, they become an understandable concern. Tranquility. There are many causes that can cause you to suffer constant headaches, but it is normal that they are not a symptom of something worse: nine out of ten are not the fruit of a hidden disease.

“Headache is a symptom of many diseases, from sinusitis to head trauma, but it may also not be when headache is the only or main symptom, without organic damage in our body causing it. It is what that doctors call primary headaches, and 90% of headaches are in this group, “ says the coordinator of the Headache study group of the Spanish Society of Neurology (SEN), Sonia Santos.

Giving the right treatment is important, and for this you must know how to differentiate the type of pain we are enduring. especially when it comes to migraines. This headache is in the group of primary headaches, and they are not always diagnosed because not all people who suffer from them go through the consultation. “And it is important for the doctor to assess the patient and see if he suffers from migraines, since depending on the number of days per month that this pain occurs, it will be necessary to provide the most appropriate preventive treatment to reduce the frequency and intensity of these attacks, since chronic migraine can seriously interfere with the quality of life of the patient, preventing him from living a normal life “,explains the neurologist. These are the characteristics that differentiate each headache, and they are important because you have to know when to go to the doctor.

Tension headache, like a helmet oppressing you

It is very difficult to determine exactly the percentage of people who suffer from it, but it is the most frequent primary headache. There are studies that calculate that 78% of the general population feel the pain it causes, with a peak of prevalence in people between 30 and 39 years old. The sensation is located on the forehead, on both sides of the head, and sometimes on the nape and neck. Its onset is slow and gradual, tends to worsen as the day progresses, and its intensity ranges from light to moderate. The pain of tension headaches is compressive in nature – it is accompanied by pressure on both sides of the head.You feel as if your brain is being squeezed with an elastic band or a helmet is being squeezed. There is also some tightness in the neck, never, and shoulders, as tension headache is usually caused by neck muscle contraction, stress, and mental tension. In these headaches, you can sometimes feel that the light or very loud voices are unbearable, but never both at the same time (as it happens with migraines), nor can it be said that it is a discomfort that prevents you from doing your normal life. It is true that the day becomes more complicated with this pain, but it does not cause nausea or vomiting.

There are studies that suggest that tension headache can be inherited in direct relatives and among monozygotic twins, and occurs when there is tension and increased sensitivity of the pericranial muscles, which are those around the skull. Sometimes this tension can be caused by bad postures or by episodes of stress, anxiety or other emotional states.

Scientists have not found a test that definitively confirms that relaxation techniques relieve all patients, but they are often recommended because doctors have observed that there are people who find relief in them. Usually, these techniques are prescribed together with manual physiotherapy, massages, stretching, the application of heat and physical exercise, all in combination with pharmacological treatment with ibuprofen or other anti-inflammatory drugs.

Headache in clusters, intense and around one eye

According to the SEN, some 47,000 people suffer from this type of headache in Spain, a pain of considerable intensity and very repetitive, which is often defined as suicidal headache. It tends to attack more men (there are between 2 and 3 patients for each woman) and normally appears around the age of 30. It is a type of headache that can disappear for weeks or months to suddenly reappear and make us suffer daily. 20% of people who suffer from it do it chronically, that is, with a constant sensation that can last more than a year, without giving even a few weeks of respite.

“Those who suffer from this type of headache present pain of great intensity, which begins quickly and generally around the eye or the temple. The crises are usually accompanied by symptoms in the eye region, usually tearing, eyelid drooping, redness …” , and also in the nasal environment, mainly with congestion or discharge, Santos explains. Another characteristic of this headache is that the pain can appear several times a day, and that it almost always does so at the same time.

Why it occurs is still unknown to researchers, although it is thought that the origin may be related to a problem in the hypothalamus, the area of ​​the brain where hormones are produced. The cause would be the sudden release of histamine or serotonin – a neurotransmitter paradoxically related to well-being – substances that are present in neurons, in the area of ​​the trigeminal nerve, located on the face.

“Although each patient has to be evaluated individually, it is normal for more than one treatment to be needed to control this pain. In addition to drugs and avoiding certain triggers, such as consuming alcohol, treatment with pure oxygen is also recommended (al 100%, supplied with a mask), given its efficacy, low cost and few adverse effects, “concludes Santos.

Migraine, when the lights precede the pain

Migraines affect more than 5 million people in Spain, of which more than 70% have a severe disability (seriously interferes in their lives) and 14%, a moderate disability. It is the most frequent reason why we go to the neurologist and, in Spain, it causes the loss of 13 million working days a year. Still, it is an insufficiently recognized and treated disorder because there are no markers to confirm the diagnosis, despite the fact that, in 1988, the International Headache Society (IHS) developed criteria that became the consensual tool with which specialists currently work.

It is a stabbing pain, which appears as a heartbeat, which lasts between 4 and 72 hours and occurs only on one side of the head,with a moderate to intense intensity. These headaches often cause nausea and vomiting, and can worsen with exposure to light and noise. There are migraines with aura and without aura, and both can occur episodically – less than 14 days a month with headache – or chronically – at least 15 days of headache per month, for a minimum of three months in which at least half have the symptoms. “The aura is a transient neurological focus, that is, they are reversible sensory alterations that install and disappear progressively (usually does not exceed 60 minutes). Generally, the patient notices this aura before the headache and its symptoms are usually visual , in the form of luminous flashes or zigzag lines, but also sensitive, in the form of clogging and tingling, or dysphasic,

The migraine is a primary biological disorder characterized by an alteration in the mechanisms of adaptation to certain external stimuli (for example, an intense light, certain smells) and internal (impaired sleep-wakefulness rhythm, menstrual cycle). The pain comes as a consequence of the release of inflammatory substances (such as CGRP, a peptide related to the calcitonin gene) by the trigeminal nerve, which is the one that collects the sensitivity of the facial region, “says the specialist. He adds: “The predisposition to migraine can be hereditary, since several genes have been discovered that favor the brain to activate this pain system.” 

During a migraine attack, it is recommended to withdraw to a dark room, without noise, and apply a cold compress to the forehead, massaging the scalp and applying pressure, especially on the temples. Migraine has no cure, but it can be controlled to achieve a good quality of life,therefore it is important that it be diagnosed. There are several therapeutic possibilities, such as the use of certain anti-inflammatory drugs, as well as lifestyle guidelines that must be combined with drugs, such as improving the quality of sleep, avoiding obesity and sedentary lifestyle. It is important for the patient to know that some habits, such as stress, fasting, hormonal changes, eating some foods, such as chocolate or cheese, help a crisis to break out (although each factor will be different for each person). “All treatment must be based on a correct diagnosis and, depending on this, plan the best therapeutic option. Today we have different preventive treatments (oral and onabotulinumtoxin type A), and the choice of one or the other will depend on the profile of the patient and of the type of migraine, if it is episodic or chronic.Drugs specially targeted against CGRP, the main therapeutic target of migraine, have been developed. They are monoclonal antibodies that have been shown to be effective and safe in prevention, and their use subcutaneously has already been approved by the European Medicines Agency, “explains the neurologist.


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