Headache
Head and facial pain are the primary types of pain that society sees as insignificant and rarely consults a physician. When the causes of headache are investigated, there is usually nothing malignant, but some of them can be serious and affect the standard of living negatively.
Under 80% of headaches that people of all ages experience at least once in their life, no organic cause has been found. Headaches of this type are called primary headaches. Often among the reasons; are migraine, tension-type headaches, or cluster-type headaches. In the remaining percentile, there are types called secondary headache by definition, under which a pathology is found as a result of research. Intra-cerebral hemorrhages, neurological and psychiatric causes, brain tumors, traumas, infections, otolaryngological diseases such as otitis-sinusitis can be counted among the causes of secondary headache.
Nerves Effective in Headache
Neural structures may be among the factors that cause headaches in humans. Especially nervus trigeminus and nervus facialis are at the forefront of these neural structures. Tension-type headaches, which are most common in society, occur as a result of these nervous structures being affected by stress or neuropsychiatric reasons.
Headache Types
Headaches are classified into two main groups; primary and secondary headaches. In addition, the International Headache Society has made a broader classification and detailed it into 14 main groups and hundreds of subgroups.
In other words, functional headaches are pains that do not have any underlying pathology. Among its subtypes; tension headaches, migraine headaches, and cluster headaches.
Tension-Type Headache: Although it is the most common type of headache after migraine in the community, the exact cause cannot be found as a result of a detailed research. These pains for which no pathological cause can be found; stress, insomnia and neuropsychiatric causes increase. Patients often describe feeling like a band of pressure is being applied to their brains. Although it is mostly seen in the second decade of life, women are more affected by this pain. Grouping tension-type headaches as infrequent, frequent and chronic provides convenience to physicians in terms of treatment. If headache episodes occur once a month, they are infrequent. These episodes can last for 30 minutes or last for days. Headache episodes lasting 1 to 15 days for at least 3 months are defined as frequent. Chronic episodic headaches are tension-type headaches that occur for 15 days or more for at least 3 months. These headaches significantly reduce people’s living standards and cause excessive drug use. In some cases, it can be difficult to distinguish from migraine. The physician must exclude types of organic causes before diagnosing tension-type headache. Caution should be exercised in cases of sudden onset headaches before the age of 10 or over the age of 50, in patients with persistent progressive findings, papilledema or fever with pain and rash. The pathological condition that may cause it should be carefully examined with neuroradiological imaging methods and laboratory tests.
Migraine: As a result of various studies, headaches of unknown origin are called primary headaches, and known ones are called secondary headaches. Migraine is the most common epidemiological headache type among primary headaches. If we look at the migraine attack rates experienced by the society, women experience migraine pain about 2 times more than men. If we look at the frequency of migraine in our country, one out of every 8 people suffers from migraine. It is most common between the 3rd and 4th decades.
What Are the Symptoms of Migraine Pain?
Migraine pain usually progresses not with a single finding, but with a wide variety of symptoms. Although these symptoms vary according to the patient, the presence of at least two of the following is very strong in terms of migraine diagnosis.
• It is usually experienced in attacks
• Continuation of attacks from life for about 4 to 72 hours
• Bilateral headache
• Being in a throbbing style
• Concomitant nausea or vomiting
• Moderate or high severity
• At the onset of pain, symptoms such as neurological findings, visual disturbances, and imbalance are seen.
• Pain that increases with movement of the head to the left or right, or with physical activity.
• Patients are often disturbed by stimuli such as light or sound.
What are the Migraine Types?
We can divide migraine pain into two main groups according to the way it occurs and the frequency or number of attacks. Migraines are divided into two groups, with and without aura, according to the way they occur. The incidence of migraine with aura in the population is approximately 10%.In migraine with aura, symptoms such as visual disturbances, blurring of vision, and seeing zig-zag shapes can usually be seen before the pain. Approximately 20-30 minutes after the onset of pain, patients may complain of dizziness, speech disorders or numbness in the arms and legs. In migraine without aura, visual disturbances do not appear beforehand.
We divide migraine into two according to the frequency and number of attacks; episodic migraine and chronic migraine. episodic migraine; It is a type of headache that occurs once a month and lasts for at least 3 months. Chronic migraine, on the other hand, is pain attack that last for at least 20-30 minutes about 15 days of each month and has been experienced for the last 3 months. The prevalence of chronic migraine in the community is approximately 1%.
What Are the Factors Triggering Migraine?
Although the factors that trigger migraine vary in each patient, if the person can detect this triggering factor, he/she may experience fewer attacks throughout his/her life and increase the quality of life. In some patients, ready-made foods containing aspartame, such as chocolate, nuts, salami and sausage, and fruit juices are blamed, while in some patients, alcoholic beverages such as red wine, cheese, and beer appear to be the cause. As you can see, the triggering factor varies from person to person. The important thing is that the patient himself finds this cause and takes precautions against it.
Apart from various foods and beverages, many factors such as irregular sleep, cigarette smoke, mental fatigue, excessively noisy environments, seasonal changes, stress, anxiety and medications are among the migraine triggers. In addition, menstrual periods in women also trigger migraine attacks. The increase and decrease in pain during menstrual periods, pregnancy and menopause in women reveals the close relationship of migraine with hormones.
Treatment Methods for Migraine Patients
Although there is no specific medical treatment for migraine pain, pharmacological treatment can be given to patients to reduce symptoms during an attack. Various pain relievers can be applied. Botox application, which has been licensed by the Ministry of Health as a prophylactic in recent years, is performed by experienced physicians. Botox application is the best option today if drug treatment does not help chronic migraine patients.
Cluster Headache: In this type of headache, patients often experience quite severe, unbearable, clusters of discharge that can last for several weeks.
Headache is severe enough to wake patients from their sleep, usually bilateral and throbbing around the eyes. After the cluster period in which the attacks are experienced, a recovery process takes months or even years. Cluster headaches are thought to be caused by biological clock anomalies originating from the hypothalamus, which reduces the quality of life of people and is mostly the underlying cause. Unlike migraine and tension headache, it is not associated with triggers. Alcohol intake greatly worsens cluster headaches. Another aggravating factor is the drugs containing nitroglycerin used by heart patients. Although it is seen in all genders, it is more common in men and usually occurs between the 2nd and 5th decades.
Headaches of Neck: Although headaches are not only caused by the skull, neck-related headaches can be seen due to the deformation of structures such as joints, discs, nerve roots located in the neck and back of the head. Although this type of pain is usually bilateral, head and neck trauma is more common in the histories of the patients. The pain usually starts from the neck and is non-penetrating, accompanied by nausea and vomiting. In the treatment of neck-related headaches, painkillers are used, as well as physical therapy and rehabilitation applications. If the patient does not benefit from these, interventional methods are evaluated in terms of treatment.
Other Headaches:
Headaches Related to Blood Pressure: Hypertension patients usually experience throbbing pain in the nape of the neck. In the treatment of tension-related headaches, cause-oriented treatments are usually applied.
Headaches Caused by Medication: Usually the type of headache caused by nonsteroidal anti-inflammatory drugs, the pain disappears after the medication is discontinued under the control of a doctor.
Headache Occurring with Exercise: During exercise and effort, stinging pain attacks can be experienced. In the treatment of these pains, the regulation of exercise methods and the use of painkillers can be applied.
