Headaches (migraines).

Headaches such as migraines may reduce a person's quality of life.

40 - 60 % of people suffer from episodic tension headaches.

40 - 60 % of people suffer from episodic tension headaches.

Headaches are among the most common symptoms in modern medicine. About 8 - 10 % of people suffer from migraines, while approximately 40 - 60 % suffer from episodic tension headaches. Headaches affect not only individuals, who suffer considerably reduced quality of life, they also have an enormous effect on the economy as a whole: The total costs associated with headaches in Europe are estimated to be 27 billion Euros.


Can headaches be a disease?

Almost three quarters of the population will consult a doctor at some time during their lives due to headaches. However, it is important to note that there is not always a disorder in the strictest sense behind every headache attack. Nonetheless, if the headaches occur more frequently or regularly, or if regular headaches change in terms of their intensity, character or frequency, you should consult a doctor.


Headaches can be treated!

It is a widely held misconception that those affected must always "tolerate" headaches. Modern diagnostics in the hands of an experienced specialist in neurology will in most cases permit a definitive diagnosis of the type of headache. A variety of drug-based and non-drug-based treatments are capable of keeping the symptoms effectively under control. Therefore, headaches are treatable and fall initially within the scope of a neurologist.


Headaches (migraines). Information A-Z

Definition. What exactly is Headaches (migraines)?

What types of headache are there?

The International Headache Society (IHS) created a classification system back in 1988, the second edition of which (2003) has since become accepted as an international standard. This classification essentially distinguishes between:

  • Primary headache disorders
    These include the most well known headache syndromes such as migraines, tension headaches, cluster headaches, etc. What all of these have in common is that the cause of these headaches is not known for certain. However, it is assumed that various types of mechanisms in the brain itself contribute to the development of headaches.
  • Secondary headache disorders
    These include a variety of headache syndromes, each of which is caused by a more or less focal trigger. These may, for example, be located in the brain (as with brain haemorrhages, brain tumours, etc.) or elsewhere in the head and neck region (as with eye, paranasal sinus or neck problems, etc.). Headaches triggered by medications are becoming increasingly prevalent among headaches of this type.
  • Other headache disorders
    The third group includes various types of headaches, the development of which is triggered by quite specific mechanisms. These primarily include stabbing, shooting pains in the area of individual cranial or head nerves (neuralgia), as well as what is known as central pain, which under certain circumstances may occur months or even years after injuries to nerve tracts in the brain.

Particularly among non-neurologists, there has for decades been considerable uncertainty regarding how to classify headache syndromes. Ultimately, this uncertainty primarily hurts patients, who have been incorrectly or inadequately treated over extensive periods.

A responsible headache specialist should therefore base their assessment on the IHS headache classification system. Commonly used but outdated terms such as "cephalgia" have today not lost any currency as diagnoses because they only describe the primary symptom of headaches, i.e. the pain and are otherwise completely non-specific.


Symptoms. What are the symptoms of headache (migraine)?

It goes without saying that the lead symptom in cephalgias is the pain itself. Thereby, in the eyes of the attending physician a headache is not always just a headache. The complete investigation of headache patients includes questions regarding the

  • Nature of the pain (e.g. oppressive, throbbing/pulsating, piercing, searing, electrifying)
  • Duration of the pain episodes (seconds, minutes, hours, days)
  • Localisation (e.g. entire head, one side, behind the eye(s), upper jaw)
  • Intensifying or attenuating factors (e.g. repositioning, substance intake, times of day, female cycle) and
  • Pain intensity. In the case of the latter, the patient is often asked to describe the maximum intensity of his pain on an imaginary line between "0" (no pain) and "10" (worst imaginable pain).

Examples of further symptoms which accompany headaches (migraine)

Furthermore, the symptoms which accompany the pain are important to establishing a diagnosis. They should also be examined and given consideration. As an example, some of the most common forms of cephalgias are listed here:


a) Migraine

  • Typically one-sided, pulsating headache of moderate to severe intensity
  • Nausea and/or vomiting
  • Sensitivity to light and noise
  • Occasionally: "aura" (transient neurological deficits usually preceding headaches, such as flickering vision, sensory disorders in the face, arms or legs, paralyses, speech defects)

b) Tension headache

  • Typically bilateral, oppressive headache of mild to moderate intensity
  • Seldom sensitivity to light or noise

c) Cluster headache

  • Typically very one-sided, severe to very severe, pulsating headache in the area of the eyes
  • Bloodshot or watery eye on the painful side
  • Runny or congested nose on the painful side
  • Swelling of the eyelid on the painful side
  • Sweating on the painful side
  • One-sided pupil contraction on the painful side
  • Physical restlessness

d) Trigeminal neuralgia

  • Typically very one-sided, severe, sharp, superficially piercing pain in the area of the forehead, upper or lower jaw
  • Typical triggers (chewing, drinking, cold, heat)

Symptoms of secondary cephalgias

Due to triggering factors or the involvement of other organ systems, secondary cephalgias reveal further symptoms in addition to the headaches themselves:

  • Traumatic injuries: bone fractures, lacerations
  • Vascular disorders: one-sided paralysis, speech defects, swallowing difficulties, double vision, crawling sensations on the arms and legs, unconsciousness, epileptic seizures
  • Retention of the cerebrospinal liquor: fatigue, reduced vitality, changes in personality, unconsciousness, epileptic seizures
  • Tumours: one-sided paralysis, speech defects, changes in personality, disorientation, impaired memory, unconsciousness, epileptic seizures
  • Infections: fever, hypotension, disorientation, fatigue, unconsciousness, epileptic seizures
  • Internal diseases: irregular or slowed heartbeat, tremor, diarrhoea, weight loss, fatigue
  • Diseases of the eyes, ears, nose, teeth and jaw: impaired vision, impaired hearing, tinnitus, halitosis, sensitivity to cold and heat

Causes. Why does Headaches (migraines) develop?

Primary headache

The causes primary headaches are not known. What is common to all of them is that the presumed mechanism by which headaches develop lies in the brain itself, possibly even in relatively localised areas in the innermost regions of the brain ("headache generators"). Some evidence suggests that the predisposition for primary headaches is congenital (genetic), even if the headaches only manifest themselves later on, e.g. during early adulthood. This explains why some families have multiple generations of patients with similar and regular headaches.

Only in recent years has it been possible for some common headache disorders to research in greater detail the changes that take place within the brain during a single headache episode. For example, with migraines, attacks include transient electrical dysfunction in nerve cells, changes in blood flow and abnormalities in metabolic systems. It is obvious that the interaction of the individual factors is highly complex and is only beginning to be understood by science


Secondary headaches

With secondary headaches, there is by definition a more or less focal underlying cause within the brain or in the head/neck area, which can in most cases be identified after thorough diagnostic assessment. The number of possible causes is too large to list them all individually in a summary of this type. However, the most important triggers include the following:

  • Trauma-related injuries to the head or cervical spine
  • Vascular disorders in the head or neck area (poor circulation, brain haemorrhage, pathological deformities in the blood vessels, clotting, tears in parts of the blood vessel walls)
  • Changes to the cerebrospinal fluid (pathological accumulation or drainage of cerebrospinal fluid)
  • Tumours in the head and neck area
  • Medications or drugs (e.g. even pain medications if used regularly!)
  • Infections (meningitis)
  • Internal diseases (high blood pressure, thyroid disorders, kidney disease, heart problems etc.)
  • Disorders of the eyes, ears, nose, teeth and jaw (uncorrected poor vision, glaucoma or cataracts, sinusitis, disorders of the middle ear, etc.

Several specialists often need to be involved in cases of secondary headache.