C.on the term of headache or headache pain in the head of any kind and nature is generally indicated. It can depend on different causes, it can occur occasionally, or it is very frequent and disabling enough to compromise work skills, family and social life. “If the headache is a symptom of other underlying diseases, such asarterial hypertension, sinusitisdifferent intracranial pathologies such as neoplasms, the vascular malformationsmeningitis is said secondary headache. When, on the other hand, it has no other causes detectable with CT or MRI, but manifests itself exclusively with pain, it is called cprimary headache», Explains the D.ottor Vincenzo Tullo, Neurologist and Head of the Headache Clinic from Humanitas
Headache: tension headache
Primary headaches are much more frequent than secondary headaches and are predominantly tension headache, migraine and cluster headache in order of frequency. “There tension-type headache it is the most common form (about 1 in 3 people suffer from it at least once a month), it is more frequent than migraines but it is less disabling. Pain is spread throughout the headoften radiates in occiput nuchal region and it is of the gravative-constricting type (not button). The triggers are nervous tension, protracted stress, poor posture, lack of sleep and climatic variations. The intensity is mild or medium and the attack can last from 30 minutes to 7 days ”, explains the expert.
Migraine, the most disabling
«Migraine is the best known primary headache and more disabling: suffers from it more than one in 10 people, in 1/3 of cases since childhood. Pain of severe intensity it is associated with other disorders which the nauseathe He retchedL’intolerance to light, sounds and smells. Crises, often unilateral, last between 4 and 72 hours if left untreated worsen with routine physical activity like climbing stairs or coughing ”, explains Dottor Vincenzo Tullo.
Cluster headache, less common
“Cluster headache is a headache infrequent which is characterized by the grouping of crises in certain periods of the year and is more frequent in males. The pain is very intense, throbbing-burning, lasting 15-180 minutes, recurring to close crises (cluster of attacks) from 1 every 2 days to 8 per day, in unilateral orbital site. It is associated with ocular congestion, nasal obstruction or rhinorrhea, drooping of the eyelid, red and sweaty cheek and forehead ».
Headaches, treatments that work: what to take and how
Often when a headache attack comes, you take any pain reliever you have at home. But if the attacks are frequent and painful, it is good to talk to the doctor and ask for the prescription of specific drugs that act quickly and for a long time. «The symptomatic treatment of migraine includes as first choice drugs i triptans that act on the serotonin receptors and induce a vasoconstriction of the intracranial arteries. Triptans are generally effective on both pain and associated symptoms and therefore do not require association with anti-vomiting drugs. If a dose of triptan is not enough a second dose can be taken after a few hours or an NSAID analgesic can be added (non-steroidal anti-inflammatory drugs) such as ibuprofen, naproxen, acetyl salicylic acid, nimesulide. NSAIDs are indicated in crises of mild to moderate intensity or when triptans are ineffective “, advises the Dottor Tullo.
If nausea or vomiting also appears
“If the nausea and vomiting persist, a antiemetic as the metoclopramide or the domperidone which, in addition to preventing vomiting, can accelerate gastric emptying. favoring the absorption of the analgesic », specifies the expert.
The pain reliever works best if taken immediately
The analgesic is all the more effective, on pain and associated symptoms, the earlier it is taken. It is important not to exceed the maximum number of 10-12 analgesics in a month to avoid the onset of a rebound effect with worsening and chronic headache, as well as to reduce the risk of side effects.
Headache: when to go to the doctor or the emergency room
Headache should not be underestimated. You need to go to your doctor or the nearest emergency room when:
1) manifests itself in a way sudden and violent, much more intense than any other headache I have had before
2) does not disappear, on the contrary gets worse over time, despite taking painkillers
3) shows up following a head injury
4) if they occur neurological symptoms: visual disturbances (blurred vision), difficulty in speaking, weakness in the limbs of half of the body
5) if the frequency and duration of attacks suddenly and significantly increased in recent times
6) if the pain, even if slight, yes associated with the presence of very high fever
7) if the headache is persistent in pregnancy
Headache: the importance of the neurological examination
A normal medical examination is, in most cases, the time when headaches can be diagnosed and treated. It is through the anamnesis that it is possible recognize the type of headache, and find out if it is a primary headache, and therefore a pathology in itself, or a secondary one. Task of the neurologist is of iIdentify the factors that trigger attacks, advise precautions And identify therapy more adequate. And request other tests, such as brain MRI, head CT, electrocardiogram, electroencephalogram, skull X-ray, laboratory tests, polysomnography or other.
Useful tests for headache sufferers
When you go to a headache treatment center, the specialist may order some clinical tests. Here are the most common.
X-ray of the skull
The radiography allows to visualize the hard components of the skull. The patient is made to lean against a wall behind which a plate is positioned, on which the X-rays are impressed. The procedure requires that the patient is standing.
The examination can be useful to determine suspected damage to the bone, the presence of certain tumors, or a simpler sinusitis: the headache could derive from one of these pathologies.
Electroencephalogram
Among the diagnostic tests, the electroencephalogram (EEG) measures the brain’s electrical activity through the use of some electrodes placed on the scalp, and reproduces it on a screen in the form of a series of waves.
The examination is not invasive or painful: the patient is made to sit on an armchair or bed, and about twenty electrodes are applied, each of which is used to record information about a certain area of the brain.
The EEG provides information not only on abnormal electrical activities, but also on their location. It is indicated in short headache attacks, in case of alterations of consciousness, epileptic seizures, focal neurological deficits and basilar migraine.
Magnetic resonance
Nuclear magnetic resonance (MRI) is based on the application of a high intensity magnetic field and radiofrequency waves to the part of the body to be examined (in the case of a headache, the skull).
The patient is made to lie down on a bed, which will enter the tube of the machine; it may require the administration of a contrast medium into a vein and requires the patient to be immobile for the duration of the examination.
Brain MRI can be used in case of headaches with atypical elements, sudden onset neurological deficits, dementias, primary tumors or metastases, demyelinating diseases such as multiple sclerosis or infectious diseases such as encephalitis or meningitis.
MRI is not for everyone: due to the magnetic field, people with pacemakers or other magnetic-activated devices cannot undergo the exam; in case of doubts about the presence in the body of metal parts (such as sutures, clips, prostheses) it is essential that the patient inform the medical staff.
The tomography
The TAC, acronym for Computerized Axial Tomography, is a radiological examination that uses X-rays to observe the inside of the organism.
The patient is made to lie down on a bed inside an open tube; it is necessary to remain motionless for the minutes required for the exam (about 5).
The CT scan produces scans of the brain, creating a geographic map that highlights the structures present, and is indicated in cases of urgency, such as following brain haemorrhage and head trauma. Generally, CT is used in case of contraindications to resonance, such as ferromagnetic clips on the vessels, heart pacemaker, claustrophobia.
Polysomnography
Polysomnography is an instrumental diagnostic test used for patients with sleep disorders, and often with nocturnal or awakening headaches.
This test detects valuable parameters in the patient’s sleep such as snoring, blood oxygenation, heart rate, body movements, micro-awakenings, sleep quality.
Color Doppler echo of the supra-aortic trunks
The ECD – Eco Color Doppler is a non-invasive examination that allows the monitoring of the arterial circulation directed to the brain through the carotids and vertebral arteries. It is useful in diagnosing cerebrovascular diseases – including some headaches.
Basically it is an ultrasound enriched by visual (Color) and acoustic (Doppler) values, fundamental for evaluating the vessels and the flow of blood inside them. The execution of the echocolordoppler of the supra-aortic trunks has no particular contraindications.
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