Diagnosis and Treatment of Headaches

Diagnosis

To find the exact cause of a headache, it is a good idea to keep a headache diary that records how the pain feels and when the headache starts. If you have any of the following symptoms, it is best to seek medical attention immediately.

• The worst headache you have ever felt in your life
• A headache that starts after age 50 (especially if you usually do not get headaches, or if it is different from your usual headaches)
• Fever, stiff neck, or a skin rash
• In patients infected with the AIDS virus or cancer patients, a headache that feels different from usual
• Numbness in the arms or legs, or seeing objects abnormally
• A headache that develops after a head injury
• A headache in which the pain suddenly reaches its peak within 5 minutes
• A headache that continues after severe exercise, coughing, or sudden movement

1. Tension-type headache Diagnosis may be helped by directly feeling whether the forehead muscles, jaw muscles, or head and neck muscles are tense. To distinguish other possible causes of headache, blood pressure measurement, vision tests, and skull X-rays may be performed. If the headache is different from one you have experienced before, or if abnormalities are found on neurological examination, brain CT or MRI is performed. General blood tests and thyroid tests are mainly done, and in people over 50, checking the erythrocyte sedimentation rate (ESR) is also helpful in determining whether the headache is caused by vasculitis.

2. Migraine Because migraine has a very distinctive pattern, it can often be diagnosed from symptoms alone without tests. Migraine should first be distinguished from other primary headaches, and it is also necessary to check for cerebrovascular diseases such as transient ischemic attack, a paralysis-like symptom caused by a temporary reduction in blood supply to the brain, brain tumors, infectious diseases, secondary headaches caused by medication, and whether the symptoms are due to epilepsy.

3. Cluster headache Like migraine, cluster headache can be diagnosed through a detailed medical history of the headache. Cluster headache is characterized by sudden onset two to three hours after falling asleep. The pain is severe behind one eye, with a constant burning and throbbing sensation. It may also occur in the cheek, around the ears, or in other areas. The eyeball becomes bloodshot, tears flow, the eyelid feels heavy, and nasal congestion and a runny nose occur; the cheek may swell and turn red. The headache occurs on one side, not both. The pain disappears one or two hours after it starts, and in some cases it occurs at the same time every day. Through detailed questions about the headache, it is necessary to distinguish whether the pain is due to musculoskeletal disorders of the head or neck, or due to migraine, temporal arteritis, and so on.

Treatment

1. Tension-type headache There is no definitive treatment for tension-type headache, but the pain can be controlled with over-the-counter pain relievers (aspirin, acetaminophen, ibuprofen). Because stress, anxiety, restlessness, depression, irritability, and sensitivity are associated with tension-type headache, medications such as antidepressants and anti-anxiety drugs may also be needed. In addition, massage, spas, a healthy diet, rest, a change of pace, and appropriate exercise are helpful.

2. Migraine There are two main principles in the treatment of migraine. The first is to prevent migraine from occurring, and the second is to treat it quickly so that the headache improves if early symptoms of migraine appear. Drug treatment can control the frequency and intensity of migraines and help prevent progression only to the prodromal or aura phase without the headache phase. It is also important to avoid situations that can trigger migraine. For example, avoiding stimulating lights, sounds, and odors, avoiding alcohol, chocolate, and foods containing preservatives, and managing stress can help. It is also a good idea to keep a headache diary and record when symptoms began and what they felt like.

Preventive medications for migraine include beta-blockers and topiramate, and these drugs help reduce the frequency of migraines. If early symptoms of migraine have begun, you should rest in a dark, quiet room to reduce triggering stimuli that worsen the pain, or take pain relievers containing acetaminophen and caffeine. Ergotamine drugs constrict cerebral blood vessels and are used to treat migraine. However, caution is needed in people with conditions such as cardiovascular disease, and it is also best not to take them if you have high blood pressure, kidney disease, liver disease, or are pregnant. Recently developed triptan medications (sumatriptan, rizatriptan, zolmitriptan, naratriptan, etc.) improve headache and nausea at the same time.

3. Cluster headache Pain relievers such as aspirin, acetaminophen, and ibuprofen take a long time to take effect, so they are not effective for cluster headache. However, indomethacin, which has both pain-relieving and anti-inflammatory effects, is very effective for cluster headache. If symptoms mainly occur at night, inhaling oxygen through an oxygen mask for 15 minutes can help reduce the headache. Ergotamine is effective in preventing cluster headache symptoms and reducing pain. Antihistamines, steroids, lithium, or calcium channel blockers may also be used. However, chronic cluster headache that continues for a long period of time is difficult to treat with medication.

So far, we have explained the diagnosis and treatment of headaches. In the next article, we will learn about nipple discharge.

Source: National Health Information Portal, Korea Disease Control and Prevention Agency