Symptoms
The dangerous headache
If you have a headache that comes on suddenly (like a whip, thunderclap, lightning, crack, explosion etc.), the nature and severity of which is unknown to you, you should go to a hospital immediately. There they will determine whether it has been caused by a dangerous hemorrhage or another disease affecting the head.
Independently of this, any new prolonged headache should also be examined by a neurologist.
The common headache
Headache can occur as an independent clinical presentation (primary headache), or as a typical accompanying symptom together with other diseases (secondary headache). Headache is one of the most common forms of pain today.
The two most common types of primary headache are tension headache and migraine. These can usually be distinguished by the different nature of the pain.
A dull, pressing tension headache is usually felt on both sides, often like a hood, a hat that is too tight, or the feeling that the head is stuck in a vice. Its cause is unknown.
Migraine is the name given to throbbing, pounding, pulsating or even stabbing headaches that occur in attacks. Most often, the pain is felt on one side in the area of the forehead, temple and eye, but it can sometimes occur on both sides. The pain is often accompanied by nausea and sensitivity to light and noise. Physical exertion aggravates a migraine headache.
Mixed headache. Occasionally, patients may suffer from both common types of headache, and often one may trigger the other.
The rarer cluster headache (“Horton’s neuralgia”) is also a one-sided stabbing headache and is more common in men. It is characterized by a cluster of headache attacks on several days (or nights), followed by a period of weeks with no attacks. After that, the cluster episode repeats again with headache attacks clustered again on several days (or nights). These headaches are often associated on the same side with eye redness and tear production, which also causes a unilateral runny nose.
Causes of secondary headache
A very common cause of headache and facial pain is inflammation of the sinuses (e.g., sinusitis, maxillary sinusitis). In this case, the headache typically worsens when the head is tilted forward or when air pressure changes. Sometimes patients also experience a sudden discharge of fluid or mucus into the throat when the congested sinus suddenly empties into the pharynx.
Headaches can also have various other causes, such as stress, over-exertion, sensitivity to the weather, cigarette and alcohol consumption, lack of oxygen, tumors, or meningitis. Persistent headaches can also indicate diseases affecting other organs, such as colds, defective vision, high blood pressure, gastrointestinal diseases or diseases of the spine.
Painkiller headache is a special form: regular use of certain painkillers over a long period of time can lead to withdrawal pain as soon as the effect of the medication wears off. This mechanism leads to increasing painkiller intake, resulting in a vicious cycle that can only be broken by painkiller withdrawal under medical supervision.
You should definitely be referred to a neurologist when
– your pain occurs for the first time
– you regularly suffer from headaches more than two or three times a month, or they last longer than two or three days.
– your headache is accompanied by serious or unusual symptoms such as speech impairment, numbness or arm or leg weakness
– the duration and severity of your symptoms increase despite treatment
– you no longer respond to the painkillers you have been using or you have to increase the dose continuously.
