Headache represents the most common disease in Germany. Over 60% of adults suffer from headaches at least once a year, and one in four suffered such severe pain in the last two weeks that they had to take an analgesic, according to one study. This year’s German Headache Day is intended to help these patients treat their headaches in a pharmaceutically correct manner.
Self-treatment only for mild symptoms
For mild symptoms, there is nothing wrong with self-treatment with over-the-counter painkillers from the pharmacy, but these medications should not be taken for more than three consecutive days and no more often than 10 days a month. If the pain cannot be controlled by this, a doctor should be consulted. Too often in these cases, analgesics (painkillers) are taken in too high a dosage. This carries the risk of unwanted side effects, secondary diseases and even the development of new chronic headaches. The Forum Schmerz im Grünen Kreuz e.V. therefore calls for sufficient information to be provided to consumers on the effects and use of these agents in order to prevent such misuse of medication.
Do not immediately reach for the tablet, if the head hums once …
Most people suffering from occasional headaches, is often already helped by a walk in the fresh air. Relaxation exercises or regular endurance training, for example by cycling or jogging, are also good prophylaxis (prevention) against the pain. A change in lifestyle habits, such as avoiding so-called “stimulants” like alcohol, cigarettes and too much coffee, and a regular lifestyle with a consistent sleep and wake rhythm can also help prevent the headache from being as severe and as frequent. Help can also be provided by stimulus shielding (darkening the room), massage (rubbing the temples), and cold and heat stimuli. Identifying and avoiding triggers of the individual headache is paramount. Too much stress, too many sports or social activities, irregular food intake, intense noise and light, family conflicts and anxiety, and certain foods such as cured foods, cheese, red wine, chocolate and nuts can trigger headaches. Keeping a headache diary can be very helpful in identifying these personal triggers.
What types of headaches are there anyway?
According to the International Headache Society, 160 different types of headache can be distinguished. They are divided into primary and secondary headaches. If the pain represents the disease in itself, it is counted among the primary headache types; if it is the result of an underlying disease, it is a secondary headache type. Such underlying diseases can be e.g. tumors, too high blood pressure, head injuries, infections (flu), inflammations. Although it is important to exclude these types of headaches when the doctor makes a diagnosis, they are due to one of these serious diseases in only 1.6% of younger patients. Primary headaches are in principle harmless. Nevertheless, they are conditions that can have a significant negative impact on the lives of those affected.
Tension-type headache
By far one of the most common types of pain is tension-type headache. More than half of all pain patients complain of headaches of this type.In 1988, the International Headache Society agreed to classify headaches according to their symptomatology rather than their cause, since causal research in this area has not yet produced satisfactory results. Terms previously used for tension headache, such as “muscle tension headache”, “stress headache” or “psychogenic headache”, only pretended that the cause of the headache was known. Therefore, the term “tension headache” includes a number of headache types of different origins. It is divided into episodic and the much rarer chronic tension headache, which occurs at least 15 days per month.
Symptoms and causes of tension headache
Tension headache is characterized by the following symptoms:
- Bilateral headache with mild to moderate intensity.
- Headache is felt as pressing and pulling rather than pulsating
- No increase of the headache during physical activity
- Normal performance is limited, but not permanently impaired
- The headache can last untreated from half an hour to a week
- Hypersensitivity to noise or light
- No vomiting or nausea.
The tension headache can have a purely psychological cause, when the “nerves are on edge” during heavy stress, exhaustion or overtiredness. Depression and anxiety can also lead to a tension headache. However, tension headache is often associated with tension or cramps in the neck or throat area, as the head muscles may be increasingly tense and sensitive to pain. A special form of tension headache is medication-induced headache. Constant use of pain medications for months can cause these headaches. They can occur several times a week, but far more often as a continuous headache.
Migraine: women are more often affected
This is related to the female hormone estrogen, which is why birth control pills and menstruation can also cause migraines. In the course of pregnancy or after menopause, an improvement in headache attacks often occurs in these cases. There are about 16 different types of migraine, of which the most common by far is “migraine without aura”. The following symptoms are characteristic of this migraine:
- The pain is unilateral, pulsating and moderate to severe.
- The headache is felt as pressing to pulling
- Amplification of the headache during physical activity
- Normal performance is permanently impaired or completely limited
- Migraine occurs in attacks
- Vomiting and nausea may occur
- There is hypersensitivity to noise and light
- Untreated, the headache lasts from 4 to 72 hours
Different forms of migraine
The description of migraine has history, because it was already mentioned in ancient times by the Egyptians and Greeks. Its manifestations are as varied as they are characteristic. In one in three sufferers, precursors such as fatigue, reduced performance and, especially in women, a craving for sweets or fatty foods are observed on the day or hours before the attack. The pain can affect both sides of the head as well as change sides. At the beginning of a migraine attack, the pain is often localized in the neck and back of the head. When it reaches its peak, the pain is most intensely felt in the temple, forehead, and eye area.
Migraine with aura
It used to be called “classic migraine.” Here, neurological disturbances, usually visual disturbances, precede the sometimes less severe or even quite mild headaches. The aura develops slowly and can last up to an hour, and sometimes different aura symptoms (visual, sensory, and speech disturbances) can occur in succession. There is a congenital predisposition for the occurrence of a migraine. However, whether or not a migraine actually occurs depends on many other factors such as stress levels, emotional conflicts, or hormonal status. The first migraine attack is usually between the ages of 10 and 20. By the age of 40, nine out of ten migraine patients have already had their first attack. The frequency of migraines can be reduced by avoiding the individual trigger factors, but it cannot be cured. In old age, however, it is not uncommon for migraine to disappear completely.
What medications help with headaches?
Ergotamines (an ingredient in ergot) have been the standard medication in migraine therapy since the 1920s. They have recently been replaced by the more effective triptans. It is interesting to note that in the therapy of migraine in general the placebo effect (sham medication without active ingredients) plays a major role, which is unanimously estimated by many authors to be in the order of 40%. For headaches in general, according to the German Migraine and Headache Society (DMKG), a combination preparation of acetylsalicylic acid (ASA), paracetamol and caffeine is the most suitable analgesic. Combination preparations have a broader active profile, act more quickly and are more tolerable, since the active ingredients can be used as a combination in a lower dose.Single substances from ASA, ibuprofen or paracetamol can also help. Chronic headaches should generally not be treated with painkillers because of the risk of drug abuse. Treatment by an experienced physician is required here. For medication-induced headache, the treatment of choice is medication withdrawal, which can be an outpatient or inpatient procedure.
