Headache: Symptoms, Types and Diagnosis

Headaches can take on very individual characteristics in terms of type, intensity, localization and temporal course. Nevertheless, typical symptoms are known for the individual forms of headache, which in many cases allow the doctor to assign certain causes. In the following, we present the typical symptoms of the most common types of headache.

Types of headache

Various types are distinguished in headaches. Roughly, we distinguish between primary headaches, in which the headache itself is the cause of the discomfort, and secondary headaches (or symptomatic headaches), which are caused, for example, by trauma to the head, by an infection, or by vascular disorders. Common types of primary headaches include:

  • Vascular headache
  • Migraine
  • Tension headache
  • Conversion headache
  • Neuralgia
  • Cluster headache

Learn more about these different types of headaches below.

Primary headache

All variants of primary headache have in common that, despite intensive diagnostics, no organically tangible causes can be found. The transitions between the individual forms of headache are usually fluid; characteristically, however, they are strongly related to the psychological and emotional state of the patient.

Vascular headache

Vascular headache usually occurs periodically, and less commonly chronically. Its intensity varies from persistent head pressure to stabbing pain of changing localization. Trigger factors for vascular headache include:

  • Emotional tension of a positive or negative nature.
  • Climatic changes
  • Physical overloads
  • For women, the period

For vascular headache, which can begin in childhood, there may be a genetic basis, as this form of headache is clustered in individual families. 10 tips against headaches

Migraine and tension headache

If the headache occurs predominantly on one side and there are additional accompanying symptoms on the part of the autonomic nervous system such as nausea, vomiting and sweating or additional neurological deficits in the early stages of the attack, the suspicion of migraine is obvious. The pain character in tension headache ranges from the feeling of a “hoop around the head” to stabbing or dull, unilateral or bilateral neck pain. In most cases, tension of the muscles close to the head is responsible, which usually occurs in psychologically stressful or overstraining situations. In contrast to vascular headache, the maximum frequency of tension headache is in middle age. There is no known familial predisposition.

Conversion headache – psychosomatic headache

The field of psychosomatic disorders includes the so-called conversion headache, which is similar in symptomatology to vascular or tension headache. As in other psychosomatic disorders, a primarily psychological, usually unconscious conflict is expressed in an organic symptom – in this case as a headache.

Neuralgia as a type of headache

Neuralgias are understood to be a certain type of lightning-like, violent attacks of pain, usually lasting only seconds, in the area of spread of a cutaneous nerve. Most frequently, neuralgia occurs as trigeminal neuralgia in the spreading area of the trigeminal nerve, which covers the forehead region, the nose-cheek region and the chin area with its three branches. Typically, neuralgia attacks can be triggered by mechanical stimulation in the corresponding area, for example by speaking, chewing or shaving. Phases with frequent attacks of pain can alternate with phases with few symptoms. Neuralgia also occurs far less frequently in the area supplied by the glossopharyngic nerve at the base of the tongue and in the posterior pharyngeal region, and in the area supplied by the occipital nerve in the occipital region.

Cluster headache

A special type of severe headache with localization in the temporal region, behind the eyes, in the upper jaw, and in the forehead is called a cluster headache or Bing-Horton headache.Typically, this type of headache occurs in middle-aged men and manifests as attack-like onset of pain usually in the early morning hours, accompanied by unilateral redness of the face, unilateral lacrimation, and nasal crying. The pain usually reaches its maximum after about 30 minutes and subsides slowly over several hours. Frequent occurrences within 3 to 6 weeks often alternate with longer symptom-free periods.

Symptomatic headache

Headaches associated with a brain tumor can take a wide variety of forms. From sharply circumscribed and stabbing to a diffuse feeling of pressure throughout the head. Only in rare cases can the localization of a headache be inferred from the localization of a brain tumor. Relatively characteristic for tumor headache is the intensification of the complaints with change of position or pressing, sometimes also with tapping of the bony skull in the region in question. However, local inflammation (abscesses), local tissue swelling (edema) or cerebral hemorrhage can also increase the pressure inside the skull and cause headaches. In such cases, the symptoms are usually controlled by additional neurological deficits, as after a stroke, or general symptoms such as fever or neck stiffness.

Headache down to the neck

Headaches radiating into the neck take on special significance in vascular malformations (aneurysms) of the brain, which sometimes precede complete vessel rupture with life-threatening cerebral hemorrhage. Such a subarachnoid hemorrhage is accompanied by acute onset, severe headache, sometimes neurologic deficits, and requires immediate inpatient monitoring and emergency treatment if necessary. Headache in meningitis or encephalitis, on the other hand, develops slowly over hours and usually has a dull pain character. After injuries to the head, for example after serious accidents, chronic recurrent headaches occur in 30 to 50 percent of cases and are similar in character to vascular or tension headaches.

Headache due to diseases

Headache may also occur as a symptom of other disorders, for example:

Temporal headache and neck headache.

Severe unilateral or bilateral temporal headache is characteristic of temporal arteritis, an inflammation of the temporal blood vessel, which may be prominent as a pressure-painful cord in the temporal region. Headaches localized predominantly in the neck, but which may radiate to the entire head, raise suspicion of a degenerative or rheumatic disease of the cervical spine. The complaints of this type are often position-dependent and most severe in the morning before getting up, so that patients are sometimes jolted out of their sleep. The diagnosis is corroborated by evidence of muscle tension in the neck and findings of spinal disease on x-ray.

Headache in general diseases

Blood pressure crises, severe kidney disease, increase in red blood cells (polycythemia) but also anemia or poisoning of various kinds can be considered as triggers of headache.

Headache: how is it diagnosed?

Making the diagnosis of headache is relatively easy. It is much more difficult to find the cause. If the pain character and course are typical, the assignment to one of the known primary causes of headache can sometimes be made from the patient’s description of the complaints alone. In other cases, organic diseases in the head, ear, nose and throat region as well as diseases of the internal organs and the entire organism must be excluded.

Complications of headache

Headache as a symptom in itself actually knows no complications. At most, these can occur in the context of underlying diseases and are dealt with in the corresponding clinical pictures.