Frequently Asked Questions about Headache
If it is a first headache episode that does not go away with analgesics such as paracetamol, or a repeated headache that affects activities of daily living, the Family Doctor should be consulted. If the intensity of the pain is severe, it is better to consult the emergency department of a Primary Care Centre or a Hospital.
To identify and control the factors that trigger the headache episode is a first step before commencing preventive treatment. In the case of migraine, they are not the same for all patients. There are more than 60 precipitating factors in migraine, and the individual mean of each patient is between 3 and 6. Approximately half of the patients identify them before 75% of their attacks. Other types of headache have other types of triggers: stress, tobacco, alcohol, tiredness, etc. Your doctor will guide you depending on the diagnosis.
90% of the patients who consult for headache have a primary headache, which is diagnosed by carrying out an interview and a complete physical examination, confirming that they meet the appropriate diagnostic criteria, and excluding alarm signs and symptoms. Thus, in the majority of cases, it is not necessary to carry out any other type of diagnostic test, except if the doctor suspects, or wishes to rule out, a secondary headache.
It is important to pay attention to the recommendations of your doctor and differentiate between the drugs that work for the treatment of the acute pain episode and those that are preventive and reduce the number of episodes. You must not self-medicate or recommend your treatments to other patients or receive them from them, since they may not have the same type of headache and, as a result, the treatment may be different. In the case of a migraine attack, the administering of the drug should be early, and repeated doses must be avoided until there is a new episode, in order to avoid abuse of the drug. To avoid headache with medication abuse, it is recommended not to take anti-inflammatory drugs more than 10 times a month, and triptans no more than 15 times. On the other hand, one in every four individuals that consult for migraine needs preventive treatment in order to reduce the intensity and frequency of the headache days in half of the cases.
Migraine is characterised by having an association with other health changes that are found present in patients in a higher percentage than usually in the rest of the population. The association of two or more factors with the migraine is known as comorbidity. Although there is controversy, migraine with or without aura has been associated with myocardial infarction and peripheral arterial diseases, while migraine with aura appears to increase the risk of cerebral infarction. Complications are uncommon, and in general other vascular risk factors co-exist (arterial hypertension, diabetes, high cholesterol, smoking). Stricter control of these factors is recommended in patients with migraine. Migraine is also associated with psychiatric disorders like anxiety and depression.
Serious acute complications like a migrainous infarction are exceptional. Migraine with aura is a risk factor, although minor, of cerebral infarction; thus, it is advisable to control all vascular risk factors in patients with migraine with aura, above all, in middle-aged women. It is recommended to stop smoking.
It is usually not the case. In the majority of primary headaches there will be a decrease in the frequency and intensity of the pain with the years, even occasionally achieving temporary or lasting remissions, with the pattern of the pain and accompanying symptoms being able to be modified. But, although less common, the opposite can happen, that it gets worse with the passing of time or with the female hormonal changes.
Yes. Migraine is an illness, which can be affected by hormonal changes, and menstruation lowers oestrogens, which can cause headaches. In any case, we recommend consulting healthcare professionals for a proper diagnosis.
Although migraine usually improves with menopause, this is not always the case. So you should always consult a healthcare professional about headaches, which start as an adult.
There is an anatomical correlation between the cervical nerves and the trigeminal brainstem nuclear complex, so that there can be neck pain in the context of a migraine, and neck pain can also trigger a migraine.
Patients with migraine are very sensitive to external and internal stimuli. Internal stimuli can include dehydration, fasting, or stress.
There have been two breakthroughs in migraine treatment. The first was the appearance of acute treatment with triptans, and the second, in 2012, was botulinum toxin treatment for chronic migraine. By late 2019, the first drug class offering specific migraine prevention treatments, monoclonal antibodies, will become available.