Headache

It is one of the most common complaints in society. The proportion of those with complaints reaches 90% in the society. Migraine and tension-type headache constitute 90% of all headaches. It should be kept in mind that headaches that are frequently encountered but not ignored may be a symptom of life-threatening diseases.
These patients usually complain of benign primary headache and only 10% of them may have findings suggestive of secondary pathology. Patients may present with a severe headache attack for the first time or may have a previous diagnosis of primary headache. The treatment approach will be different in these two patient groups. Secondary headaches, if not diagnosed and treated early, can lead to permanent or serious permanent illnesses. The table lists common primary and secondary causes of headache.
Primary Causes Secondary Causes
Tension type Vascular origin
Migraine without aura
Migraine with aura Non-vascular
Migraine with aura Infection
Cüme type Systemic disorder
(originating from facial and cranial structures)

WHYÇ TYPES OF HEADACHES?

The International Headache Society classifies headaches into 14 main groups and hundreds of subgroups. Primary headaches are headaches that occur directly with a headache picture and are not associated with another disease. These include migraine, tension-type and cüme headaches.
Secondary headaches may be of vascular origin (subarachnoid hemorrhage=SAH, ischemic attack, arteriovenous malformation AVM, carotid artery dissection, pituitary hemorrhage), non-vascular origin (idiopathic intracranial hypertension CSF pressure changes, intracranial tümör, epilepsy), infectious (such as meningitis, abscess, empyema), systemic (such as hypoxia, hypercapnia, hypertension), cranial and intracranial structures (such as trigeminal neuralgia, cervical disc originating from temporomandibular joint), göz diseases and sinusitis.
The most common symptom of subarachnoid hemorrhage is sudden onset of severe headache, which may be accompanied by nausea, vomiting, loss of consciousness, cranial nerve palsies, and meningeal irritation. In the diagnosis of subarachnoid hemorrhage, computed brain tomography (CBT) has a sensitivity of 92-93% in the first 24 hours. This rate decreases to 58% 5 days after the event. Lumbar puncture is diagnostic in cases where the bleeding area is not visualized on CT scan.
Subarachnoid hemorrhage findings:
– Sudden onset of headache
– Nausea-vomiting
– Fainting, loss of consciousness
– Meningeal irritation signs (nuchal rigidity)
– Photophobia (sensitivity to light)
Headache in head içi tümörs may develop due to increased cranial içi pressure or involvement of pain-sensitive structures. Although the most common presenting complaint is progressive neurologic loss, approximately half of patients have headache. It was stated that the headache was severe, especially in the morning hours when they woke up. It is often associated with nausea and vomiting and relief is reported after vomiting. It has been reported that 77% of cranial içi tümörs present as tension-type pain and 5%-10% as classical migraine-type pain.
The intensity of cranial içi pain may increase with bending and valsalva maneuver. Accompanying pain in the visual acuity may suggest secondary causes such as decreased visual acuity or blurred vision, temporal arteritis, temporal arteritis, psödotümör cerebri or narrow aperture glaucoma. The presence of neck pain, fever or döküntüntüng in the patient may reflect the meningitis picture. Neurologic findings such as numbness in the hands, numbness, blurred vision, slurred speech, slurred speech, difficulty in swallowing, nöbet, loss of consciousness, etc. may lead the causes of headache to more structural lesions.
After this stage, primary causes of headache should be ruled out if an underlying lesion is not considered. In addition to nausea, vomiting, and vision-related findings, the changes in pain intensity with physical activity will be instructive in differentiating these types of headaches. For example, changes in pain intensity with physical activity are observed in migraine-type headaches, but not in tension and headache-type headaches.

What are the diagnostic procedures in a patient presenting with headache?

After the patient's age, gender, headache characteristics, comorbidities, medications, etc. are questioned in detail in the section we call anamnesis, a careful neurological examination is required. If the primary causes of headache are not considered, differential diagnosis should be made and treatment should be organized. However, if the patient is moving away from the primary causes of headache or if the stimulating findings mentioned in the initial evaluation are not present, if the patient is moving away from the diagnosis of primary headache, it will be useful to perform diagnostic computed tomography and brain magnetic resonance imaging (MRI) and blood tests.
WHAT CAUSES RECURRENT HEADACHES?
In the case of recurrent headaches, it should be investigated whether there is a secondary cause. In patients with periodic pain in the past, if the pain has become persistent, it should be considered that the patient has used a large number of painkillers and that there may be underlying psychological causes.

What is the treatment for headache?

Painkillers are important. There are many treatment options depending on the diagnosis of the disease.

Do painkillers cause addiction when used in moderation?

Continuous use of painkillers is not addictive except for the morphine group. However, patients may also feel a type of pain called headache due to medication use.

What are the causes of headaches in later life?

First and foremost, an underlying cause should be investigated for headaches that occur at an older age. Migraine is a disease that decreases with age. Two diseases that cause headaches, especially in the elderly, are temporal arteritis (headache due to vascular inflammation) and hypnic (nocturnal) headaches. Therefore, if a patient over the age of 50 has newly emerging headaches, a doctor should be consulted.

WHEN SHOULD A PATIENT WITH HEAD PAIN CONTACT A DOCTOR?

If the pain is persistent and increasing in intensity;
1. The pain first appeared at the age of less than 10 years or at the age of 50 years;
2. The pain that was previously present has worsened or changed its shape;
3. If the headache is the most severe pain he/she has ever experienced in his/her life and it started suddenly,
4. If the pain appeared and increased in intensity during a physical activity (lifting heavy objects, sexual intercourse), sneezing or straining,
5. If headache occurs after head trauma,
6. If headache is associated with neurological symptoms such as speech impairment, visual impairment, numbness in the limbs, and paralysis,
7. If headache does not respond to treatment,
8. If the headache is always in the same area,
9. If there is a headache when you wake up in the morning and it is relieved by vomiting,
10. If there is high fever, drowsiness, impaired consciousness or vücut döntüntüsü, you should definitely go to the doctor.