Why it matters how your head aches

2022. February 10.

Most of us have had a headache at some time in our lives. Some of us are constantly plagued by them, for others headaches are rarer. But can a headache mean maybe we are ill? Or are we suffering a recurrent pain for which no medical cause can be found? Which complaints and symptoms cannot be waved away or treated with a painkiller, and when must we see a doctor? These questions are answered by Dr. Sándor Ilniczky, Dr. Rose Private Hospital’s neurologist.

Dr. Ilniczky Sándor

Headaches can be divided into two major groups. The first includes the so-called primary headache diseases, when we cannot detect any organ or nervous system disease, but the episodes appear with very characteristic clinical symptoms and complaints, said Dr. Ilniczky.

The other large group is secondary or symptomatic headaches, in which case the headache is the result of an organ disease and may be just one of many symptoms.

So, sufferers don’t have to despair right away as there isn’t always a physical illness behind it. What types of headaches are in this primary headache group?

That’s right. The most common primary type headache is migraine, which can affect 10-20 percent of the population. Women are more likely to suffer with migraines, especially at a young age, and they can even start in childhood. Men may also suffer from migraines but are presumably ashamed to see a doctor with such a banal complaint. Although, if they did, they would spare themselves - including those around them - a great deal of torment and suffering.

How can someone recognize that they have a migraine?

Migraine is a recurrent, seizure-like headache with characteristic symptoms and characteristic temporality - usually throbbing, spasmodic, very strong pain that makes daily activities impossible, and many sufferers take time off work because of this. Typical accompanying symptoms are nausea, possibly vomiting, and increased sensitivity to external stimuli. For example, a migraine patient is unable to tolerate strong lights, sounds and odors during an attack. Trying to do some physical activity intensifies the headache, so it is better to lie down, rest, and try to recover in a dark, quiet place. Migraines have a strong genetic background, mostly inherited from the mothers’ side. Migraine patients often fear that their complaint is caused by a neurological disease or tumor. Usually, it is possible to get a safe diagnosis by interviewing the patient, which is convincing in the sense that it is not a secondary or symptomatic headache caused by an organ disease.

If the patient may still be afraid, can the doctor help?

Yes, as we can perform a CT or MRI scan, which on the one hand confirms the diagnosis by excluding other causes, and on the other hand reassures the patient who thus more easily accepts that they have a genetically based disease that is associated with recurrent headaches. We can't cure a migraine, but we can treat it very well today.

How can you help migraine sufferers?

Nowadays, we can effectively treat migraine attacks with drugs, and we can also administer medication that reduces the frequency or duration of migraine attacks. The latter, continuous medication is usually recommended if at least 5-6 attacks regularly occur on a monthly basis. Migraine medications are not painkillers that can either be obtained without a prescription or borrowed from a neighbor because it worked for them. These are medicines made specifically for the disease and should only be prescribed by neurologists.

Please talk a little about the other group, called a secondary or symptomatic headache.

Although many people have headaches, fortunately only a minor proportion of complaints are caused by a more severe physical or nervous system disease, which can have more serious consequences without treatment or intervention.

What kind of symptoms alert you to the fact that you must see a doctor?

In adulthood, if a person has not had a headache in the past starts to suffer from them, if the nature and frequency of long-standing headaches changes, if the complaint occurs suddenly, under suspicious circumstances, or comes on with ominous accompanying symptoms, then in such cases it is definitely advisable to see a doctor as there may be background conditions that require specialist treatment and, in some cases, emergency care.

Can you give specific examples?

If someone has a sudden headache in the nape of the neck from one moment to the next, as if they have been beaten about the head, and this is accompanied by nausea, vomiting, possibly drowsiness, dullness, or confusion, then intracranial hemorrhage should be considered and the time factor to receive care may be decisive. If these symptoms occur during sexual intercourse, similar action is required. Another case is that if, for example, someone starts to have a headache with a high fever accompanied by epileptic seizures, this should also be taken seriously as it may be a sign of meningitis. I would mention here cancer patients who may develop distant metastases, such as in the brain. In a patient with a known cancer, if they are classified as otherwise cured but develop an unusual or previously unknown headache, this connection should be considered first. In each of the cases mentioned earlier, a headache as a symptom can be a sign of some serious illness and you should definitely see a doctor as this is the only chance for recovery.

However, it is important to mention that not only nervous system diseases can cause headaches. We know of a number of diseases in internal medicine, ophthalmology, otolaryngology, and even dermatology, where headaches can be the leading symptom.

Are there misconceptions about the cause of headaches?

We often hear that all kinds of severe headaches are called migraines. This is not necessarily true because migraines are not determined by the severity of the complaint but by the characteristic accompanying symptoms and temporality, which is the way they occur in terms of time.

Another very common misconception is that headaches are caused by narrowing of the cervical vessels of the neck, or cerebral atherosclerosis. This is completely untrue. This assumption may be due to the fact that if someone has atherosclerosis - a hardening or narrowing of the arteries - in their leg, their leg hurts, or if they have this in their coronary artery, they feel chest pressure. The brain is different as a brain blood supply disorder does not cause pain. It is absolutely important to see a specialist so that the patient gets appropriate care and treatment.