Headache - Symptoms & Diagnosis

With regard to type, intensity, localization and time course, headaches can take on very individual forms. Nevertheless, typical symptoms of the individual forms of headache are known, which allow the doctor in many cases a causal assignment. In the following, the manifestations and treatment options of the most important types of headache will be discussed.

Primary headache

All variants of the primary headache have in common that despite intensive diagnostics can find no organic causes. The transitions between the individual types of headache are usually fluid; characteristically, however, they are strongly related to the mental and emotional state of the patients.

The vascular headache usually occurs periodically, and more rarely chronically. Its intensity varies, ranging from persistent head pressure to the sharp pain of changing localization. Possible trigger factors for vascular headache are:

  • emotional tension of a positive or negative nature
  • climatic changes
  • physical overloads
  • in women the period

There may be a genetic basis for vascular headache, which may begin as a child, as this type of headache can be found in individual families.

Migraine and tension headache

If the headache is predominantly unilateral and there are additional concomitant vegetative nervous system symptoms, such as nausea, vomiting and sweating, or additional neurological deficits in the early stages of the onset, suspected migraine is suspected.

The pain character of the tension headache ranges from the feeling of a "tire around the head" to stabbing or dull, one- or two-sided neck complaints. Responsible for this are in most cases tension in the muscles near the head, which usually occur in psychologically stressful or overburdening situations. In contrast to vascular headache, the maximum incidence of tension-type headache is in middle age. A family burden is unknown.

Conversion headache - psychosomatic headache

In the field of psychosomatic diseases falls the so-called conversion headache, which is similar in its symptoms of vascular or tension headache. As with other psychosomatic illnesses, it expresses a primarily psychic, usually unconscious conflict in an organic symptoms. In this case as a headache.

Neuralgia as a type of headache

Neuralgia is the term used to describe a specific type of violent, violent pain attacks, usually lasting only seconds, in the area of ​​spread of a cutaneous nerve. Most commonly, neuralgia occurs as trigeminal neuralgia in the area of ​​the trigeminal nerve, covering the brow region, the nasopharyngeal region, and the chin with its three branches.

Typically, neuralgia attacks can be triggered by mechanical stimulation in the appropriate area, for example by talking, chewing or shaving. Phases with frequently occurring pain attacks can alternate with symptom-poor phases. Neuralgia also occurs less frequently in the occipital area of ​​the glossopharyngeal nerve at the base of the tongue and in the posterior pharynx as well as in the occipital nerve supply area in the occiput.

Cluster Headache

A particular form of severe headache with localization in the temporal region, behind the eyes, in the upper jaw and in the forehead is referred to as Cluster Headache or Bing Horton Headache. Typically, this type of headache occurs in middle-aged men and manifests itself as attacks of onset pain, usually in the early morning, accompanied by unilateral reddening of the face, one-sided lacrimation, and nasal discharge.

The pain usually reaches its maximum after about 30 minutes and slowly fades over several hours. Increased incidence within 3 to 6 weeks often alternates with longer symptom-free phases.

5 facts about headaches - istockphoto, Eric_Nokhsorov

Symptomatic headache

Headaches in a brain tumor can take on a variety of manifestations. From sharply circumscribed and piercing to diffuse pressure in the whole head. Only in rare cases can be concluded from the headache localization on the localization of a brain tumor. Relative to tumor headache is the aggravation of discomfort due to changes of position or pressing, sometimes knocking of the bony skull in the region in question.

But local inflammation (abscesses), local tissue swelling (edema) or cerebral hemorrhage can increase the pressure inside the skull and cause headaches. Usually in such cases, the symptoms are dominated by additional neurological deficits such as after a stroke or general symptoms such as fever or neck stiffness.

Headache right down to the neck

Special attention is paid to the headache radiating from the neck in vascular malformations (aneurysms) of the brain, sometimes preceded by complete vascular rupture with life-threatening cerebral hemorrhage. Such subarachnoid haemorrhage is associated with acute onset, severe headache, sometimes neurological deficits and requires immediate inpatient monitoring and, if necessary, emergency treatment.

Headache in meningitis (meningitis) or brain inflammation (encephalitis), however, develop slowly over hours and have a mostly dull pain character. After trauma to the head, for example after a serious accident, 30 to 50 percent of cases have chronically recurring headaches that are similar in character to vascular or tension-type headaches.

Headache can also be a symptom of other illnesses, for example:

  • Diseases of the eyes (glaucoma, eye inflammation, eye tumors, malposition of the eyeballs, ametropia)
  • Diseases of the ears (middle ear inflammation, tympanic membrane)
  • Sinus diseases (sinusitis or tumors)
  • Diseases of the jaw and teeth (caries, root abscesses, TMJ pain)

Temporal headache and neck headache

Violent unilateral or bilateral tympanic headache is characteristic of temporal arteritis, an inflammation of the temporal blood vessel, which may emerge as a tender tendril in the temporal region. Mainly located in the neck headache, but can also radiate into the entire head, to raise the suspicion of a degenerative or rheumatic disease of the cervical spine.

The symptoms of this type are often position-dependent and especially in the morning before getting up the most violent, so that patients are sometimes torn out of sleep. The diagnosis is corroborated by evidence of muscular tension in the neck and the findings of a spinal disease in the radiograph.

Headaches in general conditions

Blood pressure crisis, severe kidney disease, proliferation of red blood cells (polycythemia) but also anemia or poisoning of various kinds are considered as triggers of headache. Diagnosing headache is relatively easy. Much more difficult is the cause research. With typical pain character and course, the association with one of the known primary causes of headache can sometimes be attributed solely to the description of the patient's discomfort.

In other cases, organic diseases of the head, ear, nose and throat region as well as diseases of the internal organs and the whole organism must be excluded. Headache as a symptom in itself knows no complications. These can occur at most in the context of the underlying diseases and are dealt with in the corresponding clinical pictures.

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