Consultation on Headaches

The Headache Consultation was created with the object of diagnosing in a targeted and personalized way, patients with this neurological pathology, considered the most frequent of all ailments, providing a new differentiated treatment for these patients.

Migraine is the technical name for headache. It consists of pain or discomfort in the region of the head including the face. Headaches vary widely in their different characteristics: location, type of pain, intensity, frequency, duration and associated symptoms. For this reason more than 300 different types are considered by the International Headache Society.

WHAT IS THE CAUSE OF A MIGRAINE?

There are several structures in the head - nerves, muscles and blood vessels - that can hurt during a headache; but the cerebral parenchyma itself does not hurt.

Headaches may be the result of a structural change (nerves, muscles or blood vessels) or the consequence of a specific pathology (head trauma, sinusitis, hypertension, sleep apnea, among others). However, most headaches do not have a direct cause, such as a tension-type headache and a migraine headache, where the reason is attributed to stress and muscle tension. Although the symptoms may be varied, tension-type headaches and migraine headaches have the following symptoms in common: the onset is slow, pain on both sides of the head; pain is described as a tightness (like a tight helmet); pain may be felt at the back of the head or neck; intensity is mild to moderate, usually not associated with nausea, vomiting or sensitivity to light (photophobia).

HOW DOES ONE KNOW THE DIFFERENCE BETWEEN A HEADACHE AND A MIGRAINE?

TENSION HEADACHES

These are the most common. Stress and muscular tension are the main factors that lead to this type of headache.  

Although headaches may present varied symptoms, the following aspects are common to all of them:

-Slow onset;

-The pain is felt on both sides of the head;

- The pain is described as tightness (like a tight helmet);  

- Pain may be felt only at the back of the head or neck;  

- Intensity is mild to moderate, normally not described as severe;

- Usually not associated with nausea, vomiting or sensitivity to light (photophobia).

MIGRAINE

Migraine is a type of pain that, in addition to the headache, also presents additional symptoms: nausea, and/or vomiting, and/or photophobia/phonophobia, with severe and incapacitating intensity. The symptoms can last up to 72 hours. Migraines may have several phases, however not all patients experience them in the same sequence:  prodrome (mood/ behavior change), aura (visual, sensory or speech alterations), migraine itself (intense pain, usually throbbing, on one or both sides of the head and may be associated with nausea, vomiting, photophobia and/or phonophobia) and resolution phase.

It is important to emphasize that patients can often have more than one type of associated headache. It is common for the same patient to complain of migraine and tension-type headaches, for example.

Related Examinations

The diagnosis of the type of headache is essentially made by the medical history and physical / neurological examination and, if necessary, complementary diagnostic exams (in case there is a secondary cause). However, the medical history is determinant in reaching a diagnosis and also in identifying the type of headache. For this reason, the patient must describe all the symptoms and characteristics of his headaches as clearly as possible: at what time of the day do they occur, where is the location of the pain, type of pain, duration, associated symptoms, triggering factors or previous history of head trauma.

However, whenever a secondary cause is suspected, tests related to what is suspected should be requested: blood tests, CT Scan of the sinuses, Cranial CT Scan or MRI, among others.

The specialized headache consultation will permit:

>> Accuracy in reaching a diagnosis of Headaches and/or Migraines.

>> Availability of specific and targeted treatment for a particular headache, such as an occipital nerve block, botulinum toxin application, or the most recent treatment for migraine prophylaxis: the monthly human monoclonal antibody injector of the CGRP receptor.

Specific treatment for headache is based on the patient's age, medical history, type of headache(s), frequency and severity of the headache, patient tolerance for specific medications, procedures, and therapies.

More general measures adopted to prevent headache may be recommended; Avoiding triggers (triggering factors): certain foods (alcohol, chocolate, cured cheese, increased or decreased consumption of caffeine, nitrates, monosodium glutamate present in some Asian food), sleep deprivation and fasting.

This service is available in both the Portuguese and English languages. 

Useful Links

Sociedade Portuguesa de Cefaleias - www.cefaleias-spc.com

Sociedade Internacional de Cefaleias - www.ihs-headache.org