There are effective therapies for headaches. Careful clarification and a precise diagnosis are crucial. PD Dr. med. Heiko Pohl, headache specialist, provides information on frequently asked questions.
Mr. Pohl, headaches are one of the most common conditions. Who suffers the most?
Headaches can occur at any age, even children can be affected. The overall distribution between women and men is roughly the same, but there are gender-specific differences in the individual types of headache. Women are more often affected by tension-type headaches and migraines, and men more often by cluster headaches.
Medicine recognizes more than 200 types of headache. How do you differentiate between them?
Headaches can be a disease in their own right, in which case we speak of primary headaches. The three mentioned (tension-type headache, migraine and cluster headache) are the most common in this group. However, headaches can also occur in connection with other illnesses. We call this group secondary headaches. For example, an infection, flu or a cold can trigger a headache, as can high blood pressure, poor eyesight, medication or injuries.
The various forms of headache also differ in terms of how and where they are perceived, i.e. whether they are on one or both sides or in the entire head, whether there is a pulling, boring, stinging or pulsating sensation, as well as possible accompanying symptoms. For example, migraines are often accompanied by nausea and vomiting, while cluster headaches are accompanied by red and watery eyes and restlessness.
When should you have a headache checked by a doctor?
Sudden severe headaches are an alarm signal and an emergency and must be examined immediately (see box). Tension-type headaches are usually harmless and generally go away on their own. If headaches occur frequently or for the first time, an initial check-up should be carried out by your family doctor. This could also be due to a migraine, cluster headache or another cause.
Headache as an emergency
If a severe headache occurs suddenly, this may be a sign of a cerebral hemorrhage and must be investigated in an emergency. Medical advice must also be sought immediately if the headache is accompanied by loss of consciousness, speech disorders or signs of paralysis. If a headache slowly but steadily increases in intensity over a period of days, this may indicate inflammation or a mass. This type of headache should also be treated immediately. An emergency also exists if a headache is accompanied by severe general symptoms. A headache accompanied by a fever of over 39.5 degrees can be a sign of meningitis.
What is examined for the clarification?
The most important thing is to have a detailed discussion with the patient to find out how the pain feels, where it is felt, when it occurs and for how long. Your own experiences in dealing with the pain can also provide important information, such as whether you need to lie down during the pain or whether you tend to walk around restlessly and whether you need to switch off the light. It is helpful to keep a headache diary in which you record this information over a period of time. The assessment also includes a physical examination in which the muscles, eye movements, hearing and vision or sense of balance are tested. For most patients, this already provides a clear picture.
What happens if the diagnosis is unclear?
Magnetic resonance imaging can provide information about changes in the brain. Sometimes you look for changes in the blood. However, such examinations are not always necessary.
How are headaches treated?
Once the cause has been identified, headaches can be treated effectively and specifically. In the case of tension-type headaches, changes in behavior are often enough to get rid of the trigger and thus the headache, such as more exercise and relaxation, changing sleeping habits or adjusting your diet. If visual impairment is behind the symptoms, this must be treated; in other patients, the blood pressure medication must be adjusted. There are effective medications and other therapies for primary headaches such as migraines, which can also be cycle-related, as well as for cluster headaches.
Headache consultation
In our headache consultation at the University Hospital Zurich, we work closely with a team of specialists from various fields. This is ideal for quickly helping patients with a more complex clinical picture.
