Headache

Get your head clear again

Nearly 75 per cent of the population goes to the doctor at some point in their life due to a headache. But there is also not a headache disorder behind every headacheonset. If the headaches occur more frequently or regularly or if they change in their intensity, character or frequency, you should visit your physician.

Our experienced neurologists can make a definite diagnosis of the type of your headache by using the latest diagnostics. At Schoen Clinic, we offer you a variety of treatments to clear your head again.

Causes & symptoms

What types of headaches are there?

A distinction is made between the following types of headache disorders:
  • Primary headache disorders
    Among others, these include tension headaches and migraines, which can also occur in combination. Tension headaches have a dull-oppressive or pulling character; A migraine is often pulsating and hemiplegic on the head. Tension headaches are usually not that intense, do not worsen during physical activity and do not cause nausea nor vomiting. Cluster headaches are also among the primary headache disorders.
  • Secondary headache disorders
    This includes a number of headache syndromes, which are caused by a certain trigger.
  • Other headache disorders
    This group includes different types of headaches, which are triggered by very special mechanisms. These include lightning-like pains in the area of individual brain or head nerves, but also so-called central pain, which sometimes occurs months or years after an injury to nerve tracts in the brain.

Headaches: Causes of pain

Different factors are involved in the development of primary headaches. There are some indications that the predisposition to primary headaches is congenital, even if it first manifests later. Migraines, for example, occur very frequently in families.

With secondary headaches, the cause lies within the brain or in the area of the head or neck. The most important triggers include:

  • Accident-induced injuries to the head or cervical spine
  • Vascular disorders in the area of the head or neck
  • Changes to the cranial fluid 
  • Tumours in the head and neck area
  • Medication or drugs 
  • Infections (meningitis)
  • Internal disorders (high blood pressure, thyroid, kidney, heart...)
  • Diseases of the eyes, ears, noise, teeth and jaw

However, it is not yet clear how a migraine attack comes about. During a migraine attack, however, there can be a temporary disrupted electric function of nerve cells in the brain, changes in blood circulation and a disruption of metabolic systems. There can be a variety of triggers for individual migraine attacks. These include hormonal fluctuations in women, changes in sleep / wake rhythm, stress and also relief after stress, alcohol or certain foods.

Symptoms: common signs of headaches

The leading symptom of headache disorders is of course the pain itself. In addition, the symptoms accompanying the pain are important building blocks in the diagnosis.

Possible symptoms of primary headache disorders

  • Tension headache: both sides, oppressive headache of mild to moderate intensity, rarely light or noise sensitivity
  • Migraine: one side, pulsating headache with light and noise sensitivity, nausea to vomiting, need to rest
  • Cluster headache: severe one-sided, strong to very severe, pulsating headache in the eye area; redness of the conjunctiva or lacrimation on the painful side; Runny nose or stuffed up nose on the painful side; Swelling of the eyelid on the painful side; Sweating on the painful side; One-sided pupil narrowing on the painful side; Physical restlessness
  • Trigeminal neuralgia (also: facial pain): severe unilateral, strong, sharp, superficial stabbing pain for seconds in the area of the forehead, the upper jaw or lower jaw, caused by chewing, drinking, cold or heat

Possible symptoms of secondary headache disorders

  • In the event of accident-induced injuries: Broken bones, lacerations
  • In the event of vascular disorders: Hemiplegic paralysis, speech disorders, dysphagia, double vision, tingling sensation on the arms and legs, loss of consciousness, epileptic seizures
  • When cranial fluid backs up: Fatigue, loss of drive, personality changes, loss of consciousness, epileptic seizures
  • For tumours: Hemiplegic paralysis, speech disorders, personality changes, confusion, memory disorders, loss of consciousness, epileptic seizures
  • For infections: Fever, drop in blood pressure, confusion, tiredness, loss of consciousness, epileptic seizures
  • For internal diseases: Tachycardia, erratic heartbeat, tremors, diarrhoea, weight loss, fatigue
  • For diseases of the eyes, ears, noise, teeth and jaw: Vision disorders, hearing disorders, tinnitus, bad breath, sensitivity to cold and heat

Migraine symptoms

The frequency of attacks may vary greatly: from just a few per year to several attacks per month. On average it is once or twice per month. Untreated, such attacks can last between four and 72h ours. The headaches are typically throbbing, usually hemiplegic, but can also affect the entire head. They often start in the neck area. The affected side in hemiplegic headaches may change from attack to attack or even within an attack. Physical activity usually enhances migraine symptoms. A so-called aura occurs in 10 to 15 per cent of all migraine patients before the actual headache attack, which can last for up to an hour. Visual disturbances, paraesthesia or even speech disorders and signs of paralysis may occur here. The most frequent form of aura are visual sensations. The appearance of light flashes or a jagged ring in the field of vision are typical. After the aura symptoms have subsided, the headache then sets in.

Diagnostics

Diagnosis: How we get your headaches on track

More than two-thirds of all headache disorders can be diagnosed by our experienced neurologists just by speaking with you extensively and undergoing a thorough physical examination.

Additional technical examinations are then always necessary if a secondary form of headache is suspected. However, we sometimes also conduct additional examinations in the event of primary headache syndromes – whenever the type of frequency of known headaches changes noticeably of if a migraine has set in at an unusual time. Even for those who are suffering from headaches for the first time, it may make sense too under go additional examinations in order to rule out similar syndromes with other causes.

Extensive conversation

We get to the bottom of your headaches in a conversation with you. Here we ask you about:  
  • the nature of your pain (for example: oppressive, throbbing/pulsating, piercing, tearing, electrifying)
  • the duration of your pain attack (seconds, minutes, hours, days)
  • the localisation of your pain (such as: whole head, hemiplegic, behind your eyes, upper jaw)
  • increasing or mitigating factors (such as: change of location, intake of substances, times of day, female cycle) 
  • the severity of pain between “0” (pain-free) and “10” (strongest imaginable pain)

Additional examinations in the event of headaches

An additional examination can also eliminate your worry of suffering from a serious illness, such as a brain tumour or a stroke. The results of computed tomography and magnetic resonance imaging techniques contribute to mental relief.

Computer tomography (CT)
CTs of the head provide tomograms of the brain, bones and blood vessels. The radiologist can use this technology, for example, to detect a circulatory disorder or cerebral haemorrhage. However, there are more precise procedures for the exact diagnosis of headaches.

Magnetic resonance imaging (MRI)
The MRT provides more detailed tomograms of the brain and the blood vessels. Generated with a strong magnetic field, they can make even the smallest changes visible, such as inflammation, small tumours or abnormal vascular aneurysms.

Cerebrospinal puncture
In some cases, it is necessary to remove fluid from the lumbar spine area. It can then be proven relatively quickly in the laboratory whether there is a cerebral haemorrhage or meningitis, for example. This examination is almost painless, is virtually harmless and only takes a few minutes.

Laboratory examinations
Sometimes several values can be determined from a simple blood draw, which show typical changes in the determined headache forms. Every patient suffering from headaches should be examined in a laboratory at least once. The blood count, inflammatory values, thyroid values and kidney values are the focus here.

Additional examinations for migraines

If the symptoms are typical, a migraine can be diagnosed solely based on the description of the attacks. In the case of atypical symptoms, on the other hand, we usually carry out additional examinations such as magnetic resonance imaging or cerebrospinal puncture to rule out other diseases. The first appearance of an attack after the age of 40 is another reason to clarify this, because migraines usually begin already during adolescence or young adulthood. The differentiation from the other primary headache disorders is also important for the treatment.