Migraines and headaches

Most cases of headache are mild and transient and can be treated with an analgesic. The explanation is usually fatigue and stress, but headaches are also seen with fever, dehydration and colds or are due to specific diseases such as migraines or cluster headaches.

In rarer cases, headaches can be a warning of a dangerous or serious medical condition such as a stroke or meningitis. It is therefore important that you do not ignore an unexplained headache or a headache that is getting worse.

In the following sections, the most common headache types will be described in alphabetical order.

  • Symptoms

    Cluster headache
    Cluster headache is a rare disease with symptoms characterized by severe, cutting or throbbing pain in or around one eye. The pain comes as repeated seizures lasting up to three hours in periods of 2 weeks to several months. It affects men three to six times as often as women. The age of onset is usually between 20 and 40 years, but may come later.

    The seizures usually come in pools (clusters) of one to eight seizures per day for four to twelve weeks. The pain is unilateral, and the duration of each seizure is usually between 15 minutes and three hours without treatment. The pain is severe and has a cutting or bursting character. Between the pools of seizures, there is usually no headache.

    Headaches are usually accompanied by at least one of the following additional symptoms: red eye, tearing, nasal congestion, runny nose, sweating on the forehead and face, small pupil and sagging of the eyelid on the same side as the pain. Shyness, nervousness and restlessness are also common symptoms during seizures.

    Symptoms of migraines are classic headache attacks that often begin vaguely, but then become one-sided, pulsating, sharp and powerful. Some people notice a vague feeling already one to two days before the attack itself. Many people experience nausea during the attack. About 20 percent experience visual disturbances and other strange experiences 5-60 minutes before the headache itself - this is called aura. After the seizure is over, it is common to have symptoms similar to the initial symptoms again. There are no tests that can determine if you have migraines or not. The diagnosis is usually made on the basis of the typical symptoms, especially the characteristic headache.

    In special situations it may be necessary to do some research to rule out that there are other and more serious conditions that cause the ailments. This can be a sample of the spinal fluid, blood tests or an X-ray examination called CT.

    Medication overuse headache, MOH

    If you use regular painkillers more than 15 days each month, or migraine medications more than 10 days each month, there is a risk of developing medication-induced headaches. If the original headache was a so-called tension headache, MOH will most often resemble the tension headache with pain such as a tight band over the forehead, temples, and perhaps the back of the head. In patients treated for migraines, one can get the same tightening pain, but often with migraine-like episodes as well. You may experience more frequent migraine attacks than before. In addition, medication-triggered headaches will often be accompanied by other ailments such as lethargy, nausea, restlessness, irritability, difficulty concentrating, impaired memory, depression and sleep disorders.

    Typical of MOH headaches is that the symptoms worsen if you stop taking the medicine. All painkillers, including over-the-counter medications, can cause headaches with long-term use. The danger is probably greatest when using medicines that are a combination of two painkillers, and extra large when the medicine contains addictive substances, such as Paralgin forte. The risk increases with increasing frequency of medication intake, and it is greatest with daily use.

    The diagnosis is made on the basis of the medical history. In collaboration with the doctor, you must map your use of painkillers - including over-the-counter preparations. When the use of painkillers has persisted for more than three months, and the headache continues, there is reason to suspect this diagnosis.

    Tension headache
    The headache is long-lasting (chronic) if it is present more than 15 days a month for at least three consecutive months. Often the episodes of pain are triggered by various forms of stress. The pain is described as a tight band over the forehead and around the head. The headache is of an oppressive or pressing nature, not pulsating. It is rarely present from the morning, but shows up and increases in strength during the day. Some people may experience some nausea, but vomiting is not seen with tension headaches. Some people may have a fear of sound or light, but it is far less common than with migraines. Dizziness is not uncommon. The headache will usually not worsen with physical activity. Ten percent of patients suffering from tension headaches also have migraines.

    Tension headaches make up more than 75 percent of all cases of headaches for which help is sought in general practice.

    It is believed that the headache is associated with increased tension in the head and neck muscles, but it is uncertain whether it is a cause or a consequence of the condition. Pain and tenderness in muscles and muscle attachments around the head, in the neck and back of the head occur, but not in everyone.

    The diagnosis is based primarily on the medical history and the description of the typical symptoms. An examination of mobility and function in the neck will distinguish the condition from the ailments that come from the cervical vertebrae themselves. Typical findings can be sore muscles and sore muscle attachments in the neck, but not everyone has it. In many people, a slight pressure over the muscle attachments in the neck causes the pain to flow forward in the forehead.

  • What can I do myself?

    Cluster headache
    Cluster headaches are treated with medicine, which is prescribed by a doctor. The goal of treatment is to relieve the pain during seizures, as well as to prevent new seizures. Medications can be used both for acute seizures and as preventive treatment. The most commonly used treatment during seizures is to give a so-called triptan (eg Imigran). If the seizure periods are frequent, or if the cluster headache becomes chronic, preventive treatment is appropriate. In such situations, medications other than those used for seizure treatment are used. Be aware that alcohol can trigger seizures.

    Many people experience that certain conditions can trigger migraine attacks. Such conditions are called triggers. The most important treatment for migraines is to avoid such triggers, which vary from person to person.

    It is not always easy to find out what you are reacting to, and it is recommended that you keep a so-called migraine diary. In this you write down the date and duration of each migraine attack, and what you did and ate in the hours before the headache occurred. This way you can find your personal triggers and then try to avoid them.

    Medication overuse headache, MOH
    The goal of treatment is to reduce the frequency and severity of headaches, and reduce the need to take medication. If possible, try to stop taking medication, which is the most important measure. There is reason to remember that during this period it can be extra useful to eat and sleep regularly, and trim and get fresh air. Some may benefit from a relaxation program, and from seeking out pleasurable activities.

    Tension headache

    The goal is to prevent and relieve the pain. You can learn different relaxation techniques yourself, make sure you stay physically active and make sure you get enough sleep. You should also avoid overuse of painkillers, as this in itself can cause headaches. In acute and short-term episodes of tension headache, the use of paracetamol or iboprofen is recommended, but not for more than a maximum of two weeks.

    Physical therapy, especially with training in relaxation techniques, can be helpful. Manipulation treatment of the neck is used a lot, but there is a lack of good documentation that it has an effect.

  • What can Eyr help with?
    • Eyr can assess possible headache type
    • Eyr can give advice on self-treatment and prescribe medication
    • Eyr can renew regular medications, except addictive medications
    • Eyr can refer to a physiotherapist
    • Eyr can refer to a specialist if necessary
    • Eyr can write a doctor's statement
    • Eyr can assess whether there is a need for an assessment at the emergency room

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Reference: Norwegian Medical Handbook, NEL. Edited and medically quality assured by Dr. Theresa Franck, specialist in general medicine.