Headaches

Migraine

%20 of headaches are migraine headaches. Migraine that shows localization on one side of the head (75%) is a kind of headache, which is repetitive, paroxysmal, throbbing and can take hours and increases by head movements, may also be accompanied by nausea and vomiting. It is a genetic and dominantly inherited disease. It is 3 times more common in women than in men; it mostly begins at young and middle ages and declines at older ages.

It typically takes 4-72 hours and increases with physical exercise.  Depression, anxiety and panic disorders have been reported to be more common in migraine patients.  It is known that various factors trigger headache in persons sensitive to migraine.  The most familiar factors among these are specific foods and additives (wine, chocolate, caffeine, cheese), hunger or skipping meal, sleeping too much or lack of sleep, strong odours, barometric pressure changes, bright flashing lights, depression, hormonal changes, menstruation, medications and physical exercises.   Neurological symptoms called aura, which develops within minutes and takes less than 1 hour, are the precursor approximately in 15% of the migraine headaches.  Often, the aura is seen as a visual disorder that slowly radiates from the center of the visual field outwards.  The visual symptoms may both be in form of visual hallucinations that are in form of flashing lights and accepted as simple type and may be in form of blurred vision in which the visual field is affected.  Paresthesias are the second most common type of aura. The sensation of numbness and tingling, which begins in the fingers and radiates to arm and mostly affects the same side of the nose and around the mouth, may arise in the patient.  Besides these, speech disorders, dizziness and although rare, auditory and olfactory hallucinations may also be seen as aura symptoms.  Headache usually begins within 5-30 minutes following headache.

Symptoms of classic migraine are visual impairment, disorders of muscle strength and sensory and headaches that takes for a few minutes.  The duration of the attack may take several hours in classical migraine and several days in common migraine.  The headache can be accompanied by sensitivity to light and sound.  Symptoms seen in other parts of the body may include abdominal pain, diarrhoea.

Migraine treatment includes medical treatment as well as avoiding triggering agents.  However, if migraine attacks are more than three times a month and if the headache is severe enough to affect daily life and causes a neurological disorder, prophylactic medication should also be added to the treatment plan.

Cluster Headache

Rather than vascular pain, it is a neuropathic pain.  The exact cause is unknown.  The pain arises in form of severe seizures and ends approximately within 30 minutes.  The pain is seen around the eyes and temples, behind the ear and around the mandibular molar teeth.  The pain usually arises at night and awakens the patient.  It is the most severe headache known to humans, therefore it is also called "suicide headache".  It causes a compressive and pricking feeling.  Autonomic findings such as blood clot in the eye, tearing, nasal congestion, nasal drainage, facial sweating, eyelid drooping, pupil constriction and swelling of the eyelids appear on the same side of the head as the pain.  Unlike migraine patients, the patients prefer to go around, go outdoors and walking instead of lying in a dark room.  The painful (active) period varies from patient to patient.  It usually takes 2-3 months.  The silent period that is completely pain free ranges between 6 months and 1 year.  In the painful period, repetitive pain attacks occur almost every day sometimes several times. In 4% of cases, the pain arises on both sides.  It is more common in males and is not genetic.

There are many drug options in the treatment.  However, in cases, in which medical treatment is inadequate, surgical treatment options should be considered.