Diagnosis And Therapy Of Headaches

2023 Author: Wallace Forman | [email protected]. Last modified: 2023-08-25 11:04

Headache: Diagnosis & Therapy

A detailed doctor-patient discussion and a thorough medical history are necessary for the diagnosis. Keeping a headache diary can provide important information for diagnosis and therapy.

In any case, a physical examination is also essential.

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How is the diagnosis made?
How can you prevent headaches?
How is headache treated?
Whom can I ask?
How are the costs going to be covered?

How is the diagnosis made?

When collecting the medical history, the following is asked, among other things:

Where does it hurt?
Since when did the headache exist?
How does the headache feel?
Are there any other complaints?
Have you had episodes with similar symptoms in the past?
Are medications being taken?
Does the family have frequent headaches?

A physical and neurological examination is always required to clarify headaches. If necessary, further clarifications (e.g. by means of CT or MRT, sonography) are necessary in order to rule out other diseases. In addition, laboratory tests, X-ray procedures to visualize blood vessels or the examination of the nerve fluid (cerebrospinal fluid) are used if necessary. The different types of headache each require specific therapeutic measures. For more information, see Migraines: Diagnosis & Therapy.

How can you prevent headaches?

If there are primary headaches without an underlying disease, an attempt can be made to “expose” possible triggers with the help of a headache diary. In this way, possible triggering factors can be avoided. The use of painkillers should also be documented, as these in turn can trigger headaches.

For some people it also helps to do relaxation exercises or exercise regularly. For information on preventing migraine attacks, see Migraines: Diagnosis & Therapy.

How is headache treated?

Treatment for a headache depends on the type of headache. Medicines and other measures (such as relaxation training) are used.

Migraine: Therapy

The treatment measures for migraines can be found under Migraines: Diagnosis & Therapy.

"Tension headache": therapy

The therapy of choice for tension-type headaches are pain relievers with the active ingredients acetylsalicylic acid, metamizole, paracetamol, ibupufen and naproxen. It should be ensured that only one active ingredient is contained in the tablet except for the combination of acetylsalicylic acid, paracetamol and caffeine in a combination product. For chronic tension-type headaches, antidepressants (preferably amitriptyline) are also used to support the mental defense against pain.

For acute pain, pain medication should not be given for more than ten days a month to avoid the development of pain medication-related headaches. In addition to the measures mentioned, muscle relaxation training (PMR), EMG-based biofeedback, physical therapy and psychotherapeutic measures (especially in the field of behavioral therapy) can also provide support. A cold compress, careful application of peppermint oil, and a walk in the fresh air can also help.

Cluster headache: therapy

The acute therapy of cluster headaches is mainly medicated using triptans (vasoconstricting drugs) - mostly sumatriptan or zolmitriptan - and by inhaling pure oxygen. The triptans are injected directly under the skin or sprayed into the nose by the patient. Cortisone can be used as a short-term prophylaxis for prevention. The heart medication verapamil or lithium, for example, are also used to reduce the frequency of attacks. However, due to the possible side effects of these drugs, this prophylaxis should always be accompanied by a doctor. If none of these measures lead to an improvement in the headache, nerve blocks or surgical procedures can provide relief in individual cases.

Hemicrania / SUNCT Syndrome: Therapy

Indomethacin - combined with gastric protection - has proven its worth in both paroxysmal or continuous hemicrania and SUNCT syndrome. Long-term therapy is often necessary. The dose can be reduced after improvement and increased when the headache recurs.

New daily headache: therapy

Scientifically proven therapeutic options are still the subject of research. The therapy is currently oriented towards those of migraines or headaches of the tension type - depending on which clinical picture the symptoms are similar.

Headache from overuse of pain relievers and migraine drugs: Therapy

The treatment of headache caused by overuse of drugs (Medication Overuse Headache / MOH) takes place in stages. It is important to clarify the connection between long-term use of painkillers for headaches and chronic headaches. The use of medication in acute situations should be drastically reduced. As a rule, medication is withdrawn after detailed information. Another step is medication to prevent headaches with topiramate, onabotulinum toxin A or amitriptyline (for tension-type headaches). For more information on migraine prophylaxis, see Migraines: Diagnosis & Therapy.

If these measures prove to be insufficient or appropriate, a medication break is taken, withdrawal or controlled medication intake is carried out. Depending on the severity of the symptoms, these treatment options can be outpatient, in a day clinic or inpatient. If the drug-induced headache results from the excessive use of opioids, withdrawal must always be carried out on an inpatient basis.

The therapy measures usually last several months. Follow-up care is also useful.

Note Excessive use of pain medication can lead to pain medication-induced headache as well as addiction and kidney failure or liver damage. Therefore, a doctor should always be consulted in order to avoid these complications.

Whom can I ask?

If you suffer from a headache, do not hesitate to consult a general practitioner or neurologist. It is advisable not to wait too long to see the doctor so that the cause of it is identified and the headache does not become chronic. Even if you consume a lot of painkillers, you should seek advice on this. Psychotherapists and clinical psychologists can also be included in the treatment.

The Austrian Headache Society and the German Migraine and Headache Society also provide information on their websites on the subject of headaches and migraines (including a search for specialized outpatient clinics / headache centers, headache diaries and calendars as well as other, sometimes multilingual, downloads on special topics, etc.).

In any case, you should immediately seek medical help if you have the following symptoms:

new daily headaches,
existing headaches change in intensity or frequency,
Fever and severe headache.

The following symptoms represent medical emergencies in which the ambulance must be called at 144:

sudden extreme headaches that get worse within minutes,
Headache and stiff neck and high fever,
Headaches that are accompanied by paralysis, changes in character or sensory disturbances,
Headache followed by impaired consciousness and epileptic seizures.

How are the costs going to be covered?

The e-card is your personal key to the benefits of the statutory health insurance. All necessary and appropriate diagnostic and therapeutic measures are taken over by your responsible social insurance agency. A deductible or contribution to costs may apply for certain services. You can obtain detailed information from your social security agency. Further information can also be found at: