Headaches are classified as primary and secondary. A primary headache is not a symptom, but an independent disease. Secondary headache is a disease symptom: hypertension, brain cancer, etc. Hovhannes Manvelyan, M.D. Professor, the head of the Neurological Department in “Astghik” MC, discussed the primary headache types with the NEWS.am Medicine reporter.
As to the doctor, pain itself and particularly headache is one of the most important signal systems of our body. Usually, any inflammation or tissue injury is accompanied with pain and this pain leads us to visit a doctor. But pain may also be a disease itself and the primary headache is its obvious instance.
“Pain memory may lead to stable pain syndrome. After reaching to a certain stage the pain passes. That is, the pain does not exist physiologically. But a central sensitization occurs and the pain memory is retained in brain. Any irritation, e.g. reported from an injured part is perceived as pain. This especially refers to neuropathic pains, “says the doctor and warns that a pain should not be ignored in any case.
“We can differentiate between acute and chronic pains. Acute pain is mainly a syndrome. You’ve got an injury and you have a pain. A chronic pain is a syndrome that requires a corresponding evaluation and treatment. Every time we consider the chronic pain, we need to define the potential dangerous states, which may threat the patient’s life quality and the life itself,” says Hovhannes Manvelyan.
According to the neurologist’s clarification, primary headaches are classified into the following types: tension headaches, migraine, cluster and nervous (neuralgian) headaches.
About 80% of primary headaches are tension headaches. Actually, everyone has a tension headache, often episodic, but some people greatly suffer from it. If the pain is chronic, it is accompanied with emotional aggravation.And the patient knows that if he/she gets nervous and tense, the headache will begin. The disease name originated from its symptoms: the scalp is getting tensed, skull muscles are contracted and they feel like an unpleasant pressure. “Every patient describes the disease with typical characteristic features: a feeling of helmet, compression bandage, chill through the head, pressure. All patients describe the same state, though a bit differently. If these patients are doneelectroneurography, we’ll see the muscle panic contractions,” says the doctor.
The method for treating a tension headache is miorelaxation. Nonsteroidal anti-inflammatory drugs are less effective in that case. “Miorelaxation, physiotherapy, healthy life, regulation of weekdays, normal sleep, physical trainings, pleasure, less alcohol may also be helpful,” says the doctor. He also notes that usually patients with chronic pain syndrome have vitamin D deficiency and for this reason patients with chronic tension headaches are prescribed vitamin D.
As the doctor states, people call any headache a migraine. Sometimes doctors also confuse the types of primary headaches and their treatment methods are different. Hence, the correct diagnosis is extremely important. Migraine has clear symptoms: hemicrania continua (a unilateral headache), nausea and vomiting. “If these symptoms are missing, it may hardly be a migraine. A combination of tension headaches, migraine and other components is also possible,” says the doctor.
Migraine occurs from the contraction of blood vessels. “Usually brain vessels have similar diameter in order to release a certain amount of blood. During the migraine attack the vessel diameter changes. Blood starts to swirl in the vessel which opening is in some parts wide and in some parts narrow. For this reason, the patients have optical illusions. For example, they may see golden threads, spots or fortification buildings: images are different. This can arise from blood supply aggravation in nape sector,” explains Hovhannes Manvelyan.
As to the doctor, after the optical illusions the headache begins which gradually gets more extensive. Those who have never felt this pain are not able to understand how unbearable it is. “The migraine attack may last for a few days and even the vomiting may not relieve. During the migraine attack the patient completely withdraws from independent and public life,” says the doctor. Migraine treatment is basically prophylactic, that is, it can prevent the migraine attack but may not help during the attack. According to Hovhannes Manvelyan, there is a group of medications – beta-blockers, the prophylactic acceptance of which contribute to the decrease of migraine attack frequency. They simply should be taken on time and according to the doctor’s prescription. Migraine forms the 10% of primary headaches.
They are also called alarm clock headaches because the patient wakes up at night from the headache like the alarm clock. The pain is located in round the temples, orbits, considerably tainted in emotions and appears in clusters. Along with this, vegetative irregularities are noticeable: the nose is filled, the eyes swell. Migraine attacks can be provoked by histamine, alcohol and, as a rule, they are seasonal. The pain is so severe that the patient may commit a suicide.
“All medications are ineffective for a cluster headache treatment but oxygen has a positive influence,” says Hovhannes Manvelyan. If the patient has woken up from the severe pain in midnight, he/she can simply open the window or go to the balcony to breathe fresh air. Oxygen pillows are also effective. A 10% lidocaine nasal spray helps for the cluster pain. Hence, if lidocaine is helpful, the pain is a cluster headache.
“This is the so-called trigeminal neuralgia. It is necessary to know that nerve pains should have a momentary character, the pain lasts for a few seconds like any painful nervous pathology. It may repeat in a few seconds, anyhow the acute and unbearable pain will be fulminant,” explain Hovhannes Manvelyan. The doctor says that any type of headache should be examined and only the doctor can say whether it is a primary or a secondary headache. He calls not to ignore headaches, abuse the pain reliefmedications, especially when they are not helpful.