Headache

Headache is one of the most common complaints in neurology clinics and the most frequently reported type of pain to family doctors, pediatricians, and general practitioners.

Headaches—medically referred to as cephalalgia—can be classified into:

• primary headaches: These are characterized by the absence of structural abnormalities in the brain and are mostly represented by migraines and tension-type headaches
• secondary headaches: These include those associated with head trauma, neoplasms (tumors), vascular diseases (related to arteries and veins), medications, infections, metabolic disorders, disorders of the neck and face, and cranial neuralgias

Prevalence

Migraine is the most significant type of headache in Brazil. A Brazilian epidemiological study published by Dr. Mario Peres’s group at the Albert Einstein Teaching and Research Institute shows that the prevalence of migraine is 15.2% in the general population. It affects more women, individuals with higher educational levels, and those who do not engage in physical activity. About 92% of patients do not receive specialized treatment from a neurologist. The prevalence of tension-type headache was 13% in the general population, occurring more frequently in men and individuals with higher educational levels. Chronic daily headache accounted for 6.9% of headache cases in the Brazilian population and was more prevalent among women, individuals with high household income, the unemployed, and those who do not exercise regularly.

Symptoms

Migraine is a debilitating chronic condition that presents as headache along with a variety of associated symptoms and signs, occurring recurrently. The headache typically begins gradually and lasts from four to 72 hours in adults, and from one to 72 hours in children. It is characterized by a pulsating or throbbing quality, often unilateral, with moderate to severe intensity, and is accompanied by sensitivity to light and sound. Nausea occurs in about 90% of individuals, while vomiting is reported in approximately one-third of cases. The diagnosis is based on the criteria established by the International Headache Society in 1988 and revised in 2004 and 2006, as outlined in the International Classification of Headache Disorders (ICHD).

Migraine can be classified as either episodic or chronic, depending on the frequency of attacks. Chronic migraine is defined as headache occurring on more than 15 days per month. It is also a common condition, with a prevalence ranging from 2% to 3% in the general population, and accounting for up to 60% of consultations in specialized headache centers. Although less frequent than episodic migraine, chronic migraine has a greater individual and socioeconomic impact, with higher levels of disability.

Comorbidities

Migraine is associated with several conditions, such as fibromyalgia, depression, anxiety, and sleep disorders.

Treatment

The treatment of headaches begins with an accurate diagnosis, identifying both primary and secondary causes. Once a primary headache is diagnosed, patients benefit from a thorough explanation of their condition. Many patients with recurrent headaches worry about secondary conditions that could be triggering their pain—such as brain tumors or aneurysms—and these concerns should be addressed. Patients should be educated about their condition and encouraged to take an active role in their treatment by properly maintaining a headache diary. This helps track the frequency, intensity, and duration of the pain, as well as associated symptoms like nausea and vomiting. The diary can also help identify potential triggers. Once the treatment program begins, the diary can be used to assess the effectiveness of both acute and preventive therapies.

The headache treatment plan should follow these steps:

• educate and encourage the patient
• prevent attacks by avoiding triggering factors (hormonal changes, dietary factors, environmental changes, sensory stimuli, and stress)
• use non-pharmacological treatments such as relaxation techniques, biofeedback, and lifestyle adjustments (adequate sleep, regular physical activity, and smoking cessation)
• acute phase treatment: relieve symptoms and prevent pain progression
• preventive therapy to reduce the frequency, intensity, and duration of pain
• use alternative therapies when appropriate
• periodic reassessment and reconsideration of the treatment plan

By Einstein Editorial Board