According to data from the Brazilian Headache Society, 95% of people experience a headache at least once in their lifetime. Of this group, 70% of women and 50% of men suffer from it at least once a month. Additionally, 13 million Brazilians face headaches 15 or more days per month, which characterizes chronic headache—a condition that can be disabling, preventing individuals from carrying out their daily activities.

These numbers explain why headache is one of the main complaints that lead people to the emergency room and why many resort to self-medicating with painkillers or go from doctor to doctor across various specialties before reaching a neurologist.

“The first step is to distinguish primary headaches, which are the disease itself, from secondary headaches, which are symptoms of other conditions, including serious illnesses such as tumors, stroke, and meningitis,” says Dr. Gisele Sampaio, neurologist at the Albert Einstein Israeli Hospital. “That’s why it’s important to have emergency physicians trained to identify the potential causes of headaches. At Einstein, we have a neurologist on-site full-time, and suspected cases of secondary vascular headaches, such as subarachnoid hemorrhage, are always evaluated immediately. But not all emergency units have this specialist available,” notes Dr. Rodrigo Thomaz, also a neurologist at Einstein.

The most common primary headaches are tension-type and migraine. “The first is a more diffuse pain across the entire skull. The second is usually a pulsating pain on one side of the head, generally more intense, sometimes accompanied by symptoms such as nausea, vomiting, photophobia, and phonophobia,” explains Dr. Rodrigo. In some patients, migraines are preceded by an “aura” (symptoms that occur before the pain), which can be visual, motor, or sensory.

Contrary to popular belief, migraines are not associated with vascular or eye problems, but rather with an imbalance of neurotransmitters—substances that facilitate communication between neurons. “It’s likely that a person is born with a genetic predisposition. Family history is very common in migraine cases,” says Dr. Gisele.

The diagnosis of headache is clinical. Imaging tests are only requested when there is suspicion that the pain may be a symptom of another disease, i.e., a secondary headache. “Migraines, for example, are more common in young people. When we see a patient outside this age group having a first episode, the concern is that it may not be a migraine. That’s when tests like MRI, CT scan, and cerebrospinal fluid analysis are important to rule out other causes—not to confirm migraine,” says Dr. Gisele.

Treatment

In milder and occasional cases, common painkillers usually solve the problem. However, the easy access to these medications and the habit of self-medication can lead to effects opposite to what patients seek. “Constant use of painkillers is a risk: overuse of these drugs is one of the main causes of chronic headache,” warns Dr. Rodrigo.

During attacks, doctors often prescribe, in addition to painkillers, anti-inflammatory drugs and, in the specific case of migraines, triptans. For women who experience headaches associated with the premenstrual phase, specific medications can also help. However, for patients who have more than three episodes per month, the approach is preventive, aiming to avoid the onset of pain. In these cases, antidepressants, anticonvulsants, antihypertensives, and antivertigo medications are administered at lower doses than their primary indications. Although there are studies on specific preventive migraine medications, they are still in the experimental phase.

There are also simpler preventive measures. One is to identify—and avoid—triggers such as certain foods and drinks (cheese, wine, fatty foods, etc.). A healthy diet, avoiding smoking, physical activity, and stress-reducing practices like relaxation, yoga, and meditation are also always good measures for a healthy life.

By the Einstein Editorial Board