Why does my head hurt?

There are more than 200 types of headaches, which are divided into three large groups: primary headaches, when the pain is not associated with any injury to the nervous system; secondary headaches, when due to injuries to the nervous system or other diseases; and neuralgia, when the pain is located in the territory of a nerve. “Migraine and tension-type headache are the most common types of primary headache. The best known neuralgia is trigeminal neuralgia, which is caused by irritation of the trigeminal nerve that deals with facial sensitivity. And, as an example, among the secondary headaches we could highlight the headache that occurs as a result of the person suffering from a cerebral hemorrhage or sinusitis”, explains Dr. Pablo Irimia, coordinator of the Headache Study Group of the Spanish Society of Neurology, on the occasion of National Headache Day, which is commemorated this Tuesday. Headache is the most common form of pain in humans. According to data from the Spanish Society of Neurology (SEN), up to 89% of the male population and 99% of the female population claim to suffer or have suffered from headaches at some point in their lives. Since most headaches are benign, when it is an occasional headache, it is not necessary to go to the doctor, but it is necessary when it is recurrent and incapacitating for daily life or when it may be a symptom that indicates to a medical emergency. “When a person has a headache that starts suddenly, is an explosive pain, of great intensity, produces great disability, or starts for the first time when the patient is over 50 years old, they should be evaluated by a doctor. , because it can be a secondary headache, which in turn is a medical emergency”, says Dr. Pablo Irimia. “In any case, in more than 90% of cases, the headache is due to a primary headache, that is, it is a benign pain that is not associated with any type of brain injury. But if someone needs to take painkillers very frequently, even if the pain is well controlled, or on the contrary the pain limits their quality of life, it is also time to go to the doctor. Although primary headaches are benign, this does not mean that they cannot be disabling. For many patients, headache crises have a great impact on their daily functioning and can seriously affect various physical, emotional and/or social aspects. Something that becomes even more evident when the headache becomes chronic. A primary headache is chronic when patients experience a headache more than 15 days a month and, according to data from the SEN, more than 4% of the Spanish population, that is, more than 2 million people, suffer from some type of chronic primary headache “The excessive consumption of analgesics, suffering from depression or anxiety and obesity are the factors that most frequently influence the chronification of a primary headache. On the other hand, migraine is the type of primary headache that most tends to become chronic and, for this reason, about 50% of Spanish patients who suffer from a chronic headache suffer from migraine,” says Dr. Pablo Irimia. There are many types of primary headaches that are diagnosed based on aspects such as the characteristics of the pain, its location and the presence or absence of other associated symptoms. But all of them are characterized by the fact that, with a correct diagnosis and treatment, without falling into self-medication, it is possible to control the disease and, above all, prevent it from becoming chronic. Up to 46% of the Spanish population have some type of active headache. However, according to data from the SEN, more than 40% of patients who suffer from headache with some recurrence are still undiagnosed and around 50% of patients with headache self-medicate with non-prescription analgesics. “The first step in a correct approach to any primary headache is to identify the possible triggers. Aspects such as stress, changes in diet, in the time spent sleeping, among many others, are aspects that can have a great influence on the appearance of a headache crisis. For this reason, it is important that patients try to identify and avoid these factors and that they lead an orderly and regular life”, highlights Dr. Pablo Irimia. “But when this is not enough or triggers are difficult to avoid, it is time to correctly diagnose the disease to start its treatment.” There are many pharmacological and non-pharmacological treatments for primary headaches. Some serve as preventive treatments, preventing headache crises from occurring, and others are symptomatic, helping to mitigate pain when it occurs. But not all available treatments are valid for all types of headache, nor are they effective in all patients. “Something that also characterizes primary headaches is that they have great inter-individual variability. Even in patients with the same type of headache, there can be huge differences in possible triggers, in the frequency and intensity of pain, and in response to treatments. For this reason, when it is not a sporadic headache, it is important to insist on the need to go to the doctor to obtain a diagnosis and appropriate treatment for the type of headache and the characteristics of each patient. Only in this way will it be possible to better control the disease and prevent it from becoming chronic”, concludes Dr. Pablo Irimia.