A headache is not always just a headache
Almost everyone experiences headaches at some point in their life. In most cases, they are harmless and resolve on their own. However, if the symptoms occur frequently, are very severe or are accompanied by additional symptoms, a more thorough assessment is worthwhile. Two forms in particular are widespread in the population: migraine and tension-type headache. Both differ significantly in their causes, course and treatment.
A careful diagnosis is the foundation of any successful headache therapy. Once you know the type of headache you have, you can work together with your doctor to develop a suitable treatment plan.
What distinguishes migraine from tension-type headache?
Tension-type headache: dull and pressing
Tension-type headache is the most common form of headache. Typical features include:
- a dull, pressing pain on both sides of the head
- a sensation like a "tight helmet" or a band around the head
- mild to moderate intensity
- usually no worsening with physical activity
- rarely accompanied by nausea
Tension-type headaches may occur episodically (occasionally) or chronically (on more than 15 days per month). Common triggers include stress, muscular tension in the neck and shoulder area, one-sided postures in front of a screen, or lack of sleep.
Migraine: episodic and intense
Migraine is a distinct neurological condition. It presents with:
- usually one-sided, pulsating or throbbing headache
- moderate to very severe intensity
- worsening with physical activity
- accompanying symptoms such as nausea, vomiting, sensitivity to light and sound
- a duration of 4 to 72 hours per attack
In about one third of those affected, a so-called aura also occurs – for example visual disturbances, tingling or speech problems, which can precede the pain phase. Migraine has a hereditary component and affects women more often than men.
When does a pain medicine assessment make sense?
Not every headache requires a medical examination. However, in the following situations a professional assessment is advisable:
- headaches occur more often than on 3–4 days per month
- the symptoms are increasing in frequency or intensity
- painkillers are being taken regularly or over a longer period
- everyday life, work or social life is noticeably impaired
- accompanying symptoms such as visual disturbances, dizziness or neurological deficits occur
- the pain first appears after the age of 40
- headaches occur suddenly and very severely (so-called "thunderclap headache")
Frequent use of painkillers in particular can be problematic: if pain medication is taken on more than ten days per month, there is a risk of medication-overuse headache. In this case, the medication exacerbates the symptoms in the long term rather than relieving them.
Diagnostics: the path to the right therapy
A thorough diagnostic work-up forms the basis of any headache treatment. This includes:
- a detailed medical interview (history-taking)
- keeping a headache diary over several weeks
- a physical and neurological examination
- if necessary, imaging procedures such as MRI or CT to rule out other causes
The headache diary is a valuable tool: it helps to document frequency, duration, intensity, possible triggers and the effect of medications.
Modern approaches in migraine treatment
Pain therapy for migraine has developed considerably in recent years. A fundamental distinction is made between acute treatment and prevention (prophylaxis).
Acute treatment
For the treatment of acute migraine attacks, the following may be used, among others:
- non-steroidal anti-inflammatory drugs
- specific migraine medications from the group of triptans
- agents against nausea
The choice of medication is decided individually with the treating physician.
Prophylaxis and complementary procedures
In the case of frequent or severe migraine attacks, preventive therapy may be useful. This includes:
- certain medications from the group of beta-blockers, anticonvulsants or antidepressants
- modern antibody therapies that specifically target the messenger substance CGRP
- treatment with botulinum toxin type A for chronic migraine, provided the professional criteria are met
- non-medicinal procedures such as relaxation techniques, biofeedback and endurance sports
Lifestyle adjustments can also have a favourable influence on the symptoms: regular sleep, sufficient fluid intake, regular meals and a mindful approach to stress.
Therapy for tension-type headache
In episodic tension-type headache, simple measures are often sufficient, such as fresh air, relaxation or occasionally a painkiller. In a chronic course, the following approaches come to the fore:
- physiotherapy and targeted muscle training
- relaxation methods such as progressive muscle relaxation
- behavioural strategies for stress management
- in certain cases, preventive medication
An individually tailored pain therapy can contribute to relief and noticeably improve quality of life.
What those affected can do themselves
Alongside medical treatment, there are several measures that can be helpful in everyday life:
- regular exercise, ideally endurance sports
- sufficient sleep with consistent times
- a balanced diet and adequate fluid intake
- conscious breaks at the workplace, especially during screen work
- targeted relaxation to reduce stress
- keeping a headache diary to identify individual triggers
Conclusion
Migraine and tension-type headache are different conditions, each requiring its own treatment strategy. A pain medicine assessment always makes sense when symptoms occur frequently, increase in intensity or impair everyday life. A modern headache therapy combines medicinal, complementary and lifestyle-based approaches – with the aim of reducing the frequency of attacks and improving quality of life.
Anyone who suffers from persistent headaches should not postpone seeking medical advice for too long. The earlier the correct diagnosis is made, the better suitable treatment options can be used.
This article does not replace medical advice.