Headache and migraine

Headache is the most common neurological problem presenting both to GPs and to neurologists. However, headache is just not one condition. Headache disorders are classified as primary, such as migraine, tension-headache and cluster headache, or secondary, due to an underlying brain condition such as tumor, bleeding, infection,  or inflammation of the arteries (vasculitis).  In addition, pain killer overuse for migraines can be responsible for chronic headache.

Primary headache is the most frequent cause of headache and can be distressing in young adults, interfering with their professional and family life. The therapeutic strategies for primary headache depend on the precise diagnosis of the type of headache, the frequency, the severity of the headache and the associated signs.

Therapeutic options include:

1- Drug treatment to relieve the headache includes anti sickness tablets, pain killers, anti-inflammatory drugs such as ibuprofen, opioids, oxygen, and triptans..

2- Drug treatment to prevent the headache includes antidepressants, betablockers, calcium channel antagonists, anticonvulsivants, lithium, melatonin, pizotifen

3-Referral to a physiotherapist specialised in pain management, a change in life style or psychotherapy can be more valuable than tablets in case of tension type headache.

4- Botulinum toxin injections, can be indicated in chronic headache with headache occurring more than 15 days a month. Botox injections repeated every 4 to 6 months can be an alternative treatment for patients who often feel that have tried everything and are discouraged.