Practice headache diagnosis and treatment

2021-03-25 12:00 AM

Due to stress: working under stress for too long, staying too long in a noisy environment, or experiencing constant anxiety-causing problems

A condition that is understood in a very broad sense, from feeling a bit tense, uncomfortable in the head to the severe pain that causes the patient to roll his head around. In most cases, headaches are usually the body's response to an adverse cause, and very rarely a sign of a serious medical condition. Up to 80% of headaches are caused by stress, while only about 4 out of 100,000 headaches are caused by serious illness.

About 8-12% of adults have migraines.


The most common cause

Due to experiencing stress: working stressed for too long, staying too long in a noisy environment, or experiencing problems that cause anxiety, frustration or stress repeatedly, or after a long trip fatigue.

Pathological causes are varied, the most common being infections of the upper respiratory tract, especially sinusitis.

Migraine headache.


Head injury.

Osteoarthritis in the neck.

Some rare causes

Haemorrhage under the arachnoid membrane.

High blood pressure.

Inflammation of the temporal arteries.

Aneurysm in the brain and increased intracranial pressure.



The diagnosis and exclusion of malignancies are made based on the serious accompanying symptoms.

If there are no accompanying serious symptoms, the primary diagnosis is to follow up and promptly detect bad symptoms as soon as they appear.

Tension headache is determined by understanding the environment, the repetition of the headache under certain conditions, the severity of the pain, the feeling of tension all over the head, and the feeling of constipation. tightness or sensitivity to individual locations on the scalp, usually not accompanied by nausea.

Migraines often have characteristic symptoms

Pain on one side of the head, severe pain, dullness, pulsing tingling in the scalp, and pain that worsens during work.

Nausea or vomiting. The patient may be afraid of sound, afraid of light.

The pain can last 4 - 72 hours and repeats many times.

Visual disturbances appear in about 20% of migraine cases.

Serious signs to watch out for

Sudden headache.

Headaches are first and especially severe.

Progressive headache, worse and worse.

Onset of headache after age 50.

Headaches have changed in level of consciousness.

There was a head injury in recent times.

Unusual physical signs, especially focal nerves.

There are symptoms of meningitis.

Pain-sensitive temporal arteries.

Not responding to treatment.

In the event of any of the above symptoms or when the diagnosis is doubtful or uncertain, the patient should be referred immediately to a specialist.


Tension headaches require rest, take painkillers if needed, and reassure the patient of the non-serious nature of the disease.

Migraines are often triggered by certain triggers, such as fatigue, stress, drinking coffee or alcohol, when thirsty or hungry.

Teaching patients to identify the triggers and elimination is the best way to prevent migraine attacks.

Analgesics are only of limited effect in the initial treatment. It is possible to use paracetamol, codeine and dihydrocodeine.

Sometimes antiemetics such as metoclopramide are also needed. It is also possible to use combined pain reliever and antiemetic drugs, such as Migraleve.

If the above drugs do not work, use ergotamine such as Gynergen, Cornutamin or Gynophore, at a dose of 1-2 mg each time, after half an hour use if the pain has not subsided. The drug is used sparingly, the maximum dose in 24 hours should not exceed 6 mg and the maximum dose in a week should not exceed 12 mg.

Prophylactic treatment in patients with frequent pain can take propranolol 40 mg, 2-3 times daily, or pizotifen 1.5 to 3 mg every evening.