Headaches are divided into 2 main groups, Primary and Secondary;
Primary headaches are headaches that occur spontaneously, not related to any other pathology. They are divided into 4 separate categories;
a) Migraine (35%)
b) Tension-type headache 60%)
c) Cluster headache and other trigeminal autonomic Headaches (cephalalgias) occur due to parasympathetic causes in the face and brain.
d) Post-cough headache (lasts max. half an hour)
Headache after sports (weightlifter headache)
Post-sex headache (starting with sexual intercourse and also at orgasm) exacerbated)
Hypnic headache (It can wake the patient from sleep and last for 5 minutes – 48 hours) To name a hypnic headache, at least two of these symptoms must be present. Having more than 15 attacks per month, continuing after waking for at least 15 minutes, first appearing after the age of 50.
a ) MIGRAINE
According to the International Headache Society, there are 7 subgroups in the diagnosis and classification of migraine;
a.1) Rayic Migraine (Common Migraine) is migraine without aura, that is, there is a headache but visual impairment etc…. none
a.2) Classical Migraine is Migraine with Aura. Sometimes it can be just Aura (no headache), it is a mild non-migraine headache. This group includes “Familial hemiplegic migraine” and “sporadic hemiplegic migraine”. The patient experiences migraine and aura as well as motor unilateral paralysis. If a close relative has the same history, it is called “familial”, and if there is no such story, it is called “sporadic”.
In this group, it is necessary to mention the 3rd type of migraine, namely “basilar-type migraine”. In these patients, besides headache and aura, difficulty in speaking, dizziness, tinnitus (ringing in the ears) (like hearing a voice) complaints occur (brainstem symptoms) but no motor weakness.
a.3) Renital migraine is seen together with recurrent visual impairment, blurred vision in a certain field, temporary unilateral blindness, and headache. In this group of patients, the eye examination is completely normal in the periods between headache attacks.
Other causes of temporary sudden unilateral blindness (amaurosis fugax) in these patients, namely ”optic neuropathy” and ”carotid dissection” should definitely be excluded.
a.4 )Migraine with complications:
● Chronic migraine- if migraine headache lasts for at least 3 months for 15 days or more in 1 month, it is called chronic migraine.( A picture may occur after excessive use of migraine medication) Most of the time, episodes of migraine without aura (common migraine) can turn into chronic migraine.
●Status migrainosus- It is called migraine headache attack that lasts more than 72 hours. Headaches are severe. (same picture may occur after excessive use of migraine medication) This condition should be ruled out for diagnosis.
● One or more of the aura complaints (visual disturbance, nausea) persist for more than 1 week, but there are no signs of brain infarction, it appears rare.
● One or more of the aura complaints are seen together with brain infarction (Ischaemic brain infarction).
●Seizur is added 2 hours later during the aura of migraine. Migraine and epilepsy (epilepsy) are examples of paroxysmal disorders in the brain. The coexistence of these two conditions is called “migralepsy”.
a.5) In childhood, some periodic syndromes can often be a precursor of migraine. In the child, attacks of vomiting, attacks of abdominal pain (abdominal migraine) and attacks of dizziness.
Signs and complaints in migraine:
It differs in each patient. Migraine attack consists of these 4 phases, but not all patients complain of the same complaints;
1) Prodrome Phase- Occurs hours or days before the headache attack, being sleepy, craving for special food (eg chocolate), tension in the muscles especially in the neck, feeling of warmth in the ears, diarrhea or constipation, increased urination. Many patients can understand the imminence of a migraine attack from the appearance of these symptoms.
2) Aura Phase- This phase, which is observed in 20-30% of patients with migraine, progresses in 5-20 minutes and generally lasts less than 1 hour. Headache attack usually starts 1 hour after the end of the aura phase (sometimes it can start hours after the aura). ). The most common aura symptoms are visual disturbances (visual aura). For example, seeing white, black or colored lights (photopsia), blurred vision field etc…. The aura may also be somatosensory, which manifests itself as a pinprick (paresthesia) sensation in the hands, feet, and nose-mouth of the same side. Paresthesia (pins and needles) may spread to the arm and face (lips and tongue). Other symptoms of the aura phase, such as hallucinations in the sense of sound and smell (migrainous deliria- oliver sacks)
3) Pain Phases: Typical migraine headache, unilateral, throbbing moderate or severe, and usually worsened with activity These complaints may not be constant, the pain may start on both sides and then unilaterally or vice versa, the attacks may change places, the pain can last from 4 hours to 72 hours in adults and from 1 hour to 48 hours in children, the interval of attacks can be very variable (from a few moves throughout life). , up to a few moves per week) but usually 1-3 headache attacks per month. In the pain phase there is 90% nausea, but only 1/3 of vomiting occurs, being disturbed by light and sound is very common. There may be hardening of the veins in the temple and dizziness.
4) Postdrome Phase;
The phase after the headache is over. In this phase, the patient may feel tired and exhausted (hungover). Difficulty in recognition, gastrointestinal findings, mood changes occur. Some patients feel refreshed and happy during this period, while others are depressed and unhappy.
Factors Triggering Migraine:
Increases the likelihood of migraine onset in the first 48 hours;
Allergic reactions
Too much light, loud noise, special smells., Spiritual or physical stress
Changes in sleep patterns,
Smoking or exposure to smoke,
Skipping meals
Alcohol
Changes in men’s cycles,
Birth control pills (ocp)
Menopause transition period.
Foods: Chocolate, avocado, broad beans, cheese, smoked foods, soy sauce and red wine, beer, sherry, monosodium, glutamate, nitrate, nitrite and all foods with tyramine (preserves, cheese, etc.)
Pathophysiology of Migraine;
Although everything is not fully clear, “Migraine” is a disease in which both genetics and environmental factors play a role. It is probably caused by a change in the Trigeminal nerve, which is a major pain pathway. Brain biochemical (serotonin) imbalance causes disruption of pain regulation in the nervous system. Serotonin level drops in migraine, which causes some neuropeptides to be secreted from the trigeminal system and consequently lowers the pain threshold.
b) Tension type headache (TTH):
Different names for this type of headache are contraction headache, psychogenic headache, stress headache. The reason may be completely primary or secondary to another disease. The most common headache is the headache (60%). Intermittent (episodic) intermittent, frequent headache (more than 1 episode per month is included in the frequent category), and finally, chronic tension headache (Chronic tension headache is a serious disease that reduces the quality of life).
