Disease Description (Causes and Symptoms)
- Definition summary: Headache is a symptom and is sometimes an independent disease (primary headache: migraine, tension-type headache, cluster headache, etc.), while in many cases it is a sign of another disease (secondary headache: cerebral hemorrhage, brain tumor, encephalitis·meningitis, etc.).
- Main causes and pathophysiology (brief):
- Primary: migraine (inflammatory signals involving the trigeminal nerve·vascular system — cortical spreading depolarization·trigeminovascular activation), tension-type headache (excessive tension in the head and neck muscles·changes in central sensory processing), cluster headache (sympathetic/parasympathetic imbalance, hypothalamic association).
- Secondary: infection (meningitis, encephalitis), hemorrhage (subarachnoid·subdural), tumors, metabolic·toxic causes, etc.
- Main symptoms:
- Pain characteristics: tenderness, a heavy feeling, throbbing pain, etc.
- When intracranial pressure increases: vomiting, severe headache, impaired consciousness.
- Associated symptoms: fever (suggestive of infection), visual disturbance, sensory·motor abnormalities (focal neurological deficits), changes in consciousness, history of concussion·trauma, etc.
- Warning signs (immediate evaluation required): “sudden, worst-ever headache (thunderclap headache),” new persistent worsening, fever·neck stiffness, focal neurological abnormalities, decreased consciousness, repeated vomiting, headache in a person taking anticoagulants, etc.
Treatment Methods
- General principles
- Primary headache: symptom relief (acute phase) + preventive treatment when necessary (for patients with frequent·severe headaches).
- Secondary headache: treatment of the underlying cause takes priority (e.g., meningitis → antibiotics/antivirals, hemorrhage → emergency neurosurgical treatment).
- Drug treatment (representative examples)
- General analgesics: acetaminophen, NSAIDs (ibuprofen, naproxen) — mild to moderate headache.
- Acute migraine treatment: triptans (such as sumatriptan), antiemetics (such as metoclopramide).
- Cluster headache: high-concentration oxygen (100% 7–15 L/min) alone or subcutaneous sumatriptan; verapamil, etc. for prevention.
- Preventive medications: beta-blockers such as propranolol·metoprolol, amitriptyline (prevention of tension-type headache·migraine), topiramate·valproic acid (migraine), calcium channel blockers (cluster headache), CGRP inhibitors (monoclonal antibodies), etc.
- Non-drug treatment and self-management
- Maintain regular sleep·meals, consume sufficient fluids, regulate caffeine intake, exercise regularly, and manage stress (relaxation therapy, cognitive behavioral therapy, biofeedback).
- For eye-related problems (when there are vision abnormalities), an ophthalmologic examination is recommended; an otolaryngology examination is recommended for sinus symptoms.
- Precautions and complications
- Medication-overuse headache (occurs with excessive use of analgesics·triptans) — risk increases when general analgesics are taken 15 or more days per month, or triptans/opioids/ergot drugs are taken more than 10 days per month.
- If an emergency situation (the warning signs above) occurs, visit the emergency room immediately.
- If left untreated for a long time, headaches may interfere with daily life and become chronic.
Checklist Before an Outpatient Visit (Items to Bring · Information to Provide to the Doctor)
- Items/information to prepare
- A list of currently taken medications (including over-the-counter medicines·herbal medicines), along with the dosage·frequency of use.
- Past medical history (cerebral hemorrhage·stroke·hypertension·anticoagulant use·cancer·immunosuppression, etc.).
- Whether there has been recent trauma and when it occurred.
- Symptom record: onset, duration, pain characteristics (throbbing/pressure-like feeling/lightning-like pain), pain intensity (0–10), aggravating/relieving factors, and associated symptoms (vomiting·fever·visual disturbance·weakness, etc.).
- Headache diary (date and time of occurrence·duration·triggers·response to medication) — recording for 2–4 weeks is recommended if possible.
- Results of previous tests (CT/MRI/blood tests/cerebrospinal fluid tests, etc.) and test reports.
- Examples of key items the doctor may ask about during the visit (the consultation may proceed more quickly if the patient prepares these in advance)
- When the pain began and its pattern (sudden onset/gradual worsening).
- Whether there is a history of headaches with the same characteristics.
- Impact on daily life (work·sleep disturbance, etc.).
- Family history (migraine, etc.).
Examples of General Questions to Ask the Doctor
- “What are the side effects of this medication (the prescribed analgesic/preventive medication)? Is it safe to take it long-term?”
- “Given my current symptoms, do I need emergency tests (CT/MRI/cerebrospinal fluid tests, etc.)?”
- “What is the prognosis? Is there a risk that this headache will become chronic (frequent)?”
- “What lifestyle changes must I make?”
- “How should I take the medication to avoid medication-overuse headache?”
Examples of Customized Questions by Disease
- “I recently developed an extremely severe headache that reached its peak in an instant. Do I need a CT scan or lumbar puncture?”
- “If I take analgesics several times a day, can my headache become worse? How can I determine whether I have medication-overuse headache?”