GENERAL INFORMATION ABOUT HEADACHES
What is migraine?
Migraine is characterized by headaches and attacks. In some patients, attacks occur 1-2 times a year; in others it can be seen several times in a month. Pain is usually severe. This may be accompanied by nausea, sound and light discomfort.
If your headache is accompanied by nausea, if you are disturbed by sound and light, if the pain prevents you from doing your daily work, you probably have migraine. However, the diagnosis of migraine may sometimes require a long and complex process.
What Causes Migraine?
Migraine does not mean there is an abnormality inside the head. The family may have inherited from their elders.
Who is Migraine?
Migraine occurs in 1 out of every 6-7 adults. It is 3 times more common in women than in men. It usually starts in childhood and adolescence. It is not a rare or fearful disease.
How Many Types of Migraine Are There?
There are various types of migraine. Migraine without aura is the most common type. Only 3 to 4 of migraine sufferers have this type of migraine. Aura without migraine is seen in 9 out of 10 patients with migraine with aura. If migraine attacks bothers the person, treatment is required.
What are the signs of migraine?
Between attacks, people are completely healthy. Approximately half of migraineurs can anticipate the future of the attack. Before the attack; nervousness, depressed mood and fatigue. In contrast, some people find themselves unusually energetic before the attack. Some may experience a difficult eating sensation.
If the person has migraine attacks with aura, “aura” follows the first stage. The aura usually lasts 10-30 minutes and often causes visual complaints. Bright or flashing lights or colored zigzag lines emitting towards the center of the visual field appear.
Rarely, numbness and tingling may occur from the fingers to the arms and subsequently spread to the face and tongue on the same side. Difficulty in speaking or not being able to find the right words while speaking may also be part of the aura. For most patients, the headache phase is the most troublesome; from several hours to several days. Pain, classically felt in the eyes and temples, throbbing, can be unilateral or bilateral.
When Does Migraine Attack Begin?
Some people are more prone to migraine attacks than others. If a person's migraine threshold is high, it is more difficult to develop a migraine attack. The risk of developing a migraine attack is greater if the migraine threshold is low.
The importance of migraine triggers emerges here. In those with a low migraine threshold, a single trigger migraine attack can be initiated. In those with a high migraine threshold, several triggering factors need to be combined. Fatigue (the need for sleep and rest), fear and anxiety, stress (physical or mental) lowers the migraine threshold and makes it easier for triggers to initiate a migraine attack.
What are triggers?
Migraine triggers vary from person to person, and may even vary from attack to attack in the same person.
Diet: Some foods, skip meals or meal delay, not drinking enough water
Sleep: Changes in sleep patterns, less or more sleep
Physical: Intense exercise or journey
Environmental factors: Bright and flashing lights, sharp odors, meteorological changes
Psychology: Emotional factors (sadness, anger, depression, etc.)
Hormonal changes in women: menstrual periods, birth control pills, hormone therapy
may trigger migraine.
Which treatment should be applied?
The right medicine can stop the migraine attack when taken at the right time. If there is nausea, it is useful to add anti-nausea medication to the treatment. Prevention of nausea will enable more effective absorption of the drug taken.
The medication used by one migraine patient may not be good for another. Pharmacists or other migraine patients may recommend certain medications. If these medications are not beneficial to the person or if higher doses are needed for the effect, a specialist should be consulted.
Take the medicine early!
Migraine patients should always have the medicine that is good for them. The drug should be taken as early as possible when the attack begins. Early medication is more effective. During migraine attacks, stomach movements are slowed down, absorption is reduced, and therefore oral medications take longer to flow into the blood than usual.
Avoid Taking Pain Relief Too Frequently!
For headaches, there may be drawbacks to using painkillers 2 or 3 days a week. After a while, tolerance develops in the body and painkillers become the source of pain. After this stage, it becomes more difficult to treat the headache.
If the painkillers don't work ...
Atak Preventive treatment orsa is an option if the attacks are frequent and severe and cannot be controlled by painkillers. Drugs used in prophylactic treatment are taken daily and their mechanism of action is completely different from painkillers. It acts by raising one's migraine threshold.
Almost all preventive drugs were originally developed for different diseases. Therefore, migraine patients can be prescribed blood pressure lowering, epilepsy medication or antidepressant.
The effects of medications used for migraine prophylaxis begin after an average of 3 weeks (after practically using 1 box). First, the side effects of the drug are apparent, the therapeutic effect occurs later. Therefore, the patient should not discontinue the drug at the beginning of the treatment by saying “It did not feel good for me”. Drugs will not be useful unless used regularly.
What can the patient do for treatment?
Regular exercise and fitness will benefit the treatment. It is important to avoid the factors that reduce the migraine threshold and the triggers of migraine. Therefore, all risk factors should be recognized. While it may be possible to avoid and avoid some triggers, some may not be able to avoid them.
Keep Daily!
Keeping a headache diary would be beneficial. Diary; can be used to identify triggers, monitor the course of treatment and regulate treatment
If you are pregnant…
Many drugs used in the attack and prophylactic treatment of migraine are not suitable for pregnant women. If a pregnant woman is uncomfortable with migraine attacks, she should consult a specialist.
Do You Need Examinations?
Headache characteristics, physical and neurological examination are sufficient for the diagnosis of migraine. No tests are needed to confirm the diagnosis. If the doctor is not sure about the diagnosis, he or she will ask for the necessary tests to distinguish between headaches.
Can Migraine Be Treated?
There is no known cure for migraine. However, with advancing age, attacks become more rare. However, in order to control migraine attacks, patients should also take an active role in the treatment.
Migraine and Obesity
Migraine and obesity are two major health problems. Both significantly reduce the quality of life To date, many scientific studies have investigated the relationship between headache and obesity. In these studies, the relationship between obesity, episodic headache and chronic daily headache was examined in general and migraine was specifically emphasized. Patients with obesity and episodic migraine had a greater risk of developing chronic daily headache than non-obese episodic migraine patients. Following this, many studies have been conducted on the subject. The common finding of all these studies is that both general obesity (known as the Body Mass Index) and abdominal obesity (around the waist, life-like fat) increase the headaches, especially in young adults. General and abdominal obesity in women increased the incidence of migraine or severe headaches by 40%; in men, it has been shown that general obesity increases this frequency by 40% and abdominal obesity increases by 30%. In addition, it was found that the incidence of headache increased proportionally with increasing body mass index. In contrast to these findings, no association between obesity and migraine prevalence has been identified in older adults, such as menopausal women.
What are the common mechanisms between migraine and obesity?
The details of the relationship between episodic headache and chronic daily headache and obesity are not fully known. However, some mechanisms are likely to overlap with each other. One of them may be the hypothalamus; because it has a role in regulating appetite and becomes active during migraine attacks. Hypothalamic brain chemicals such as aton seratonin ”and“ orexin oyn play a role in both nutrition and migraine and chronic daily headaches. In addition, adiponectin and leptin are hormones produced mostly by fat cells and have receptors in the brain. They have a role in inflammation (germ-free inflammation, also claimed to be the origin of migraine). It is also thought to play a role in migraine and chronic daily headache.
What Recommendations Can Migrainees Have?
Information to date has shown that weight loss and exercise reduce the frequency of migraine. In particular, studies have shown that aerobic exercise reduces the frequency of migraine attacks in recent years. Therefore, considering all these data; those with episodic migraine or chronic daily headache should avoid gaining weight. Relatedly, considering the options that would not cause weight gain in preventive treatment; if necessary, the migraine patient should lose weight.
Migraine and Exercise
Although there is some evidence that exercise triggers migraine, moderate aerobic exercise has a significant impact on migraine.
Migraine and General Health
The positive effect of exercise on general health is known. Regular physical activity; hypertension, diabetes, depression and obesity. It also plays a role in reducing stress, lowering blood cholesterol, improving sleep quality and creating a sense of well-being.
Attention!
Severe exercise can trigger migraine attacks. If this excludes the person from exercising, he or she is deprived of the beneficial effects of exercise on general health and migraine.
Useful Effects of Exercise on Migraine
Recent studies have shown that mild exercise reduces the frequency and severity of migraine attacks and may be useful in the preventive treatment of migraine. Exercise shows a change in the level of body chemicals. Exercise stimulates the release of endorphins known as natural painkillers and enkephalins known as natural antidepressants in the body. Therefore, entering a regular exercise program will reduce the amount of medication used and support if preventive treatment is taken.
How Exercise Should Be?
Non-strenuous, regular aerobic exercise is most useful for migraine. Therefore, in order to be particularly regular, one should choose the most appropriate physical activity for him or her. These exercises:
Jogging
Swimming
Dance
Bicycle
Can be brisk walking.
When starting the exercise program, one should avoid challenging or combat-based exercises until he / she feels fit. Exercise should be moderate for at least 3 days 30 minutes per week. A period of at least 6 weeks must be allowed to see its effect.
Sleep and Ligament Pain
Main points:
Every night should be 7-8 hours.
Regular and adequate sleep reduces your headaches.
Both sleep more or less cause headaches.
Waking up from sleep with headache is an indication of a possible sleep disorder.
Increases the risk of insomnia, depression and anxiety. Headache, sleep and emotional state should be evaluated as a whole and the doctor should be treated according to this combination.
Snoring can cause headaches. It may also be a sign of sleep apnea. Treating apnea reduces or alters the headache frequency.
The time to fall asleep, the time of waking up, the duration and quality of sleep should be noted together with migraine attacks. In this way, it may be possible to recognize insomnia and triggers related to sleep.
Patients with migraine are at great risk for sleep disorders. This risk is 2 to 8 times higher than in the general population. More than half of the patients attending headache clinics have chronic sleep problems. As the frequency and severity of headaches increase, so does sleep disorders. Regular and relaxing sleep reduces headaches.
About half of migraine attacks occur between 04:00 and 09:00 in the morning. Frequent waking at night with headaches at night or at night can mean that sleep triggers a headache. This pain may be in the form of migraine or tension headache. The important point to consider is the timing of the headache, ie its relationship with sleep. Waking up in the morning with a headache requires the patient to be evaluated for sleep disorders.
Obstructive (obstructive) sleep apnea and insomnia are the most common sleep disorders leading to headache. Other common causes are restless leg syndrome, excessive daytime sleepiness and tooth grinding. Sleep disorders and sleepwalking, also called narcolepsy, are other causes of headache.
Snoring and Sleep Apnea
Snoring is a risk factor for chronic daily headache. Snoring is the first sign of serious respiratory illness. Not every snoring has sleep apnea. Snoring is a result of sleep apnea. Other signs of sleep apnea include significant pauses in breathing, waking up, night urination, sleep sweats, and daytime sleepiness. It is associated with sleep apnea, hypertension, heart disease and stroke. Those who wake up with a headache should tell their doctor that they snore. Sleep test is required for diagnosis. The headache of a significant proportion of patients with sleep apnea will be significantly reduced or disappeared after treatment.
insomnia
It is the most common sleep problem in headache patients. Insomnia is characterized by difficulty falling asleep and sustaining, early morning and tired waking up. Total night sleep time is usually less than 6 hours. Insomnia disrupts daily functions; fatigue, weakness of concentration and attention and loss of motivation. Insomnia is also the cause of irritability, anxiety, or depressive mood. Sleep diary is very important in the diagnosis of insomnia. Sleep time, waking time, sleep time and sleep quality should be noted for at least two weeks. By keeping the sleep and headache diary together, it is possible to clarify the relationship between sleep and headache.
Headache patients with insomnia often have anxiety or depression. Combined with sleep and mood disorders, headache disrupts daily functions and reduces quality of life. Addressing sleep and mood disorders is a critical point in the treatment of headache. Behavioral therapy or antidepressants may be useful. Drug selection should be made according to the patient's medical condition. Some antidepressants may be beneficial for sleep. The preferred treatment for insomnia is behavioral sleep therapy. Some sleep specialists and psychologists may offer more intensive treatments, such as cognitive therapy, relaxation and regulation of sleep behavior.
Biological Relationship Between Headache-Sleep-Emotion
Sleep, headache and mood are controlled by common areas of the brain. At the same time, common chemical agents play a role in the regulation. Sleep disturbance therefore poses a risk for both headache and mood. Poor sleep lowers the pain threshold. This makes the patient more psychologically and physically vulnerable. On the other hand, good sleep reduces pain and affects emotional state positively.
Sleep-Related Headache Triggers
Inadequate sleep, excessive sleep and sudden changes in sleep patterns are common triggers for migraine and tension headache. The ideal sleep time for a migraine should be 7-8 hours. Sleep less than six hours and longer than 8.5 hours has negative effects on pain. It is ideal for patients with migraine to have regular sleep times and to sleep for a certain period of time without getting more or less. Adolescents and young adults need more sleep.
Healthy Sleeping
Regular and restful sleep has positive effects on headache. Healthy sleep habits prevent insomnia and headaches:
Sleep and waking hours should be regular.
Ideal sleep time for adults is 7-8 hours, may be longer for younger
Caffeine, nicotine and alcohol should be avoided.
It should be a dark, quiet and suitable sleeping place.
Activities to keep the brain awake (television, internet, books, etc.) should be avoided.
Before sleep, you should engage in calming mental activities.
Regular sleep and other healthy sleeping habits should be continued for at least 4 weeks to see the effect on headache. Combined sleep and headache diary will help the person to keep.
Migraine and Women
The relationship between female hormones and headache mechanisms is quite complex. All standard hormone tests are within normal limits, even if hormones are identified as a definite factor triggering headaches.
There is no difference in hormone levels between hormonal factors and women triggered by headaches and women not triggered by headaches. The problem is probably related to the response of the central nervous system to normal hormonal fluctuations.
Puberty is the period in which girls begin periodic bleeding and monthly cycles of hormones occur. From this point on, the hormonal effects begin to affect the headaches for the first time. It is known that most women with migraine experience their first attacks after menstruation.
The prevalence of migraine is similar in boys and girls before puberty; however, after this period, this ratio differs and the ratio between men and women increases to 3. However, the frequency and severity of migraine decreases with age and menopause. Many women notice the relationship between headaches and menstruation. During the menstrual period, headaches typically become more frequent and more severe. As a result, it is more difficult to combat such migraine attacks. In this case, medications can be used to control the symptoms of migraine, as well as options to prevent menstrual cycle can be considered.
In particular, drugs sold for menstrual migraine are not available; however, some drugs are useful in most patients. The choice of drug is the most appropriate way to do it in relation to other symptoms encountered during the period and usually requires consultation with a doctor.
What is Menstrual Migraine?
Menstrual migraine is more common in the first 3 days and 2 days before the menstrual period. Most women have migraine attacks outside the menstrual period, while women with pure menstrual migraine experience pain only during the menstrual period.
Compared with other migraine attacks, menstrual attacks are more severe, longer and recurrent attacks the next day. Therefore, they are more difficult to treat than migraine attacks other than menstruation.
Who is seen?
About 50% of women become aware of the connection between migraine and its periods. This is often noticed in the late 30s or 40s. Women who experience other problems in their periods may not realize that migraine is the cause of their headache. Migraine during this period can also be missed by doctors.
What Causes Menstrual Migraine?
It is thought that a decrease in estrogen level at the beginning of menstrual cycle triggers migraine attacks. In addition, migraine attacks and pain may occur in the first days of women's periods.
What is the Treatment of Menstrual Migraine?
Most women do not use a different treatment for menstrual migraine attacks; treatment outside the period is sufficient.
Patients can detect the relationship between migraine attacks and periods by keeping a headache diary. In this way, when the periods approach, they can be protected from the attack by staying as far away from the triggers as possible.
The drug should be taken as early as possible. If the pain starts on the same day or the next day, the same treatment can be applied again. There are several treatment methods for menstrual migraine. Some drugs and hormonal therapy (estrogen band, contraception, etc.) are options.
Is Migraine Harmful for Baby?
Compared to pregnant women without migraine, there is no evidence that migraine with or without aura may increase the risk of miscarriage, stillbirth or congenital disorders.
What can be used for treatment?
The drugs have the greatest effect on the developing baby in the first month of pregnancy, usually in the period before the woman learns that she is pregnant. Although many drugs used by pregnant women rarely show harmful effects, it is not easy to advise the pregnant woman about what to take in her attacks. Most evidence of reliability is coincidental; Because of the ethical limitations, few drugs could be tested during pregnancy and lactation. As a result, drugs should only be used when their potential benefits outweigh the possible risks.
Non-Drug Therapy
Many pregnant women, especially those who know the possibility of migraine recovery during pregnancy, adopt non-medication methods. When symptoms of early pregnancy, such as nausea, are severe, they can trigger migraine by preventing food and fluid intake, leading to lower blood sugar and dehydration. These problems can be solved by measures such as frequent and little food, consuming plenty of fluids. Other reliable preventive measures include biofeedback, massage and relaxation techniques.
Headache Hygiene
Some foods, activities, medications, or stress can trigger or aggravate headaches. The following list lists the changes that can be made about life tarsi. With these changes, the frequency of headaches can be significantly reduced.
Regular sleep
You should wake up every day at certain times. Too much on weekends and very little sleep on weekdays. Most adults require about 6 to 8 hours of sleep at night.
Regular Meal
A drop in blood sugar can trigger a headache. Meals containing protein, fruit, vegetables and carbohydrates should be consumed three times a day at regular intervals. Too much sugar causes the blood sugar to rise rapidly, causing it to drop again quickly; as a result, it can trigger headache.
Reasonable Routine Exercise
Adequate exercise done 3 to 5 times a week will help reduce stress and maintain physical fitness. Excessive or regular exercise may trigger headaches.
Consume plenty of liquid
A normal adult should drink plenty of water during the day. Dehydration can cause headaches.
Limit Caffeine, Alcohol and Drug Intake
Caffeine is a stimulant and caffeine withdrawal can cause headaches. Alcohol can be a triggering factor for headaches.
Reduce Stress
Stress can lead to an increase in headache. Relaxation and coping with stress can reduce headaches.
Nerve Blockage and Headache
Main Points:
Nerve blockage consists of giving the active substance to the nerve periphery.
Nerve blockage for headache is performed on the occipital nerves behind the head.
It requires expertise to predict which patients will respond to nerve blockade.
Local anesthetics and, more rarely, steroids (cortisone) are used for injection.
Nerve blockages are non-hazardous procedures, but side effects may occur.
The Place of Injections in Headache Treatment
Purpose of nerve blockade; nerve, muscle, ligament (the joints in various joints, organs of the body), bone and skin to reduce the number of signals. To understand the place of nerve blockade in headache, it is necessary to have knowledge about acute and preventive treatment. Acute treatment is used for the treatment of only one attack. The aim is to relieve the current headache. There is no effect for the next attack. Frequent use of acute attack treatment leads to an increase in headaches.
Nerve blockages can be used to relieve acute headache. However, sometimes the effect can go beyond just preventing an attack and continue for longer. In other words, injection is not a simple treatment of acute attacks. While some patients do not benefit from the injection, the effect lasts days or weeks in most patients. In order to use nerve block as a preventive treatment, injections should be repeated every 4-6 weeks. However, this is not a preferred route for a significant number of patients.
When duration of action and patient preferences are considered; nerve blockade does not fall into the acute treatment or preventive treatment class, usually used as transitional therapy. In other words, they serve as preventive treatment until the effect of the preventive treatment applied.
Occipital Nerve Blockage as the Most Common Method Used
The most common nerve block used for headache is “occipital nerve blockade”. The occipital bone forms the back of the head. The occipital nerve originates from the upper cervical vertebrae and gives the sensation of the back of the head. The site of injection may vary from person to person. As a general rule, the site of injection is the occipital bone border with the neck.
The nerves in the head area are close to the skin and any nerve in the head can be blocked. For example, the supraorbital nerve provides sensation to the forehead and upper part of the head. Where the nerve comes out of the skull is just above the eyes. The injection site for the supraorbital nerve is usually on the forehead, on the eyebrows.
It may be difficult to know who will benefit from the blockage
Occipital nerve blockade is not effective for all types of headache. It is generally applied under the following conditions:
In cluster headache, occipital nerve blockade has been shown to be effective when combined with local anesthetics and steroids.
Cervicogenic headache is a unilateral headache triggered by head movements and compression of the occipital nerve. The cause may be head or neck trauma. Additional supportive findings include limitation of neck movements and sensory disorders behind the head. Occipital nerve blockade has been shown to be beneficial in cervicogenic headaches. However, responding to this type of injection does not mean that the diagnosis is cervicogenic headache.
Unilateral or bilateral injection of chronic migraine attacks has been reported to be beneficial. There is no clear evidence of the effect of occipital nerve blockade on migraine; however, it is more likely to be useful if pressure on the occipital nerve causes pain.
Lumbar puncture (taking fluid from the waist, spinal anesthesia at birth, etc.) is likely to occur after headache. It is especially noticeable when the patient stands up, decreases or disappears at bedtime. Although not routinely administered, occipital nerve blockade has been shown to be beneficial in this type of headache.
Drug overuse headache is another form of application of occipital nerve blockade. In particular, it can be used in the treatment of headache when all painkillers taken by the patient are discontinued for the purpose of clearing the drug from the body.
Occipital neuralgia (short-term pain in the back of the head, lightning flashes, severe pain such as knife sinking) is another type of pain using blockade.
In headaches that cannot be fully typed, if there is tenderness in the sensory nerves of the head, it can be used as a treatment method.
If headache is triggered by applying pressure to a certain nerve, blockage of these nerves may still be a solution for treatment.
If there is allodynia in the first place (where light contact is perceived as pain), blockage may be attempted.
It can be used for neck pain or spasm of the neck muscles.
When should injection be done?
If the patient is diagnosed with cluster headache, cervicojen headache, occipital neuralgia, or has tenderness behind the head, nerve blockage may be considered. If the person has chronic migraine and at least one of the occipital nerves is sensitive, blockage may be considered.
Botulinum Toxin and Migraine
Botulinum toxin has strong effects on the nervous system. Toxin is used in the treatment of certain diseases in which muscles are overactive by loosening the muscles at certain doses.
Can It Be Used For Migraine?
Although it is not known how botulinum toxin reduces the frequency of headache, it is thought to act by blocking pain signals to the brain. The number of injections for headache is usually 31-39. Botulinum toxin; forehead, temples, nape, neck muscles are given into. Injections may be repeated every 12 weeks. The clinical effect is usually 2-6 months.
How Effective is it?
Botulinum toxin has no effect on episodic migraine (less than 15 headaches per month). Botulinum toxin has been shown to be beneficial in patients with headache for at least 15 days per month and more than half of these 15 days have migraine characteristics.
Which side effects can there be?
Side effects are rare. Neck pain in 6-9% and muscle weakness in 5-6% of patients receiving botilinum toxin have been reported. Other side effects include falling in the eyelid, muscle pain and muscle hardening. These spontaneously regress within a few weeks. Rarely, pain and bleeding occur at the injection site. More rarely, difficulty in swallowing may occur.
How long can it take to understand the impact?
It may take several weeks to notice the improvement. The effect usually lasts several months. If the effect is observed to be weakened, injections may be repeated no more than 12 weeks.
How long can you use?
Clinical experience shows that five botulinum toxin treatments are safe and well tolerated at 12-week intervals. Few patients have been reported to develop antibodies that inhibit the effect of botulinum toxin. This was found to occur in patients who were toxin frequently and at a higher dose than recommended. If injections are used at the lowest effective dose and are not repeated frequently, there is less risk of developing antibodies.
Can I interact with other drugs that I can take together?
Some antibiotics can increase the effect of botulinum toxin. If possible, not using aspirin within the week before treatment reduces bleeding at the injection site.
If you want to get pregnant…
The safety of botulinum toxin during pregnancy and lactation has not been established. It is generally not recommended unless the benefit of treatment outweighs any potential risk.
Who is not suitable for?
In addition to pregnant and lactating women, the toxin should not be used by people who have previously had an allergic reaction.
Depression and Anxiety in Migraine Patients
Key Points:
People with migraine have a higher risk of developing depression and anxiety.
Depression and anxiety are more pronounced in patients with migraine pain 15 days or more per month.
When depression and anxiety increase, migraine attacks are more frequent.
It is useful to recognize the symptoms of depression and anxiety.
There are various medication and behavioral treatment methods for depression and anxiety.
If a person is experiencing symptoms of depression or anxiety, he or she should seek medical advice.
Migraine, Depression and Anxiety
Many migraine patients complain of symptoms of depression and anxiety. Those with migraine are 2-5 times more likely to show these symptoms than those without migraine. About one quarter of migraine sufferers have depression and half have anxiety symptoms. In some people, symptoms of these diseases develop after they begin to live with the restrictions caused by migraine. In others, these symptoms occur before migraine develops. No matter what time it develops, it is not clear why these diseases are more common in migraineurs.
All these diseases are thought to have some common problems. One of them is a chemical substance called serotonin that provides communication between neurons. Changes in this hormone in both men and women affect the development of depression. In most women, these hormone changes are also important for the development of migraine. People with migraine, depression and anxiety are more sensitive to internal and external variables.
Symptoms of depression and anxiety are more common in people with chronic migraine. Chronic migraine is characterized by headaches every two days or more, for 3 months. In people with headaches, the presence of depression or anxiety is associated with an increased risk of headaches over time. Depression and anxiety also affect other health conditions. Quality of life is lower than migraine patients without depression or anxiety. Unless these diseases are treated, it is not possible to obtain full efficiency from headache treatment.
Depression patients are more difficult to adapt to medication and to maintain a lifestyle to prevent migraine triggers. Such patients are less responsive to headache treatments and relapse rates are higher, although they improve.
Stimulating Symptoms: Disorders of Emotion and Thought
Treatment of depression and anxiety begins with the recognition of symptoms. Symptoms can be difficult to recognize. Both cases often present with physical symptoms. There may be some common symptoms with migraine. For example, sleep problems, impaired appetite, difficulty concentrating, fatigue and dizziness are seen in both migraine and depression and anxiety. Therefore, taking into account the patient's feelings and thoughts will help to distinguish the difference between diseases. Depression is usually manifested by feelings of sadness and helplessness. Some migraine patients who are depressed do not feel sad, depressed or helpless; but instead they don't seem to be as interested in the work they normally do with pleasure. In another part, there may be feelings of worthlessness, guilt or suicidal thoughts.
Types of Anxiety
Anxiety disorders are the most common type of mental disorders. About 30% of people meet the criteria for anxiety disorder at some time; but this is true for 50-60% of migraine patients. Although there are many types of anxiety disorders, most include chronic anxiety or fear and behaviors to escape objects and spaces that trigger these emotions.
The most common anxiety disorder in migraine patients is panic disorder, generalized anxiety disorder and phobia. In panic disorder, the person develops an unexpected sense of repetitive fear. Heart rate is accelerated and breathing becomes difficult; other symptoms include perspiration, death, or fear of losing control. Although these attacks do not last long and are not dangerous, in most patients severe anxiety develops between the attacks. Patients avoid going to certain places and fear some normal physical stimuli because they are associated with a panic attack.
Patients with generalized anxiety disorder may not be able to control their concerns about events that may not occur at all. Usually this exaggerated anxiety is accompanied by physical symptoms. Phobias are fears against certain objects or places. Social phobia in social settings is an example. Doctors evaluate these symptoms within the framework of patient interviews, patient-filled questionnaires, and observations of patient behavior.
Treatment Options
There are many drugs and behavioral treatment methods in the treatment of depression and anxiety symptoms. Antidepressants reduce symptoms of depression and anxiety. It makes changes in hormone levels in the brain, such as serotonin, which carries a chemical message from one neuron to another. Sometimes a single drug or behavior therapy is good for both depression / anxiety and headache symptoms. However, most patients need two different drugs or behavioral treatment for a while.
Behavioral therapies are effective in mild to moderate depression and tend to be more effective than anxiety medications for anxiety disorders, especially when looking at the long-term effect. For many patients with depression, anxiety, and headache, combining medical and behavioral methods is far more beneficial than applying one alone. It is important to determine the most appropriate treatment option for different patients. In addition, headache of treating depression and anxiety; it is important to understand that treating headache will also benefit depression and anxiety. It is extremely important to arrange the best treatment for each.
Tension Type Headache
What is Tension Type Headache?
Tension headache is a common type of headache and is seen in most people.
Who Has Tension Type Headache?
Tension-type headache occurs in about 80% of people periodically. Around 3% of people are present almost every day.
What are the different types of tension headache?
Episodic tension headache is often referred to as insanlar normal headache tarafından by people.
When headaches occur every month and at least 15 days a month, chronic tension headaches are mentioned. In some, these pains reduce the severity, but they never disappear completely and are called “chronic daily headaches.. Due to the persistence of headaches, this is troublesome and restrictive.
What are the symptoms of tension-type headache?
Typically, the pain gives the feeling of a hat or band that tightens the head around the head. Some people describe it as a feeling of “jamming” or “pressure”. It is usually felt on both sides of the head, often spreading eastwards or upwards. It is usually mild or moderate; rarely can be severe. The pain can last from half an hour to 1 week. Often, pain is not accompanied by any other symptoms. Some patients may be disturbed by bright light or loud sound, and anorexia may occur.
Is Any Test Required?
No test is required. The diagnosis is based on the characteristics of the headache and the absence of abnormal findings on examination. If the diagnosis is suspected, tests to exclude other causes of headache may be performed.
What Causes Tension Headache?
The causes of tension-type headache are numerous and variable. Mental tension, anxiety or stress are the leading causes.
What can you do for your headaches?
Relaxation: Taking a break between work, walking or exercising will take the person away from the normal routine.
Coping with stress: If the person is facing a stressful job or a stressful situation that he cannot stay away from, he can try breathing and relaxation exercises.
Depression treatment: If the patient often feels depressed and depressed, it is important that he or she receive medical treatment for the effective treatment of headache.
Regular exercise: Tension-type headache in people who do not exercise, is more common than those who do. Stairs should be preferred over lifts, vehicles for walking cannot be used, and physical exercise should be made as routine as possible.
Keep Headache Diary
Noteing painful days allows recording of a significant amount of information about headaches. Especially; it should be noted how often, how long it lasts, and how it shows symptoms. They are also important in diagnosing, determining triggering factors and evaluating treatment efficacy.
Take Medicines Early
Painkillers such as aspirin or paracetamol are often effective in relieving pain. But medications are only meant to relieve pain; In long-term treatment, it is better to try to eliminate the cause.
Painkillers should not be taken too often. After a while, tolerance to painkillers develops; pain relief is no longer needed 1, 2 tablets are needed. To prevent this condition, these drugs should not be used more than two days a week. But if the doctor has prescribed a medication that should be used every day (preventive treatment), this is a completely different situation. Preventive treatment for headache works in a different way than symptomatic treatment.
When the causes triggering the headache are discovered and treated, tension-type headache is no longer a problem.
Chronic Daily Headache
Chronic daily headache ”is not a diagnosis. It simply means that painful days in the last three months are more than painless days. Migraine and tension headache may also be the cause of chronic daily headache.
About 1 in 20 people develop chronic daily headaches at some time in their lives. Migraine is one of the most common causes of chronic daily headache and is also called “chronic migraine”. “Drug overuse headache” is another common cause and a special complication of migraine.
Do you need any test?
If the person does not have anything other than headache that goes wrong for a long time, it is unlikely to be a serious cause. The most important test is the physical and neurological examination performed by the doctor. Many patients, relatives and doctors are not satisfied without having brain imaging. Magnetic Resonance (MR) is more preferred than computed tomography. With computed tomography, some important diseases may be overlooked. MRI is very sensitive; 1 out of 4 healthy individuals may have abnormalities of no importance due to technical reasons. In 1 out of 40 healthy individuals, the pathology is determined by MR.
How is Chronic Daily Headache Treated?
Diagnosis is the key to treatment. In the treatment of drug overuse headache, all pain medication used by the patient in the first stage should be discontinued. In chronic daily headache caused by migraine and tension headache, preventive treatment is initiated. In preventive treatment, the patient should use the medication prescribed by his doctor for a certain period of time each day. The aim of this treatment is to dilute the pain as much as possible, to reduce its severity and duration and to make it easier to respond to the painkiller.
Drug Overuse Headache
Any medication used for headaches may take headaches if taken too long and frequently. Aspirin, paracetamol and in fact all painkillers are associated with this condition. In addition, some medications used only for migraine pain may cause this problem when used frequently.
Excessive use of caffeine can cause headaches of a similar type. The source of caffeine is usually painkillers containing coffee, tea, cola drinks and caffeine. It may not be objectionable to use painkillers 1-2 times a week; but the continuous use of these drugs more than three days a week, drug overuse causes headaches.
The only way to remedy this situation is to discontinue over-used medication. In clinical studies, discontinuation of overdose has been shown to improve greatly in many people. But full recovery may take up to 3 months. Generally, the route of administration is not to reduce the drug but to discontinue it at a time. In the first 48 hours after discontinuation of the medication, headache aggravation, nausea, anxiety and insomnia occur, which may last up to two weeks. This is a type of deprivation.
What Causes Excessive Drug Use?
It is not right to continue taking medication if excessive medication causes headaches to increase. Because headaches will become more frequent in this case and will not respond to painkillers or preventive treatment. At worst, medications will also damage the liver and kidneys.
Once the headache has been relieved from drug overuse, painkiller may be used again, provided that it is cautious. There is a risk of recurrence of the same condition. If the headaches start to become more frequent again, the person should not try to continue to treat himself / herself and should consult a doctor.
Keep Headache Diary
It is especially important that people who are at risk of drug overuse headaches because of frequent drug intake keep a headache diary; because it allows them to monitor how often and how many medications they take.
What is Cluster Headache?
Cluster headache; unilateral, very severe headaches in the eye or around the eye, which last for a short time. These attacks occur one or more times each day, usually at the same time of day or night. Pain often wakes up around an hour after falling asleep.
Who Is Cluster Headache?
Cluster headache is not common. It affects no more than three out of every 1000 people. It is five times more likely to occur in men than in women, making cluster headaches different from other headaches. Although the first attack usually occurs between the ages of 20-40, it can be seen at any age.
What are the types of cluster headache?
The iz episodic ”type of cluster headache is more common. Occurs in clusters at certain periods (episodes), pain occurs every day during the episode and then stops. Because of this feature, headache is called “cluster den headache. The duration of these periods usually varies between 6 and 12 weeks, but for any reason, the pain period may end after two weeks or may continue for up to 6 months. Pain periods often tend to occur at certain times of the year, such as spring or autumn. However, in some patients, these episodes develop two or three times each year, while others may have two or more years without episodes.
Other than these periods, the patient has no complaints about headache. In one out of every 10 people with cluster headaches, the pain period does not end and attacks continue to be excessive every day or day without interruption for years. In this case, “chronic” cluster headache is mentioned. In time, episodic cluster headache can be transformed into chronic form and chronic form can become episodic form.
What are the symptoms of cluster headache?
Most importantly, cluster headache is unbearably painful. Female patients state that these pain can be compared with birth pain. Pain is always unilateral and always on the same side (episodic cluster headache may change sides from episode to episode). It is defined as a pain in the eye, around the eye or behind the eye, as if it is a burning, stabbing, or piercing. Increases severity very quickly; Reaches the most severe state within 5-10 minutes.
It takes between 15 minutes and 3 hours without treatment (often 30-60 minutes). Remarkably, most people with migraine attacks want to look for a place as quiet as possible; cluster headache patient is restless. When a cluster headache episode arrives, it cannot remain calm, wandering in the form of volts, or swings back and forth in its seat. Redness of the eye on the painful side, watering occurs and eyelid fall may occur. At the same time, the nose may become clogged or flow continuously. The other side of the head is completely normal.
What Causes Cluster Headaches?
Although a lot of medical research has been conducted on the cause of cluster headache, its cause is still unknown. Most attention has focused on the fact that the attacks are always at the same time. This indicates the connection between the attack time and the biological clock. Recent research on this subject points to the role of the hypothalamus.
Most of the cluster headache patients have intensive smoking. Although this contributes to the formation of cluster headache, its role is not known. Quitting smoking is always the right health but it rarely affects cluster headaches.
Is Any Auditor Necessary?
Due to its features, cluster headache is easy to recognize. No test is required to confirm the diagnosis. The diagnosis is confirmed by the characteristics of the headache and the absence of an abnormal finding in the examination. Therefore, it is very important that headaches and other symptoms be explained carefully.
What are the treatment options?
Cluster headaches are usually a group of useful treatment options. The most common treatment for attacks is to breathe 100% oxygen through the mask during the attack. This can be achieved with an oxygen cylinder. It may be wise to provide an oxygen cylinder at home for those who have attacks at night and those who have attacks during the day. Oxygen therapy is both inexpensive, has no side effects, and can be administered repeatedly during the day if necessary.
Preventive treatment is the best treatment option for most patients with cluster headache. Medications recommended for preventive treatment should be taken every day during the cluster period to stop the recurrence of headaches. These drugs are effective but require close medical monitoring because of possible side effects.
What if these treatments don't work?
There are various preventive treatment options. If one doesn't work, the other can be tried. Sometimes two or more can be used together.
What should be done?
Ordinary painkillers don't work. The duration of the bee is shorter than that of simple painkillers. For effective treatment, the doctor should be consulted at the beginning of the cluster episode as much as possible. It seems that more successful results are obtained in the early treatment.
Keep Headache Diary
Noteing painful days allows you to record a significant amount of information about your headaches. They are especially important in diagnosing, determining triggering factors and evaluating treatment efficacy.
Cluster periods can continue for years. Particularly in chronic cluster headache patients, headache is often improved later in life.
What is Secondary Headaches?
Secondary headaches are headaches caused by some other diseases. The term "secondary" refers to this type of headache; migraine, tension-type headache and cluster headache, such as primary headache disorders (underlying headaches that do not cause any disease headaches) is used to distinguish. Many medical conditions can cause headaches, but usually medical history or examination has a number of clues that give the impression of secondary headache.
Headache can be caused by severe hypertension or general medical illnesses, such as when the brain and its structures are affected. One of the symptoms of head and neck infections such as pharyngitis, sinusitis and meningitis is headache. Head trauma, even if it is mild, often causes headache.
Any formation that takes up space in the head, such as tumor, bleeding and hydrocephalus (accumulation of fluid-cerebrospinal fluid in the brain) can cause headaches. Severe headaches may also develop due to vascular problems such as cerebral hemorrhage due to aneurysm rupture. The key to distinguishing secondary headaches from primary headaches; headache characteristics, other concomitant symptoms and physical examination are reserved.
Your Doctor Queries Symptoms Often Pointing To Secondary Headache
These:
First or worst headache in life
Sudden onset of headache without warning
Development of a completely different headache from previous recurrent headaches
First occurrence of headache before 5 years of age or after 50 years of age
Presence of conditions such as cancer, AIDS or pregnancy
Physical examination is not within normal limits
Headache; coexistence with seizures, temporary loss of consciousness, or after exertion, sexual intercourse or straining
Your doctor will also question some of the characteristics of primary headache. These:
Headaches that develop continuously throughout the year and show the same characteristics
Long-standing headaches
Similar headaches in the family
Physical examination is normal
Headaches consistently;
Hormonal cycle
Certain foods
Triggered by certain sensory stimuli (light, smell, air exchange)
If the person is worried that headaches may be due to other medical conditions, he or she should talk to their doctor. Making sure that headaches are not related to any other underlying cause is the first important step in developing an effective treatment plan.
Headache and Imaging Techniques
MRI and Computed Tomography
Main Points:
Many patients with headache complaints do not need imaging techniques. Situations requiring imaging are quite complex. Different types of problems require different types of imaging methods. The reason for headache patients to consult a doctor is often that they have a problem.
Most of the patients' minds are the presence of pathologies such as brain tumor, aneurysm (vascular ballooning), congestion in the blood vessels or infection. However, rarely, the underlying cause of headaches is a serious disease. Risky headaches are often emerging headaches. Many patients also consult a doctor to find out if headaches are really migraines.
Migraine pain occurs as a result of highly complex interactions between the blood vessels of the head and face with the brain. Imaging techniques do not show these interactions in the brain. Imaging is no different from that of people without headaches. In some cases, however, imaging is necessary to ensure that there is no underlying life-threatening pathology.
The following are cases where Viewing is Required:
Sudden and very severe headache
Sudden change in the characteristics of the headache
Headache starting after the age of 50
Headaches associated with the position of the head; headache
Epileptic seizure (epileptic seizure) with headache
The presence of headache and / or fever during the course of a disease
Hearing sound with headache
Having had recent head trauma prior to headache
Headache caused by exercise, sex, coughing, sneezing or straining
Headache is accompanied by unconsciousness, speech disorder, paralysis, numbness or imbalance, or incompetence of hands.
Patients with diseases such as cancer or AIDS
Headaches not responding to medication
People who can't get rid of the idea that there's a discomfort in the head
Imaging Methods for Headache
There are two basic imaging methods used for brain imaging:
Computed Tomography (CT): CT take only a few minutes. Claustrophobia, the fear of staying indoors, is not an issue for CT. Detailed images may not be obtained with CT. CT patients expose only slightly more radiation than direct chest radiography. Pregnant women are not eligible for CT. However, if it is very necessary, it can be tried to protect the abdomen.
Magnetic Resonance (MR) Imaging: Magnets and radio waves using the detailed images of the brain allows. MRI provides more information than CT. MRI takes more time than CT; sometimes it may take longer than 1 hour. The machine is quite noisy. During the examination, the patient has to lie in a narrow narrow tunnel. Claustrophobia is an important problem for MRI. Soothing medication can be used for shooting. Another option is open MRI; however, image quality is not as good as classical MRI. MRI is not performed on patients with pacemakers, metal heart valves and clips in the brain vessels.
The madde contrast agent ”(gadolinium) is often used in classical MRI; injector is given to the veins in the arm. It becomes possible to learn more about the brain with contrast material. It should not be used in patients with severe kidney problems as the contrast agent affects renal function.
The contrast agent used for CT contains iodine. If you are allergic to iodine or shellfish, you should tell your doctor in advance. Otherwise a severe allergic reaction to the contrast agent may occur.
If a pathology is thought to be present in the vessels (ballooning, narrowing, etc.), MR angiography or CT angiography examination may be requested. However, it is not possible to detect anomalies smaller than 2-3 mm with the mentioned methods. In case of doubt, classical angiography can also be applied.
What to Know About Imaging Methods
Migraine is diagnosed in 94% of the patients who consult a doctor for headache.
With an accurate history and examination of the disease, most people are diagnosed correctly without imaging and can be successfully treated.
Imaging in a person diagnosed with migraine does not alter the treatment.
If the headache has been present for months or years, imaging is most likely not helpful.
If headaches are controlled with medications, imaging is usually not needed.
Due to a random finding during imaging, other tests may be necessary and may follow the tests. This chain of events ends up with a lot of examinations, a lot of doctors' opinions, a waste of time and money; however, the diagnosis does not change.
Migraine Diagnosis
Migraine is an important cause of headache in children. Studies have shown that 60% of children between the ages of 7-15 experience headaches. Approximately 1-2% of 7-year-olds and 2.5% of 9-year-olds have migraine; More than 5% of children aged 15 years have migraine.
The frequency of migraine is equal in girls and boys until puberty, and it is higher in girls after puberty. Due to severe pain and vomiting during attacks, children often cannot go to school and continue their daily activities. If these attacks are frequent, school absenteeism may increase due to migraine.
Migraine in children is different in many ways than adults:
Headache is not usually unilateral, covers the entire head
Headache may be a minor symptom or not at all
Vomiting and / or abdominal pain is common
Attacks are shorter, sometimes less than an hour
As in adults, children are pale and sluggish during an attack. There is no examination that helps to diagnose migraine, the diagnosis is made according to the history. Migraine diary is very valuable in diagnosis and treatment. If a healthy child has recurrent headaches accompanied by nausea and vomiting and is completely healthy between attacks, it is probably migraine. Some children appear pale and stretch for several hours before the headache begins; others may be overly mobile. Some children typically have bright zig-zags, blind spots, and migraine aura that last for up to an hour before headache. Attacks may take several hours; For parents, it can be surprising that children return to normal quickly after an attack.
When should I take my child to a doctor?
If there is a clear cause of the attacks, if the symptoms respond to painkillers and the child is otherwise normal, there may be no need to see a doctor. But if there is any doubt about the cause and nature of the child's headaches, if the child does not look good in general or headaches affect daily life, a doctor should be consulted.
You should see your child in the following cases:
Headache starting before age 7
Differentiation over time in the form of headache
Significant increase in frequency, severity and duration of attacks
Recently lost school
Personality / behavior changes
Fainting or unconsciousness
Balance-coordination problems
Lack of growth and development
When Do I Need To Go To A Doctorate Urgently?
Increasing frequency of severe headache; especially if you are accompanied by seizures, persistent vomiting, fever or loss of consciousness, you should see a doctor immediately.
Migraine Treatment
Migraine in children is treated as in adults. Here are the situations to be answered:
· What causes headaches?
· What is good for headaches?
Reasons:
Unbalanced nutrition is the most important trigger in children, especially adolescents. Children often go to school with an inadequate breakfast in order to catch up with the school; It is not surprising that many children start headaches in the afternoon. Parents should ensure that their children have a good breakfast, so that even if their children skip lunch, they can at least spend the day with breakfast.
As a result of missed meals, children start looking for candy or chocolate. Seeking sweets is a pioneering sign of migraine, and chocolate is often blamed - if not true - as a migraine trigger. Few children have a relationship with the onset of migraine after consuming certain foods, but this can be clarified by keeping a food diary.
However, it is unnecessary to restrict food in general, more importantly, children should be regular meals. Spore can sometimes trigger thirst and blood sugar, which can trigger migraine. It is also important for children to take time to rest and relax; they benefit from adequate and regular sleep.
Keep Daily
As in adults, migraine is not triggered by a single event, but by a combination of these. If the child is large enough, the diary for triggers should be encouraged. Missed meals, sports activities, stressful lessons, late night before night to study, emotional changes should be noted. Unlike these records, migraine attacks and other headaches should be kept in diary. After a few months, the diary can be examined with the child and triggers can be identified. In fact, it may not be possible to get away from all potential triggers and it may even be unnecessary; but moving away from a few of these triggers can keep children below the threshold required for an attack.
Drugs to Control Symptoms
Relaxing in a quiet, dark room, massaging with a cold or warm treatment to alleviate pain may be enough to relieve non-serious symptoms. Many children want to lie down during an attack and may be advised to sleep because it accelerates their recovery. If possible, the child should eat healthy food. However, simple painkillers may be sufficient for an attack. Soluble or effervescent painkillers are both flavored and more effective if they are administered by melting in a beverage. As the digestive system develops shortly after the onset of a migraine attack, medication may not be effective if given late. It may be necessary to inform the child's school about migraine.
Preventing Migraine
The basis of treatment is to identify and avoid migraine triggers. It is often unnecessary to start preventive treatment for children unless headaches affect daily life. If the attacks are especially during the exam periods, short-term preventive medications may be given. These medications should be started earlier than considered critical. This ensures that the drug is tolerated and that the side effects do not affect the child's daily performance. The most commonly used drugs in children are prescribed.
If Pains Still Continue
If the child has frequent migraine attacks or headaches and simple treatment strategies do not work, depression, school problems or emotional problems may be underlying. Excessive use of acute drug therapies can also cause headaches. Drugs used during migraine attacks should not be used regularly and should not be given more than two to three days a week.
In summary;
Migraine occurs in children and adolescents and is more frequent than expected. In a healthy child, recurrent headaches accompanied by vomiting are probably migraine. Headache may not always be a feature of childhood migraine; abdominal pain and vomiting may be more prominent.
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