Headaches

Headaches don't always feel the same and we each experience them differently, perhaps as dull and pressing, or as a stabbing, drilling, or throbbing pain. Sometimes your whole head might hurt, and sometimes only one side or just the temples. The pain might also change during an attack, from dull to throbbing.

Other symptoms are possible depending on the type of headache: For instance, people with migraines might also feel nauseous or have temporary vision problems. A runny nose and a red, watery eye on one side are typical of cluster headaches.

It is not entirely clear why some people have primary headaches like migraine, cluster headaches or tension headaches. Genes might play a role. And some factors are known to trigger individual attacks. They can include things like changing your day-night rhythm, skipping meals and stress. Known triggers of cluster headaches are alcohol and spending time at high altitudes.

The causes of secondary headaches are usually harmless, such as colds, tense muscles, hangovers after drinking too much alcohol, and hormonal fluctuations in women during the menstrual cycle. Medications containing hormones, for treating heart problems and high blood pressure, and impotence can also cause headaches. Taking painkillers or migraine medication very often for headaches can cause even more headaches.

Illnesses that require treatment only rarely cause headaches. They can include very high blood pressure, high inner eye pressure ( glaucoma), meningitis and brain tumors. But unlike primary headaches, there will be other symptoms or abnormalities as well. Injuries to the head or spine can also cause secondary headaches.

Headaches are very common, in young and old people, in women and in men. But there are some differences between frequency depending on the type:

• over 300 out of 1,000 people have tension headaches,
• about 100 to 150 out of 1,000 people have migraines, and
• cluster headaches affect about 1 in 1,000 people.

The number of men and women affected isn’t always the same, either: For example, migraines are more common in women than men, while men are more often affected by cluster headaches.

Headaches can develop in very different ways. Migraine attacks are a typical example of acute headaches. Experts talk about "episodes" if several acute headache attacks occur over a certain time period. Those kinds of episodes can come back regularly, with no symptoms in between.

If there are hardly any or no painless phases at all between the headache episodes, then doctors refer to them as "chronic" headaches. There are clearly defined reference values for the different types of headache: For instance, tension headaches are considered to be chronic if they occur on 180 or more days per year and last for several hours at a time.

An in-depth conversation with your doctor is usually enough for a diagnosis. Key questions include:

• What exactly do the headaches feel like?
• Where does it hurt – and since when?
• Have you had symptoms like these in the past?
• Do you have any other symptoms?
• Are you currently taking any medication?

You will usually have a thorough physical examination afterwards. If there are still any unanswered questions, in rare cases other measures such as an MRI scan of your head might be needed.

People with primary headaches can try to identify the possible triggers by keeping a pain diary. If you know what triggers the headaches, you can then try to avoid it. It can also be a good idea to note down when you take painkillers to find out if you are using them too often. Because taking painkillers too frequently can make headaches worse.

Some people also find that endurance sports, yoga and relaxation exercises help. Medications to prevent headaches, such as beta blockers for migraine, may be a good idea if the symptoms are severe.

Headaches often clear up on their own. Some people find that dabbing a little peppermint oil on their temples and forehead, placing a cold compress on their forehead or going for a walk in the fresh air can help. Treatment with medication usually isn’t necessary. But people who feel restricted by acute headaches can take painkillers such as acetylsalicylic acid (the drug in medicines like “Aspirin”), ibuprofen, or paracetamol in the short term.

Other medications or treatments can be a good idea depending on the type of headache and how often you have it: For example, triptans are suitable for migraine and cluster headaches, but don’t help with tension headaches. Cluster headaches can also be relieved by inhaling pure oxygen. A combination of various treatments, such as medication and behavioral therapy, can also be a good idea for chronic headaches.

When people are ill or need medical advice, they usually go to see their family doctor first. In our topic "Health care in Germany" you can read about how to find the right doctor – and our list of questions can help you to prepare for your appointment.