10 embarrassing questions about headaches: neurologist Patimat Isabekova answers.

We have collected what you really wanted to know about, but were embarrassed to ask.

In this series of articles, well-known experts answer questions that are usually awkward to ask: it seems that everyone already knows about it, and the questioner will look stupid. We have collected what you really wanted to know about, but were embarrassed to ask.

Today we'll talk about headaches. Let's discuss what causes it, why it feels different, and how it differs from migraine.

Patimat Isabekova Neurologist NMRC named after V. A. Almazov, Lahta clinic

1. What causes a headache if the brain does not have pain receptors?

Headaches can be divided into two types: primary and secondary. The latter occur due to head injuries, hematomas, strokes or tumors. That is, when there is objectively some damage to the brain and surrounding tissues.

If it is a tumor or hemorrhage, compression of the surrounding tissue occurs and swelling occurs. There are pathways in the brain that convey information about this, and a person feels pain.

But much more often, in 90% of cases, there are primary headaches that do not have a specific obvious cause. If we do an MRI, we will see a completely normal brain, without inflammation, trauma or hemorrhage.

The most common type of primary headache, which occurs periodically in almost all people, is tension headache. This condition often occurs due to stress. Against the background of fatigue, a person’s head muscles tense, and a decrease in the pain threshold and insufficient functioning of the brain system responsible for reducing pain also contribute.

Migraine is also a common primary pain. This is not a synonym for headache, but a separate disease that has its own criteria.

The development of migraine is based on increased excitability of neurons, which is caused by genetic factors. There is a certain area of ​​the brain - the nucleus of the trigeminal nerve, which in people with migraine is very sensitive to various external and internal influences. Certain triggers, such as lack or excess sleep, alcohol, stress, can trigger a throbbing, severe headache.

In addition, there are mechanisms that make headaches more frequent - peripheral and central sensitization. The first is associated with increased activity of pain receptors in the scalp, the second is associated with increased excitability of neurons in the brain, provided that the pain continues.

Roughly speaking, nerve cells are constantly in an excited state and become accustomed to this. As a result, it is no longer the muscles, but the brain that creates the feeling of tension.

2. Why does my head hurt in different ways?

Each person perceives pain differently. If he experiences it often, he gets used to it to some extent and describes it differently than before. The characteristics of a person’s personality also have an impact.

Even if you take people with the same disease, they will all describe their feelings differently. Moreover, even in one patient the pain can shift - today the back of the head ache, tomorrow the temple. Why this happens is unclear.

There are rare types of headaches. For example, coin-shaped, in which all the unpleasant sensations are concentrated in a small area the size of a coin. Or a primary stabbing headache - when a person feels as if a needle was stuck into the eye and immediately pulled out. The sensations are very strong, but short-lived.

But none of this says anything about the real causes of pain. Some patients think that if they say: “It’s like they’re sticking a needle into my temple,” the doctor will immediately understand everything and make a diagnosis. In fact, from one description, it is most often not clear what is happening to you. To find out the reason, you need to communicate with the person for a long time. Sometimes it takes more than one visit to make a correct diagnosis.

According to the international classification, there are more than 200 types of headaches. Therefore, when a person says: “I have a tingling sensation in my forehead,” this does not mean anything at all.

As for intensity, it can indeed indicate serious problems. With a serious injury, such as a cerebral hemorrhage, the pain can be thunderous—sudden and very intense—while with a migraine it is more of an increasing and gradual pain. But this is not 100% of cases.

It is also believed, for example, that thrombosis causes a very intense headache. At the same time, in my practice, several patients with this diagnosis described their sensations as not particularly vivid. This is the difficulty of assessment.

3. Should I take pills if I have a headache?

You definitely shouldn’t endure discomfort, especially if it’s severe. For example, with migraines, attacks can last for several days in a row and make life very difficult: disrupt sleep, cause nausea and vomiting, and dehydration. Additionally, a severe headache can increase blood pressure, which is dangerous for people with hypertension.

But here it is important to consider how often a person takes pain medication.

If you take at least 4-5 painkiller tablets every month, you should consult a doctor.

Those who take more than 15 tablets of non-steroidal anti-inflammatory drugs per month or more than 10 tablets of anti-migraine triptans and combination medications increase the risk of developing headaches. This is a chronic background pain that haunts a person constantly and further worsens his condition.

Of course, it is better to see a doctor before you start taking painkillers every other day. The longer you delay starting treatment, the more difficult and expensive it will be.

For rare headaches, you can choose any non-steroidal anti-inflammatory drug. I can't say that one of them is better than the other. Everything here is individual. Ibuprofen helps some, while aspirin works better for others. Someone can get rid of pain only with the help of triptans, and other analgesics have no effect on them. So choose what suits you.

If you are an elderly person or have any chronic diseases, it is better to consult a doctor before taking analgesics. Some medications may not mix well with what you are already taking.

4. Does sex, a warm shower or a cabbage leaf on your forehead help with headaches?

Perhaps someone will be upset, but sex most often does not help. Moreover, there are different types of coital headaches that appear during sex: pre-orgasmic and orgasmic. The first occurs during intercourse, and the second - immediately after orgasm. And almost always it is a very severe headache.

Sex can also make migraines worse. With this disease, pain often increases during physical activity, and intercourse can be quite intense.

As for a warm shower, it can help if you are dealing with tension headaches. For such a condition, in principle, any measures aimed at relaxation will be effective. But all this is very individual, and there are no guarantees.

The same goes for the cabbage leaf. If it is used as a cool compress on the head and helps you relax, why not. But you can just as easily put a damp towel on your forehead.

The same dubious methods include the “Star” balm. People apply it on their fingers and massage different points of the head. If this helps, it is at the level of a placebo effect, and it certainly does not save you from migraines.

There is even a joke about this: “Before I just had a headache, but now I have a headache in a pine forest.”

In general, for tension headaches, any method that helps you relax can work. Or they may not work, depending on your luck. If we are talking about migraines, the effectiveness of folk methods tends to zero.

5. How to distinguish a migraine from a headache?

First of all, migraines are genetically determined. So the more close relatives who have suffered from this disease, the higher the likelihood that you will have it too.

There are several characteristic signs of the disorder:

1. Episodes of severe headaches began before the age of 18. If you have had to miss classes because of this, there is a high probability that it is a migraine.
2. Severe headache that is difficult to tolerate. With migraine, mild attacks may occasionally occur, but at least sometimes really strong ones occur.
3. Severe photosensitivity. When upset, people often tend to go into a dark room or cover themselves with a blanket to reduce the intensity of light. They may also be irritated by other stimuli: loud sounds, strong smells.
4. Nausea. The attack can even lead to vomiting.
5. Unpleasant sensations right in the morning. Migraines can occur immediately upon waking or even at night.
6. Gradual increase in pain. As a rule, with a disorder, pain increases.
7. Increased discomfort during physical activity. The person may get worse from bending, moving the head, or other activity.

But the location of the pain does not matter. Many people believe that migraines should only cause discomfort on one side of the head. In fact, the back of the head, the jaw, and both temples can hurt.

You should not rely on the frequency of attacks. Some people experience migraines once a year.

If you suspect you have a disease, try keeping a diary for a month. Describe each attack - when and under what circumstances the pain appeared, how intense it was, how long it lasted. This will help you determine whether there really is a problem and more accurately describe your condition at an appointment with a neurologist.

6. Can your head hurt from working at the computer?

Working at a computer in itself is not dangerous. A headache can be caused by prolonged strain and lack of adequate rest.

For example, if a person slept poorly, and then spent many hours sitting at the computer in the office, was nervous, missed lunch, was tired physically and mentally.

Some people believe that sitting in a crouched position or sleeping in an awkward position can cause headaches. Actually this is not true. Poor posture can cause problems with the musculoskeletal system, but headaches have other causes.

If you often have a headache after a working day, most likely it’s not the computer, but general fatigue. Change your lifestyle: get enough sleep, take breaks and don’t skip meals.

7. Can magnetic storms and weather changes cause headaches?

Many people say: “I don’t have a headache at all. Only for the weather." In most cases, this indicates a migraine. Also, with this disease, the condition may worsen in the heat. Therefore, in the warm season, it is better for people with migraines not to go out into bright sunlight, stay in the shade and drink more water.

As for headaches in general, there is no clear evidence to support the influence of weather. There is some evidence that changes in atmospheric pressure increase the risk, and low temperatures, on the contrary, improve the condition.

But these are only individual scientific works, and there is no consensus on this matter. The same applies to magnetic storms. There is no evidence that they have any effect on headaches.

8. Can a headache be a sign of dangerous diseases?

Unfortunately yes. There are a number of signs that may indicate serious illness:

1. Thunderous pain that becomes very severe within a few minutes.
2. The appearance of neurological deficit. For example, when a person’s corner of his mouth droops, weakness or numbness appears in his hand, and his vision becomes impaired.
3. Increased body temperature or visual signs such as redness or swelling in the scalp.
4. Increased blood pressure. There may be a feedback here, when the pressure increases due to pain, but until we find out this, the symptom should be alarming.
5. First appearance after 45 years. As a rule, primary headaches occur in childhood or adolescence. If a person has never had a headache, and in adulthood pain suddenly appears, this is a bad sign.
6. Oncology. In this case, brain metastases are immediately suspected.
7. HIV. People with immunocompromise are at greater risk of infectious brain diseases such as toxoplasmosis.

But we must understand that these “red flags” do not always indicate dangerous diseases, and their absence does not mean that everything is in perfect order.

For example, people with bleeding or swelling do not always experience intense sensations. At the same time, cluster headaches, which are primary, can cause such severe suffering that they are sometimes called “suicidal.”

9. Which doctor should I go to if I have a headache?

To a neurologist. But if we are talking about a state clinic, you will first have to make an appointment with a therapist, because it is difficult to get to a specialist without a referral.

If we are talking about a private clinic, go to a neurologist right away. You can also check in advance whether he deals with headaches. A highly specialized doctor, a cephalgologist, works with such problems.

10. Can nerves cause headaches?

If by “nerves” we mean physical or emotional overload, then yes. This can trigger tension headaches, but this does not happen often in healthy people. Once a month or several times a year.

At the same time, mental illnesses, such as anxiety-depressive disorder or bipolar disorder, can cause headaches. Such pain is sometimes called psychogenic, although many refuse this definition so as not to stigmatize patients.

In people with migraines, depression can worsen the condition and cause headaches to become more frequent.

In principle, a neurologist can prescribe you medications for depression, but he does not specialize in the psyche and does not know all the nuances. For example, bipolar disorder may not be recognized and antidepressants may be prescribed, which will only worsen the condition.

So, if, in addition to a headache, you notice a low mood or other signs of mental illness, consult a psychiatrist.