What is headache?

Pain is the most common source of annoyance of all pains.

80% of all people suffer from headaches, 10% even experience regular discomfort. Headaches can have different causes which can be used to describe different forms.

Trigeminal neuralgia: Trigeminal neuralgia or facial pain, also called 'tic douloureux', is a type of headache characterized by suddenly occurring agonizing pain attacks in the face. An attack takes a few seconds and is almost always provoked by wind or activities such as brushing teeth, swallowing, talking, eating, shaving, etc.

The pain is observed unilaterally at the level of the lower jaw (V3) and / or the upper jaw - from the nose to the ear (V2). Pain on either sides or the forehead area (V1) hardly occurs.

The painful episodes can disappear for months (sometimes even years) after they have occurred intensely for weeks to months.

Most trigeminal neuralgias are caused by a blood vessel that tapes the trigeminal nerve (microvascular compression). The treatment is usually surgical.

Trigeminal neuropathy: trigeminal neuropathy occurs in an injury or malfunction of the trigeminal nerve. It is characterized by a constant burning pain in the face, with or without flare-ups.

Cluster headache: Cluster headache, also known as 'Horton's neuralgia', is more common in men than in women. The attacks occur in periods or clusters that cover several weeks or months, hence the name 'cluster headache'. It is not unusual for such a cluster period to return every year around the same period. There are forms in which the headache is not attacking but is present for a longer period (sometimes a year), this is called 'chronic cluster headache'.

An attack is characterized by insufferable, burning and stabbing pain that occurs on one side of the head, in and around the eye. It is typical that the affected eye shows tears and redness.

During a cluster headache attack, the patient is extremely agitated and completely distraught. The pain can be accompanied by autonomic reactions such as: changing blood pressure, frequent urination, diarrhea, nausea, vomiting, heart rhythm disorders, flushing, etc.

An attack can last from 15 minutes to a few hours and usually occurs during the first hours of the night, but it can also occur during the day.

Putting pressure on the side of the head or applying a heat source to the affected eye can sometimes relieve the pain a bit. Medication usually has little or no effect on the extremely severe pain. In ¾ of patients, administering oxygen can shorten the duration of an attack.

The cause of cluster headache is not known but it seems that it is a malfunctioning of sympathetic and parasympathetic fibers of the sinus cavernosus, a blood vessel in which several veins of the eye end. If this area becomes irritated, it might activate a 'trigeminal vascular' system which can lead to autonomic dysfunctions (changing blood pressure, frequent urination, diarrhea, nausea, vomiting, heart rhythm, flushing, etc.).

Tension headache: Tension headache is the most common type of headache. It is often accompanied by painful muscle tensions of the neck and is often linked by patients to disorders of the neck, reduction of vision or stress. Patients describe the pain as a band that is strongly tightened around the head. The pain is rarely so bad that daily activities are hampered.

The actual cause of tension headache is still unknown, although arguments point to the involvement of dysfunction of the jaw joints (temporomandibular dysfunction, TMD). Psychosomatic complaints (stress, depression, anxiety disorders, and sleep disorders) can also be a possible cause.

Another hypothesis may be that the processing of sensory stimuli from the body is disturbed. As a result, normal sensations can be experienced as painful, which can also be seen in people with fibromyalgia.

Headache due to vascular processes: (unlike with migraine) painful stimuli that originate from blood vessels in the brain or on the skull can be seen in a different location than the source of the pain. Some examples of vascular causes of headache include vasculitis, arterial dissection, and arteriovenous malformation, bleeding under the skull or in the brain, thrombosis, elevated blood pressure, etc.

Cervical syndrome: A cervical syndrome gives typical pain at the back and forehead and sometimes in the eyes. The pain is usually constant and is not tied to specific patterns. The pain usually worsens as the day progresses and by moving the head and neck. Patients can wake up from the head and neck pain at night.

Headache in the context of cervical syndrome is often due to a problem of the root of the second cervical vertebra (C2). This gives typical symptoms such as tension of the neck muscles, sensitivity and movement limitation of the neck.

Whiplash, wear of the cervical vertebrae, 'computer posture’, etc. can be caused by the cervical syndrome.

Medication-dependent headache or 'rebound headache': people with chronic headaches are at risk for developing headaches due to over-consumption of analgesic medication (paracetamol, acetylsalicylic acid).

If pain medication is taken too often and too quickly (often at the first sign of headache), habituation for the active substance can occur andthe medication will no longer or insufficiently work so that the headache persists.

'Rebound headache' is constantly present and is perceived as pressing, pulsatile pain. It can be observed both on one side and over the entire head.

Nausea, vomiting, malaise feeling, hypersensitivity to light and sound are symptoms that can be associated with this type of headache. Some patients also complain of concentration problems, sleep disturbances, mood swings and blurred vision.

Migraine see item 'Migraine'.

How can headaches be treated?

The treatment of headache depends on the cause, this is usually examined by the general practitioner, pain specialist or neurologist. If the reason cannot be sufficiently demonstrated or treated, then neuromodulation may possibly bring relief.

Stimulating the back of the head, the C2 dermatome, or the trigeminal nerve with neuromodulation can alleviate headaches.

If there is stress, neuromodulation methods can be applied to other brain areas. The placement of a patch or membrane on the eardrum (tympanic patching) may influence certain forms of tension headache, facial pain, cluster headache, etc. At BRAI3N, this will be carried out and researched scientifically