Headaches are among the most common ailments seen in our neurology practice. Most of them are migraines and stress headaches, but sometimes they are also a consequence of excessive analgesics consumption. There are also numerous other types of rare headaches that require a special examination and treatment.

Warning symptoms

A headache that starts suddenly within seconds may be a sign of a cerebral hemorrhage. This type of headache is often accompanied by neck stiffness and impaired consciousness. If additional symptoms include high fever, this points to bacterial meningitis. If headaches gradually worsen over the course of several days, this can be due to constricted or inflamed vessels. If a headache is also accompanied by deteriorating vision or impaired speech or movement, this is cause for serious concern.


Migraines hare a very common type of headache with clear diagnostic criteria:

  • They occur in episodes of medium to high intensity.
  • Migraines are often (but not always) focused on one side, around the temple or forehead.
  • The pain is of a pulsing, piercing nature and occurs particularly when the person is under stress. At first, the sufferer usually experiences a feeling of pressure in their head.
  • Patients are frequently unable to continue going about their day-to-day activities.

Typical accompanying symptoms:

  • Nausea and vomiting
  • Sensitivity to noise, odors and light
  • Irritability, fatigue, restlessness or other change in mental state

10% – 15% of patients describe what is referred to as an aura before the onset of the onset of migraine. Its origin is on the surface of the brain itself, often in the regions involved with vision, but it can also affect the sensory or speech regions.

Stress and analgesic-related headaches involve a dull feeling of pressure. They are usually concentrated in the area of the forehead or neck. There are usually no other symptoms.

Cluster headaches are typified by shooting, unbearably acute pain and are often localized behind the eyes.

Facial pain in the case of trigeminal neuralgia is manifested in the form of severe, sharp, shock-like pain. It is the result of damage to the facial nerves.

What will the doctor want to know?

The patient’s medical history is crucial for the diagnosis. How often do the headaches occur and how long do they last? The doctor will ask about the nature and where the pain is focused as well as other symptoms that accompany it. What aggravates the pain and what alleviates it? The patient will also be asked whether they noticed a flickering or bright light or any odd sensations in their mouth or hands prior to the pain attacks.


The diagnosis mainly involves asking the patient to describe the pain attacks (history) and performing a neurological examination. If required, additional examinations such as imaging of the head (usually MRI) or tests on the blood or cerebrospinal fluid will be performed.

Common causes

The primary or hereditary forms of headaches that are not associated with brain damage include migraines, stress headaches, cluster headaches (hemispheric headaches) and other less common types.

Secondary or symptomatic headaches, on the other hand, occur following cranial injuries or in the case of vascular disorders and strokes, for example. Medications and drug abuse are another possible cause. This category also includes metabolic disorders, infections, and neuralgia of the cranial nerves.

Treatment possibilities

Therapies include specific drug and non-drug treatment, including injections, botulinum toxin treatment, TENS units, acupuncture and lifestyle counselling.