Headaches and migraines
What is it?
Almost five million people in Italy suffer from migraine, and every year at least 12 million working days are lost because of headaches: this means a social cost of over 6000 billion only for the loss of productivity: these are some of the most important numbers related to headache. Headaches are one of the most common disorders: from 70% to 90% of the general population suffer from at least one headache attack per year and only 10% of people can report never having suffered an attack in their life. In Italy, it is estimated that at least 4 million doctor visits every year are made just because of headaches, and that for the majority of patients this disorder is so debilitating as to heavily affect the normal rhythms of life, relationship and work. In almost half of the cases, in fact, the crises are so intense that they prevent any activity. It is no coincidence that headache is defined as a social disease of great proportions, since those who suffer from it are often severely limited even in periods of well-being: the fear that a new crisis may occur is experienced as a real spectre, as the headache is able to alter relationships with family members, social relations and the general welfare of the subject. The International Headache Society has classified nearly 100 different types of headaches.
Basically, they can be divided into primary headaches (those where there is no specific organic cause, i.e. factors that can be identified as real triggers of pain), and secondary headaches (where there is a well-defined disease that is the cause of the pain).
Primary headaches include migraine with aura, migraine without aura, vestibular migraine, tension headaches, cluster headache, trigeminal neuralgia, chronic headache and trigeminal autonomic headaches. Migraine belongs to the primary headaches, and is one of the most common and debilitating neurological diseases in the world. On average, 15% of the world's population on all continents suffers from it, mostly in the young and productive age group, with peaks of almost 25% for women of childbearing age. This disease was recognized since the beginning of civilization and has been a torment for historical figures such as Julius Caesar, Immanuel Kant, Sigmund Freud, Virginia Woolf, but it is also the daily reality of millions of anonymous individuals who suffer in silence. According to Plato, Socrates did not prescribe any medicine for headaches until the patient had relieved the mind of its discomfort; the body and the soul, he said, must be treated together.
Which are the symptoms?
Although pain in the head is the primary symptom that characterizes headaches, patients with migraine or cluster headaches may also experience a plenty of symptoms, such as nausea, watery eyes, concentrating difficulty, increased sensitivity to light or sounds. These complaints may precede the onset of pain or may persist even after resolution of the headache.
- Tearing up
- Increased sensitivity to sound
- Concentrating difficulty
How is it diagnosed?
The diagnosis process at the Headache and Facial Pain Center consists of several stages:
- Neurological examination: the neurological specialist investigates the clinical manifestations of headache, lifestyles and any risk factors of the patient through accurate anamnesis and accurate objective neurological examination;
- Clinical diary: the person is asked to write down the episodes of headache to assess the frequency, intensity and any triggering factors daily, until the next visit;
- Diagnosis: the doctor elaborates a personalized procedure and, if necessary, prescribes instrumental tests.
As part of the diagnosis, all neurophysiological or neuroradiological tools can be used if the headache complained of by the patient is of such a quality that a secondary form, i.e. symptomatic of an underlying neurological disorder, is suspected. Based on the assessment of the neurologist, after the medical history collection, the patient may be offered some tests useful to understand the type of headache in case secondary forms are suspected:
- Nuclear Magnetic Resonance Tomography
- Magnetic Resonance Angiography
- Cervical X-Ray
- Basal electroencephalogram
Follow up: follow up visits and checks are scheduled to check and evaluate the progress.
How is it treated?
Based on the diary and examinations performed, the specialist identifies the type of headache and proposes a personalized treatment, including with the involvement of other specialists depending on the causes of the headache. Headache therapy is based on symptomatic treatment (i.e., capable of resolving the attack itself in the short term) and, if the crises exceed a certain number per month and the disability experienced by the patient is particularly severe, on preventive therapy (i.e., capable of reducing the frequency and intensity of the attacks themselves). Dietary support and lifestyle corrections are also provided.
Based on the results of the examinations, the specialist will propose to the patient personalized therapy according to the type of headache identified and subsequent follow-up visits to verify the results of the therapy and any further steps. The following treatments are offered by the Center:
- Symptomatic drug therapies;
- Treatment with neuro-modulating drugs;
- Treatment with botulinum toxin;
- Treatment with monoclonal antibodies;
- Infiltration of the great occipital nerve;
- Nutraceutical and dietary approaches;
- Admissions for detoxification from drug abuse.
The Headache and Facial Pain Center is actively participating in the study of monoclonal antibodies that block the receptor for CGRP and have demonstrated efficacy and safety in migraine prophylaxis. The center is currently conducting clinical trials to evaluate the efficacy and safety of new monoclonal antibodies in the prevention of migraine in children and adolescents suffering from this disease.
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