Headaches, Migraines, Dizziness and Other Causes of Headache

Headaches, migraines, dizziness and other headaches may have neurological causes. Headache is one of the most common complaints in the general population, affecting 90% of the population. Most of these headaches consist of migraines and tension-type headaches.

Primary headaches are those that present directly as a headache syndrome without being related to another disease. These include migraine, tension-type, and cluster headaches.

Secondary headaches, occurring in approximately 10% of cases, are headaches that arise during the course of identifiable diseases, particularly cerebrovascular diseases, nervous system disorders, brain tumors, eye diseases, sinusitis, and meningitis.

What are the characteristics of migraine?

• Pain is usually on one side of the head
• Pain is throbbing, moderate to severe in intensity
• Nausea and vomiting may occur
• Occurs in episodes (attacks)
• Pain lasts 4 to 72 hours
• Visual disturbances may occur at pain onset (in the aura type)
• Pain worsens with head movements and physical activity
• Sensitivity to light and sound may occur

Aura: Symptoms, mostly visual, that occur before migraine pain begins. These may include bright lights, zigzag lines, blurred vision, or loss of vision in a specific area. Additionally, numbness in the arm or leg, dizziness, and speech disturbances may occur. These symptoms last approximately 20–30 minutes and are frequently followed by pain.

Is the cause of migraine known?

Environmental factors create activation in the brain of genetically predisposed individuals. This activation causes dilation of brain blood vessels and release of chemical substances. These stimulate nerves and cause pain.

Does migraine occur in children?

In 10–15% of all migraine sufferers, the disease begins in childhood. The prevalence of migraine in childhood is approximately 3–5%. This figure rises above 10% after puberty. Children with sleep irregularities, difficulty sleeping, unexplained vomiting, allergies, and motion sickness have a higher likelihood of developing migraine in the future.

What factors trigger migraine?

• Altitude changes
• Air pollution, cigarette smoke
• Bright light or flickering light
• Loud and continuous noise
• Perfume, strong odors, and chemical substances
• Weather changes (barometric pressure, temperature and humidity changes, warm winds)
• Seasonal changes (autumn and spring are the worst times)
• Hunger, skipping meals
• Sleeping too much or too little, disrupted sleep patterns
• Air travel
• Birth control pills
• Hormonal changes in women (menstrual period)
• Certain foods and beverages (chocolate, nuts, red wine, etc.)

Many foods are considered responsible among migraine triggers. However, the food that worsens migraine pain may differ for each patient. The important thing is for each person to identify and discover the substance that triggers their pain.

Why is migraine more common in women?

This is related to women's hormonal system. Migraine attacks become less frequent in menopausal women. During pregnancy, migraine attacks also decrease between the 3rd and 9th months.

Does heredity play a role in migraine?

Close relatives of migraine sufferers have a higher likelihood of having migraine. Genetic abnormalities have been demonstrated only in certain special types of migraine.

How can tension-type headache be distinguished from migraine?

• Tension-type headache is mostly caused by stress
• It can affect the entire head, spreading from the back to the front
• It can very rarely be unilateral
• Nausea may occur but vomiting is not seen
• Pain may last one week to 15 days (mild)
• Pain does not occur in crisis form
• No visual disturbances occur before pain onset
• Physical activity may worsen the pain

How should migraine be treated?

In migraine management, it is necessary to reduce factors that trigger attacks and thereby suppress the sensitivity of the nervous system and the vascular and perivascular events that occur during pain. If a patient's headaches occur once or twice a month, only acute treatment during attacks is recommended. In this case, treatment should be taken before the pain intensifies. If headache frequency is higher, prophylactic treatment should be planned to reduce attack frequency and severity and prevent pain.

What causes persistent headaches?

In persistent headaches, it should be investigated whether there is another underlying cause. In patients who previously had periodic headaches that have become continuous, the possibility should be considered that the patient has used excessive painkillers or that underlying psychological causes may exist.

What are the causes of headaches in the elderly?

In headaches that begin at an advanced age, it should first be investigated whether there is an underlying cause. Migraine is a disease that decreases with age. It can begin at an advanced age in approximately 2% of cases. Two diseases that particularly cause headaches at an advanced age are temporal arteritis (a headache caused by a specific type of vascular inflammation) and hypnic (nocturnal) headaches. Therefore, if a patient over 50 has newly developed headaches, a doctor should be consulted.

When should a person with headaches see a doctor?

If the pain is persistent and of increasing severity

• If the person experiencing headache for the first time is under 10 or over 50 years old
• If the severity or character of a pre-existing headache has changed or is not responding to treatment
• If the headache is the most severe pain ever experienced and began during or was worsened by physical activity (lifting heavy weights, sexual intercourse)
• If headache began after head trauma, accompanied by vomiting
• If fever, rash, and headache are present
• If there is a disease such as cancer or HIV, or if treatment is being received for such a disease
• If symptoms such as vision loss, speech disturbance, or weakness in an arm or leg accompany the headache, a doctor must be consulted

What is cluster headache?

More common in men, cluster headache is a type of headache characterized by painful periods lasting weeks or months followed by pain-free periods lasting months or years. Cluster headache recurs 1–8 times per day and frequently wakes patients from sleep at night. Pain always localizes to the same periorbital, supraorbital, and/or temporal area. The pain begins very intensely with a boring quality. It typically lasts about 1 hour (15–180 minutes). Autonomic symptoms accompany the pain on the same side, including eye redness and/or tearing, nasal discharge, eyelid edema, forehead and facial sweating, miosis and/or eyelid drooping.