Headache - symptom or illness?

Pain is often the result of external influences, for example, if you burn yourself on a hot hob or due to pathological processes within the body, e.g., in connection with inflammation. The body reacts to this by releasing chemical messengers that are recognised by pain sensors, also known as nociceptors. These are located at the nerve endings and transmit the pain impulse via the spinal cord to the brain, where it is felt and interpreted.

There are, however, types of pain that are not caused by damage to the body or another underlying illness. Instead, they occur as the system of pain generation, pain transmission or pain processing itself is disrupted and thus can no longer work optimally. The majority of headache types can be ascribed to this category.

Headaches as the condition itself

Headaches are among the most frequent health-related problems in Germany. Around 90 per cent of those affected suffer from primary headaches where the pain in the head is the actual condition. This includes, in particular, migraines and tension headaches. In essence, this means that the pain is not due to a secondary cause.

Despite intensive research, the cause of primary headaches is not yet fully understood. However, given the many different types of migraines that exist, which are classed as primary headaches, it is safe to say that various mechanisms are responsible for these symptoms. It is also certain that the risk of suffering from migraines is hereditary. Furthermore, it has been established that the nerve cells in the cortex of migraine sufferers are hypersensitive. As such, the ability to protect the brain from sensory overload is diminished.

During a migraine, messenger substances are released at the nerve endings of one of the facial nerves, in this case the trigeminal nerve and the small vessels of the cerebral membrane. It is only then that pain is experienced. One of the central messengers is CGRP (Calcitonin Gene-Related Peptide). Scientists have confirmed that the CGRP level in the blood also increases with other headache disorders.

In the case of chronic, i.e., permanent headaches, the pain establishes itself, becomes increasingly severe and lasts longer. Everyday life as well as physical and physiological well-being are seriously impaired. Trying to tolerate the pain is not an option; effective pain management can alleviate the symptoms considerably.

Headaches as the symptom of another disease

Headaches can also, albeit less frequently, be a symptom or result of another disease. For example, high blood pressure, hypertension and meningitis are all associated with headaches. Medical professionals then refer to secondary headaches. These must be closely monitored and the cause must be treated. Sunstroke, the flu or dehydration can also cause secondary headaches.

Targeted treatment

Given that primary headaches are not due to another disease, pain relief itself is the aim of treatment that is composed of a number of different components. In addition to pain medication, treatment plans can also include preventive measures, relaxation techniques and exercise. Your doctor will be able to offer you detailed advice.

It is essential that you describe your pain to your doctor as accurately as possible in the interests of a tailored treatment plan. To this end, keeping a pain diary or similar documentation can be useful. This allows you to note the type, duration, intensity and frequency of the pain and also potentially determine whether pain is experienced after certain activities or mealtimes.

App TK-Doc

With the TK-Doc app you can get expert medical advice about your problem from a doctor from the comfort of your own home.

Can pain be quantified?Our experience of pain is shaped by many physical and psychological factors. As such, it is difficult to assess how each individual perceives pain as well as the intensity of this pain so as to measure it against other days or the pain experienced by others. Pain is experienced and described differently by all of us. In order to enable comparisons nevertheless, a range of questionnaires and scales are available which can be used to record the personal pain experience as well as the nature, duration, trigger and frequency of pain attacks.

Deutsche Migräne- und Kopfschmerz-Gesellschaft (DMKG). URL: www.dmkg.de (Stand: 20.08.2018).
Gaul, C.; Totzeck, A.; Nicpon, A.; Diener, H.-C.: Patientenratgeber Kopfschmerzen und Migräne. 3., überarbeitete und erweiterte Auflage Berlin: ABW 2016.
Göbel, H.: Erfolgreich gegen Kopfschmerzen und Migräne. Ursachen beseitigen, gezielt vorbeugen, Strategien zur Selbsthilfe. 8. Auflage Berlin, Heidelberg: Springer 2016.

S1-Leitlinie Clusterkopfschmerz und trigeminoautonome Kopfschmerzen, Deutsche Gesellschaft für Neurologie (DGN) (Stand: Mai 2015).
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S1-Leitlinie Therapie der Migräneattacke und Prophylaxe der Migräne, Deutsche Gesellschaft für Neurologie (DGN) in Zusammenarbeit mit der Deutschen Migräne- und Kopfschmerzgesellschaft (DMKG) (Stand: April 2018).
S1-Leitlinie Therapie des episodischen und chronischen Kopfschmerzes vom Spannungstyp und anderer chronischer täglicher Kopfschmerzen, Deutsche Gesellschaft für Neurologie (DGN) (Stand: März 2015).