When do headaches become concerning?

A headache can have multiple causes: from migraines or tension headaches to more serious secondary conditions, such as cerebral haemorrhages. More than 70 per cent of Spanish residents have suffered some type of primary headache. Nevertheless, of those who have recurrent pain (caused mainly by migraines), the Spanish society of neurology (Sen) estimates that more than 40 per cent do not have a correct diagnosis.

These estimates coincide with those of neurologist Dr José Antonio Reyes of Hospital Vithas Xanit Internacional, who believes that between 40 and 50 per cent of headaches are not properly diagnosed.

That 40 per cent corresponds to approximately 100,000 people in Malaga province (65,000 of whom suffer from chronic migraines). "A migraine is a more intense and debilitating headache that affects a person's quality of life and daily activities. It can be unilateral, on one side of the head or the other. Sometimes it can be bilateral. It causes symptoms such as nausea or vomiting, sensitivity to light, sound or even smells," Dr Reyes says.

Many people spend up to six years waiting to receive a correct diagnosis, the Sen points out. This Sunday, 19 April, is National Headache Day.

"Migraines can occur with highly variable frequency: some people have an attack once a month or every few months, while others experience pain almost daily. If pain occurs more than 15 days a month, we call it chronic migraine," the neurologist says.

"It's a very debilitating condition that has a major impact on social, personal and professional life. It also affects young people, especially women, as it has a strong connection to hormones. It's very important to recognise it and diagnose it early in order to provide treatment tailored to the person," Dr Reyes states.

More than 1.2 million people in Malaga province have experienced headaches at some point, with migraines and tension headaches being the most common. Around four per cent suffer from chronic headaches. In Spain, headaches affect more than five million people and are the leading cause of disability in women under 50.

Why do so many people lack a correct diagnosis? According to Dr Reyes, this proportion primarily refers to migraines. "Many haven't even seen a doctor or they self-medicate. That's another problem. There are people with low-grade headaches or who have sporadic attacks or who can't see a doctor for various reasons and don't seek medical assistance," he says.

Dr Reyes also attributes the underdiagnosis to waiting lists. "By the time they finally see a doctor, six months or a year has passed, and the headache has disappeared or resolved on its own," he says. The Sen indicates that half of the patients self-medicate, "which makes the condition chronic."

The range of treatments available for migraines has expanded significantly in recent years. "We have the traditional treatments: drugs used for other conditions, such as antidepressants, beta-blockers (for high blood pressure) or anti-epileptics. But in recent years, various drugs known as anti-CGRP agents have been developed that act on the protein believed to be responsible for the onset of migraine. Now, this protein can be blocked, thereby controlling the condition. Their effectiveness increases the earlier the patient starts using them."

In any case, there is a wide variety of triggers. In general, migraines are considered genetic. Some people are more sensitive to hormonal fluctuations, others to changes in atmospheric pressure and weather or to their diet. Alcohol, chocolate and cheese can also trigger migraines, so it is best to avoid them. Added to this are fasting, lack of sleep, fatigue and stress.

"The most basic step is to see a doctor when the headache, regardless of the cause, significantly affects your quality of life," Dr Reyes recommends. Tailoring treatment to the individual is key.

There are more than 200 types of headaches. One very common type is tension headaches. "It's usually a bilateral headache, like a helmet squeezing. It causes moderate pain and doesn't usually cause nausea or discomfort. It's consistent and can occur on a daily basis, as it is related to stress, lack of sleep and certain medications. It can cause disability if not treatedproperly," Dr Reyes says.

As the Sen explains, migraines and tension headaches are the most common primary types: tension headaches affect about 60 per cent of the population, while migraines affect approximately 13 per cent. Cluster headaches affect 0.1 per cent of the population.