Headaches and facial pain

Headaches and facial pain may have various causes, both neurological and non-neurological. In the first place, it is best to consult your GP about such issues, as he or she knows you best and can form an accurate picture of the nature and severity of your complaints. Furthermore, specialised advice is often not necessary for such complaints, nor are additional examinations required.

If a referral is necessary, you can contact the specialists at the Clinic for Headaches and Facial Pain in the Neurology service. The Clinic for Headaches and Facial Pain is a functional partnership made up of various disciplines that deal with headaches and facial pain from various points of view in a systematic manner.

Frequent headache types:

Tension-type headache

Symptoms

A tension-type headache is a mild to moderately serious, oppressive headache:

  • The headache usually affects both sides and can often be compared to the feeling of having a band around the head or wearing a cap or hat that is too tight.
  • The headache does not usually prevent ordinary everyday activities.
  • There is no nausea or vomiting, nor any over-sensitivity to sound or light.

Cause

The cause of tension-type headaches is still unknown. Tension-type headache is actually a collective term for headaches that do not fall within the criteria of the other types of headache. Tension-type headache is a rather confusing name as it suggests that the headache is due to tension and/or stress, which is not always the case. Another name could be ordinary headache without a known neurological cause.

Treatment

  • Some patients with tension-type headaches are helped by physiotherapy with relaxation exercises.
  • Drug treatment is sometimes started for long-lasting tension-type headaches.

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Medication overuse headache

Symptoms

This type of headache is caused by taking too many painkillers and occurs fairly frequently. It is still insufficiently well known to the general public and to care providers.

Treatment

Immediately discontinuing all painkillers, possibly in combination with medication, usually results in a clear reduction in the headaches after a brief ‘withdrawal period’.

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Migraine

Symptoms

Migraine is a severe, beating or thumping headache, usually on one side.

  • The pain is accompanied by nausea or vomiting.
  • Patients also have to contend with oversensitivity to stimuli such as sound, light and smells.
  • Physical exertion, such as walking upstairs, causes a clear worsening of the headache.
  • Most patients with a migraine attack prefer to go and lie down in the dark.

Untreated, a migraine attack lasts between four hours and a maximum of about three days. For approximately one in three patients, the migraine attacks starts with a so-called aura:

  • Moving flashes of light, coloured strands or black spots.
  • Patients sometimes also feel bothered in one arm or leg or the whole of one side of the body, or may even experience disrupted speech (difficulty in finding words, for example).

Although an aura like this can be very distressing, it always passes completely and usually lasts no more than one hour.

Treatment

Migraine treatment is always two-pronged:

  • Preventive treatment (often medication) to ward off attacks. Preventive treatment (with medication) is considered for patients who often have migraines (two or more attacks per month) and/or do not respond sufficiently to attack medication.
  • Drug-based treatment to suppress an attack (attack treatment). Treating the migraine attack itself often starts with the combination of a painkiller (paracetamol, for example) together with drugs to overcome nausea (e.g. Motilium® or Primperan®). If this proves insufficient or with very serious attacks, more powerful painkillers or even specific anti-migraine drugs (e.g. so-called triptans) are often prescribed.

Scientific research

The Neurology service is currently conducting research into preventive migraine drugs.

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Cluster headache

Symptoms

A cluster headache is a rare and often unrecognised type of headache:

  • A cluster headache attack consists of an extremely severe headache around the eye and/or the temple (always on one side), accompanied by a red and/or watering eye.
  • Sometimes patients also have a swollen or drooping eyelid, a narrowed pupil, a runny nose or conversely a blocked nose.
  • The attacks last for about 15 minutes to a maximum of three hours.

Patients often have numerous attacks during a specific period (a ‘cluster’), after which the headache can sometimes disappear again for a while. During a cluster like this, alcohol can trigger an attack. One clear difference compared with a migraine is that patients with a cluster headache do not want to lie down, but on the contrary display an urge to move around and are very restless.

Treatment

Cluster headaches and related headache types always require specialised neurological advice and structural imaging.

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