Headache Center

Headache disorders are among the most common disorders of the nervous system. It has been estimated that almost half of the adult population have had a headache at least once within the year. Headache disorders, which are characterized by recurrent headache, are associated with personal and societal burdens of pain, disability, damaged quality of life, and financial cost. Repeated headache attacks, and often the constant fear of the next one, damage family life, social life and employment. The long-term effort of coping with a chronic headache disorder may also predispose the individual to other illnesses. For example, anxiety and depression are significantly more common in people with migraine than in healthy individuals.

Several hundred known types of headaches represent this area of medicine as one of the most complex.

Pulse Cardiology Center – Headache Center

The Pulse Cardiology Center within the Headache Center offers modern diagnostics and treatment of headaches and migraines.

Respecting the protocols of the International Headache Association, our center successfully applies diagnostic and therapeutic procedures that significantly improve the quality of life of people with headaches.

Above all, our experienced team of neurologists, cardiologists, radiologists and ENT specialists will carefully monitor for signs that your headache and dizziness may be a sign of something more serious. Dizziness with headache can sometimes indicate the need for emergency medical care that requires urgent treatment.

Headaches – the most common symptoms

The most common symptoms of headache described by patients are: throbbing or dull headache, nausea, vomiting, dizziness, complete or partial incapacity to perform daily professional or family duties, indisposition

It’s often alarming to have a headache or dizzines, sometimes at the same time. However, many things can cause the combination of these two symptoms, from dehydration to anxiety. The International Classification of Headache Disorders (ICHD) defines more than 150 different types of headaches.

Since headache can be a primary disease and a symptom of many pathological conditions that can be directly related to tissues and organs of the head, systemic disease or disease of distant organs, ie organ systems, the treatment of headache is very diverse and complex.

Treatment and diagnosis of headaches

Specially created examination packages within the Headache Center offer our patients fast and modern CT, ultrasound and Doppler diagnostics, specialists from all related medical branches (neurology, cardiology, radiology, internal medicine, vascular surgery), minimal waiting time and all that in one place.

Neurological package 1

Neurlogical examination              

Doppler ultrasound – blood vessels of the neck  

PACKAGE PRICE 10.000 din.        

Neurological package 2

Neurlogical examination              

Doppler ultrasound – blood vessels of the neck  

TCD       

PACKAGE PRICE: 15.000 din.       

Headache package         

Neurlogical examination              

Doppler ultrasound – blood vessels of the neck  

TCD       

Cardiologist examination             

Lab analysis       

Head CT scan    

PACKAGE PRICE: 36.000 din.       

How to cure a headache

Treatment of primary headaches includes a group of diagnoses with clearly defined symptoms and mostly effective therapy, which includes the use of medication, psychotherapy, electrostimulation of the fifth cranial nerve (trigeminal nerve), methods of physical therapy and newer methods of treatment.

Treatment of symptomatic headaches involves a variety of treatment methods that are conditioned by a previously made diagnosis. The treatment of these headaches belongs to the domain of various specialties: neurology, neurosurgery, ophthalmology, maxillofacial surgery, otorhinolaryngology, infectology, internal medicine, dermatovenerology …

Headache Classification

Headaches are grouped into three main areas:

Primary headaches, Secondary headaches and Neuropathy – facial pain and other headaches.

1.Primary Headache

Primary headaches are the most common headache type. They are not caused by other anatomical or physiological abnormalities. They are not related to inflammation or infections.

These headaches include: migraines, tension headaches, trigeminal autonomic cephalgias, and other primary headache disorders.

Migraine

Migraines are intense headaches that happen on one or both sides of your head. People who often get migraines describe the pain as throbbing. This intense pain can be accompanied by dizziness.

Other symptoms include:

  • nausea and vomiting
  • sensitivity to light or sound
  • trouble seeing
  • seeing flashing lights or spots

There’s no cure for migraines, but certain things may help to reduce your symptoms or prevent them in the future. The effectiveness of different treatments tends to vary from person to person, so it’s a good idea to work with your doctor to find a treatment that works best for you. 

Tension-type headache (TTH)

TTH is the most common primary headache disorder.

Episodic TTH,occurring on fewer than 15 days per month, is reported by more than 70% of some populations. Chronic TTH, occurring on more than 15 days per month, affects 1-3% of adults.

TTH often begins during the teenage years, affecting three women to every two men. Its mechanism may be stress-related or associated with musculoskeletal problems in the neck.

Episodic TTH attacks usually last a few hours, but can persist for several days. Chronic TTH can be unremitting and is much more disabling than episodic TTH.

This headache is described as pressure or tightness, often like a band around the head, sometimes spreading into or from the neck.

Trigeminal autonomic cephalalgias (TAC)

Primary headaches that occur with unilateral pain in the trigeminal distribution in the head. Occurs with cranial parasympathetic autonomic symptoms (such as eye watering, droopy eyelids or ptosis, nasal congestion), these features are lateralised and ipsilateral to the headache. Typically of short duration.

There are five different types of TACs:

  • Cluster headaches
  • Paroxysmal hemicranias
  • Short-lasting Unilateral Neuralgiform Headache Attacks (either with conjunctival injection and tearing (SUNCT) or cranial autonomic symptoms (SUNA))
  • Hemicrania continua
  • Probable TAC

Cluster headache is more common, the other three types of trigeminal autonomic cephalgia are fairly rare.

 

Cluster headaches

Characterised by severe unilateral pain, which has ipsilateral autonomic symptoms and often also causes restlessness and / or agitation.

Due to the severity of the pain, they can have a major impact on a patient’s quality of life.

The pain is located behind the eye and autonomic symptoms can include eye watering and nasal congestion.

Can last from 15 minutes to three hours and they occur in clusters. Clusters can last from weeks to months or sometimes over a year.

Cause is unknown, but it is thought to involve a coordinated, abnormal activity in the hypothalamus, the trigeminovascular system and the autonomic nervous system.

Appears that the hypothalamus has a major part in generating the state that initiates an episode. The attacks themselves likely also require involvement of the peripheral nervous system.

Risk factors for cluster headaches include:

  • A history of exposure to tobacco smoke
  • A family history of the condition

They can be triggered by alcohol and nitro-glycerine.

2.Secondary Headache

Headaches that can be related to an underlying medical condition or process, as well as trauma to the head or neck, infection or other disorders.

  • Many different types of secondary headaches, including occipital headacse, sleep apnea headaches, external compression headaches, idiopathic carotidynia headache, post-traumatic headache, medication overuse headache, trauma to the head and neck type headache, infections that cause headaches, substance abuse or substance withdrawal type headache and concussion.

Brain aneurysm

A brain aneurysm is a balloon that forms in the blood vessels of your brain. These aneurysms often don’t cause symptoms until they rupture. When they do rupture, the first sign is usually a severe headache that comes on suddenly. You may also feel dizzy.

Other symptoms of a ruptured brain aneurysm include:

  • nausea and vomiting
  • blurred vision
  • neck pain or stiffness
  • seizures
  • sensitivity to light
  • confusion
  • loss of consciousness
  • a droopy eyelid
  • double vision

If you have a severe headache and feel dizzy or notice any other symptoms of a ruptured brain aneurysm, seek emergency medical treatment.

Head injuries

There are two types of head injuries, known as external and internal injuries. An external head injury affects your scalp, not your brain. External head injuries may cause a headache, but usually not dizziness. When they do cause a headache and dizziness, it’s usually mild and goes away within a few hours.

Internal injuries, on the other hand, often cause both headaches and dizziness, sometimes for weeks after the initial injury.

Post-concussion syndrome

Post-concussion syndrome is a condition that sometimes happens after a concussion. It causes a range of symptoms, which usually include a headache and dizziness, for weeks or even months after the original injury. The headaches associated with post-concussion syndrome often feel similar to migraines or tension headaches.

Other symptoms include:

  • trouble sleeping
  • anxiety
  • irritability
  • memory or concentration problems
  • ringing in the ears
  • sensitivity to noise and light

Post-concussion syndrome isn’t a sign that you have a more serious underlying injury, but it can quickly get in the way of your day-to-day life. If you have lingering symptoms after a concussion, talk to your doctor. In addition to ruling out any other injuries, they can come up with a treatment plan to help manage your symptoms.

3.Neuropathy – facial pain and other headaches

Persistent burning or lancinating facial pain with no clear etiology may point to a diagnosis of neuropathic pain. Neuralgias are syndromes characterized by intermittent attacks of sharp and paroxysmal pain along the course of a nerve. The neuralgias involving the face are often misdiagnosed and seen initially by the dentist or otolaryngologist. Therefore treatment is often delayed and patients may unnecessarily suffer from neuropathic pain until someone correctly recognizes the signs and refers the patient to a neurologist.

Symptoms of neuralgia

When patients present with persistent burning or lancinating paroxysmal pain in the facial region and no clear etiology, one should consider neuropathic pain in the diagnosis. There are many modalities of therapy currently available for such patients. Early recognition and treatment will also avoid the long-term psychological and physiological consequences of chronic pain. All neuropathic pain patients should be screened for presence of anxiety or depression commonly seen in such patients. It is important to treat these common comorbidities for successful management of the neuropathic pain.

Occipital Neuralgia

Neuropathic pain originating in the back of the head along the distribution of the occipital nerves is called occipital neuralgia. The greater occipital nerve, which originates from the posterior root of the second cervical nerve in the neck, is the most common nerve to be involved. The lesser occipital nerve, arising from the posterior branch of the third spinal nerve in the cervical spine and situated behind the mastoid, is less commonly affected.

This neuralgia is characterized by sudden (paroxysmal) stabbing pain in the distribution (area of ​​nerve distribution) of the large, small or third occipital (occipital) nerve. The pain is sometimes accompanied by decreased sensation or dysesthesia (altered sensation) in the affected area. There may be continuous pain in the innervated area between occasional punctures. The affected area is sensitive to touch.

The pain can be temporarily relieved by applying a local analgesic – blocking the appropriate nerve. We must distinguish this neuralgia from the pain that is transmitted to the occipital area from the upper cervical vertebrae. Occipital neuralgia is common in athletes and is a consequence of compression (pressure) on the nerve. Occipital neuralgia can also be caused by a twitching injury to the neck.

If drug treatment has not given a favorable therapeutic effect (antiepileptics with antineuralgic effect), success is often achieved with surgical treatment (partial posterior rhizotomy directed to the C1-C3 root or microsurgical C2 gangliotomy).

Symptoms and signs of Occipital Neuralgia

The pain associated with greater occipital neuralgia is intermittent, sharp, jabbing or throbbing and usually starts in the suboccipital region at the base of the skull near the midline, involves the entire posterior and lateral scalp, and usually radiates towards the vertex. Insult or injury to the lesser occipital nerve will cause pain around the mastoid process and radiate to areas near the ear and lower temple. Pressure on the suboccipital region over the occipital nerve will reproduce pain with radiation. Severe cases may actually have Tinel’s sign in which tapping on the area of the nerve causes sharp, throbbing pain and tingling. One may encounter extreme tenderness upon palpation over the occipital notches and upper cervical region with paroxysms of pain. On sensory exam, there may be hypesthesia or dysesthesia or paresthesia in the posterior scalp. Patients may also report spasms of the para vertebral muscles and restriction of neck movements.

Glossopharyngeal Neuralgia

This is a rare type of neuropathic pain originating from the 9th (glossopharyngeal) and sometimes also the 10th (Vagus) cranial nerves. It is therefore also called vagoglossopharyngeal neuralgia.6 The glossopharyngeal nerve exits from the skull through the jugular foramen, behind the styloid process, to supply the tongue and pharynx (see Figure2). It is responsible for sensory and motor supply to the pharynx, taste and general sensations from the back of the tongue, external ear and internal surface of the tympanic membrane, and salivation (supply to parotid gland). It also receives fibers from the carotid body and sinus and participates in the maintenance of blood pressure and sympathetic tone of blood vessels.

Glossopharyngeal neuralgia is manifested by repeated attacks of severe pain in the supply area of the 9th cerebral nerve (posterior part of the pharynx and tongue, middle ear).

Glossopharyngeal neuralgia sometimes occurs due to compression of the nerve by an aberrant, pulsating artery, similar to trigeminal neuralgia and hemifacial spasm. Rarely, the cause may be a tumor in the cerebellum or neck. Usually the cause cannot be determined. The disorder is rare, affecting men more often, usually after the age of 40.

Symptoms and signs of Glossopharyngeal Neuralgia

Typically patients have paroxysmal, lancinating pain on jaw movements, which radiate to areas innervated by the 9th nerve including external auditory canal and posterior oropharynx. These attacks of pain may be associated with syncope8, cardiac arrest, or even seizures, because of the close proximity of the glossopharyngeal nerve to the carotid body. Loss of taste at the base of tongue is sometimes reported. Neurological examination is usually entirely negative, but sometimes may show decreased oropharyngeal sensations, gag and cough reflex.

Sphenopalatine Neuralgia

 

Sluder first described this neuralgia in 1905 and observed that some patients recovering from inflammation of ethmoid and sphenoid sinuses were left with residual neuralgic pain. He attributed it to the spread of inflammation to the spheno-palatine ganglion and described a syndrome that included neuralgic, motor, sensory and gustatory symptoms. Sluder named it a “lower-half headache.”

The sphenopalatine ganglion is a small traingular structure situated between the sphenoid and maxillary bones, behind the middle turbinate of the nase, 1-9 mm from the lateral nasal wall but separated from the nasal cavity by mucus membrane. It is the relay station through which many nerves pass and therefore problems with this region will cause dysfunction of nerves passing through it. The nerves passing through this ganglion include the maxillary nerve (sensory supply to nose, palate, tonsils and gums), greater petrosal and deep petrosal nerves (taste sensation, lacrimation and salivation) and medial pterygoid nerve which innervates the muscles of the soft palate. Irritation of the ganglion may therefore cause problems in the sensory, motor and autonomic functioning of the nose, mouth, and throat.

Signs and Symptoms of Sphenopalatine Neuralgia

Unilateral burning or aching pain initially starts at the base of nose, and then involves the cheek, eye, teeth, frontotemporal and mastoid region. Bilateral pain can occur on rare occasions. A metallic taste before or during attack and decreased taste sensation have been reported. Parasympathetic hyperfunctioning during an attack of pain include lacrimation, conjunctival injection, nasal obstruction, rhiniorrhoea and serous nasal discharge.

On neurological exam, there may be either loss of sensation or hyperesthesia of soft palate, pharynx, tonsils or nose. Sometimes elevation of the palatine arch on affected side and deviation of the uvula to the non-affected side can be seen.

Combined Hyperactive Dysfunction Syndrome

 

Multiple cranial neuralgias involving the 5th, 7th, and 9th cranial nerves can occur together in the same patient. Thus a patient may present with trigeminal neuralgia (irritation of 5th cranial nerve), hemifacial spasm (irritation of 7th cranial nerve), and glossopharyngeal neuralgia at the same time. This condition is described as combined hyperactive dysfunction syndrome.14 This syndrome is most often secondary to irritation of the nerve roots due to compression by blood vessels which are usually situated too close to these nerve roots. Surgical treatment with separation of the artery from the nerve called microvascular decompression is the treatment of choice.

Treatment of combined hyperactive dysfunction syndrome

 

Surgical treatment with separation of arteries from nerves called microvascular decompression is the method of choice for treating this condition.

4.Other causes

  • Bacterial and viral infections
  • Dehydration
  • Low blood sugar
  • Anxiety
  • Labyrinthitis
  • Anemia
  • Poor vision
  • Autoimmune conditions
  • Medication side effects

Many things can cause a headache and dizziness at the same time.

If you or anyone else shows signs of a stroke, ruptured brain aneurysm, or severe head injury, seek immediate medical attention. If you are still not sure what is causing your headaches, make an appointment at the Pulse Cardiology Center and our team will be there after the diagnosis to help you treat the headache and its symptoms.

 

Several centers of excellence have been established within the Pulse Cardiology Center. You can get more information about our Centers by clicking on the links:

 

Dizziness Center

Stroke Center

Chest pain Center