Headaches, what could be more common? And at the same time of the most diversified as their causes, their occurrences and their level of pain vary.
This executioner of skulls makes you see all the colors... The impression of having your head compressed in a vice, flying away after a night's rest. Or the hammering sensation just above a temple for three long days. Or an unbearable pain around one eye as if you had been stuck with a knife, and several times a day.
We all think we know what headaches are, referred to by doctors as headaches. But in reality, their symptoms are as multiple as their causes are varied: according to the International Headache Society, there are more than 200 kinds!
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On what criteria to distinguish them? First of all, some are a disease in themselves, others are not. Many headaches occur secondary to another medical problem – hence the name secondary headaches. Often, they follow a fever, itself possibly synonymous with infection: Covid, flu, meningitis, encephalitis, etc. But they can also be induced by sinusitis, glaucoma, taking drugs or toxic substances, a psychiatric disorder, a tumor, a stroke, etc.
Certain characteristics should alert, they are real “red flags”. “The most alarming thing is a very sudden onset headache, with pain which, within a minute, goes on the intensity scale from zero to seven out of ten, or even more”, indicates Jérôme Mawet, neurologist at the University Hospital of Lariboisière-Fernand-Widal (Paris).
This "thunderclap" headache sometimes results from a vascular problem, and going to the emergency room quickly allows you to be taken care of in time. In addition, we must also worry about headaches that do not resemble the headaches to which we are accustomed, or that occur in someone who has never had one.
However, the worst is not the most likely. “Not all secondary headaches are serious, and the problem is generally resolved by the attending physician, who, if necessary, refers his patient to a neurologist or the emergency room,” insists Dr. Mawet.
Unusual, therefore necessarily distressing, the secondary ones are clearly distinguished from the primary headaches which are manifested by repeated attacks. The latter each have different symptoms, rhythm and intensity, which also divides them into many categories.
“Crises have invaded my daily life, it falls on me anytime. My life and that of my loved ones are coming to an end,” confides Emmanuelle. "Over twenty-four hours, I have a dozen crises, I sleep very very little, it's a real vicious circle", explains Diane to the media Brut. Emmanuelle and Diane suffer from chronic primary headaches – a situation experienced by between 3 and 5% of French people. “Simplified, this means that there are more days with headaches than without,” comments Dr Mawet.
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This high number of monthly crises makes the headaches of the two young women a very debilitating disease. Much more than another headache, felt by many French people: the so-called episodic tension headache, with pain in the neck, temples or forehead, which we sometimes feel at the end of the day, after ten hours of work with his back bent and his eyes glued to a screen.
“That one is a bit of a catch-all headache,” comments Dr. Mawet. There are both pains in the head born of muscle tension, and others resulting from stress and nervous tension. Without treatment, the pain sometimes disappears after half an hour, but can also persist for seven days in a row.
"Sedentary lifestyle, lack of physical activity, constraints, lack of sleep, stress and of course anxiety risk making headaches more frequent," emphasizes Anne Ducros, neurologist at the Montpellier University Hospital. Headaches can then be present 12 to 180 days a year, as for two to four out of ten adults. Or even settling down every other day, or even more, significantly altering the quality of life.
“In this case, we are talking about chronic tension headache, a disease that is difficult to treat and often masked by depression,” warns Michel Lantéri-Minet, neurologist at the Nice University Hospital Center. It is thought to be due to daily stress and malfunctioning pain control systems, much like another disease, fibromyalgia. And it is frequently associated with migraine, which accounts for two-thirds of chronic headaches, but is fortunately most often episodic...
Most of the time, in fact, migraine headaches are infrequent: no more than 12 days a year. Their intensity, however, is a notch higher than that of tension headaches. And they are associated with other disorders – digestive and/or sensory. So, when the level of pain or the frequency of seizures become too high, basic treatment is required.
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Even if the most excruciating pain is that of another and rare primary headache: cluster headache, nicknamed “suicide disease”. With her, during seizures, the pain in one eye is comparable to an amputation without anesthesia! Treating it is all the more complicated because the attacks may only be present for an interval of one to two months, then disappear for several years.
So much so that the patients wander from one consultation to another, without anything being detected: the delay in diagnosis is on average seven years! By surfing the internet, many end up guessing the nature of their illness. A headache distinct from migraine. And a thousand leagues from that, called circumstantial, which occurs for example by eating an ice cream that is too cold. Headaches are so varied…