Cephalalgia (headache)

Cephalalgia is the medical term describing pain in the head. It is a pain felt in the head, jaw, or upper neck. They can be occasional or recurrent, mild or very intense, and affect different areas (forehead, temples, back of the head…).
Headaches are not a disease in themselves: they are a symptom that may occur in many situations such as fatigue or stress, or may reflect a more specific neurological condition.

Symptoms vary depending on the type:

Tension-type headache

• Sensation of pressure, tightness, or a band around the head
• Continuous pain, mild to moderate
• Rarely associated symptoms
• Often linked to stress, fatigue, or poor posture

Migraine

Migraine is a specific type of headache, often more severe. It is not just a bad headache: it is a neurological disorder with specific features (ICHD3 criteria):
• Pulsating pain, often on one side
• Duration of 4 to 72 hours without effective treatment
• Sensitivity to light, sound, or smells
• Nausea or vomiting
• Sometimes preceded by visual, sensory, or motor disturbances called “aura”

Migraine is therefore a specific type of headache requiring tailored management.

Other types of headaches

Less common types include trigeminal neuralgia, cluster headaches, paroxysmal hemicrania, medication-overuse headaches, and secondary headaches due to underlying conditions.

Headaches are very common:

• Most adults experience at least one headache per year
• About 20% of adults report migraines yearly in Belgium
• Women are more affected than men
• Migraines and tension headaches are the most common

Management depends on the type of headache, its frequency, its intensity, and its impact on daily life. It is based on:

• An accurate diagnosis
• Identification of triggering factors
• An appropriate treatment plan
• Prevention of recurrence

Diagnosis

Diagnosis is mainly based on:

• Medical consultation: description of the pain, frequency, duration, and associated symptoms
• Clinical (neurological) examination
• International diagnostic criteria (e.g. number of attacks, duration, associated signs, etc.)

In most cases of primary headaches (such as migraine or tension-type headache), no additional tests (CT scan, MRI) are required as a first-line approach.

Treatment – Acute Phase

Objective: to relieve the attack when it occurs

For tension-type headaches:

• Rest and hydration
• Simple analgesics (paracetamol, ibuprofen, according to medical advice)

For migraine:

• Specific treatment to be taken at the first signs
• Medications such as triptans, sometimes prescribed by a doctor depending on the situation
• Anti-nausea medication if nausea is present

Treatment taken too late or too frequently may sometimes worsen headaches (rebound effect).

Chronic Treatment / Follow-up

If you experience frequent or disabling headaches:

• Keep a headache diary (date, duration, etc.)
• Regular medical evaluation with your general practitioner and follow-up with a neurologist if necessary
• Prevention with:
  • Lifestyle modifications (sleep, hydration, stress)
  • Preventive medications (by prescription)
  • Complementary techniques (physiotherapy, stress management, relaxation, physical activity, etc.)

For chronic or severe migraine, specific preventive treatments may be proposed. For these, it is necessary to complete and keep headache calendars throughout the course of the condition.