What if you have a pulsating headache

a headache

Causes & Symptoms

What types of headache are there?

A distinction is made between the following types of headache disease:
  • Primary headache disorders
    These include tension headaches and migraines, which can also occur in combination. Tension headaches have a dull, pressing or pulling character; Migraines are often pulsatile and affect one side of the head. The tension headaches are usually not that severe, do not worsen with physical activity, and do not cause nausea or vomiting. Cluster headache is also one of the primary headache disorders.
  • Secondary headache disorders
    This includes a variety of headache syndromes, each caused by a specific trigger.
  • Other headache disorders
    This group includes headaches of various types that are triggered by very special mechanisms. These include lightning-like shooting pains in the area of ​​individual cranial or head nerves, but also so-called central pain, which may occur months to years after a nerve pathway in the brain has been damaged.

Headache: causes of the discomfort

Various factors are involved in the development of primary headaches. There is some evidence that the predisposition to primary headaches is innate, even if they do not manifest themselves until later. Migraines, for example, occur more frequently in families.

In secondary headaches, the cause lies within the brain or in the area of ​​the head or neck. The main triggers include:
  • Accidental injuries to the head or cervical spine
  • Vascular disorders in the head or neck area
  • Changes in the cranial nerve water
  • Tumors in the head and neck area
  • Medication or drugs
  • Infections (meningitis)
  • Internal diseases (high blood pressure, thyroid, kidney, heart ...)
  • Diseases of the eyes, ears, nose, teeth and jaw
How a migraine attack develops is not yet fully understood. In the course of an attack, however, there are temporarily impaired electrical function of nerve cells in the brain, changes in blood flow and a disruption of the metabolic system. There can be a wide variety of triggers for the individual migraine attacks. These include hormonal fluctuations in women, changes in the sleeping / waking rhythm, stress and also relief after stress, alcohol or certain foods.

Symptoms: common signs of headache

The main symptom in headache disorders is of course the pain itself.
In addition, the symptoms accompanying the pain are also important building blocks in making a diagnosis.

Possible symptoms of primary headache disorders

  • Tension headache: bilateral, pressing headache of light to medium intensity; rarely sensitivity to light or noise
  • Migraine: one-sided, pulsating headache with sensitivity to light and noise, nausea and even vomiting, need for rest
  • Cluster headache: strictly one-sided, strong to very strong, pulsating headache in the area of ​​one eye; Reddening of the conjunctiva or tearing on the painful side; Runny nose or congestion on the painful side; Swelling of the eyelid on the painful side; Sweating on the painful side; unilateral constriction of the pupil on the painful side; physical restlessness
  • Trigeminal neuralgia (also: facial pain): strictly one-sided, strong, sharp, superficial stabbing pain for seconds in the forehead, upper or lower jaw, triggered by chewing, drinking, cold or warmth

Possible symptoms of secondary headache disorders

  • In the event of accidental injuries: broken bones, lacerations
  • With vascular disorders: Unilateral paralysis, speech disorders, swallowing disorders, double vision, tingling sensations in arms and legs, loss of consciousness, epileptic seizures
  • When the cranial nerve water builds up: tiredness, loss of drive, personality changes, loss of consciousness, epileptic seizures
  • For tumors: one-sided paralysis, speech disorders, personality changes, confusion, memory disorders, loss of consciousness, epileptic seizures
  • With infections: fever, drop in blood pressure, confusion, tiredness, loss of consciousness, epileptic fits
  • For internal diseases: rapid heartbeat, stumbling heartbeat, tremors, diarrhea, weight loss, fatigue
  • For diseases of the eyes, ears, nose, teeth and jaw: visual disturbances, hearing disturbances, tinnitus, bad breath, sensitivity to cold and heat

Migraine symptoms

The frequency of attacks can vary widely: from just a few attacks per year to multiple attacks per month. On average, it is once or twice a month. If left untreated, such an attack lasts between four and 72 hours. The headaches are typically throbbing and pulsating, mostly on one side, but can also affect the whole head. The beginning is often in the neck area. The affected side can switch from attack to attack or within an attack in the case of a half-sided headache. Physical activity usually makes migraine symptoms worse. In 10 to 15 percent of all migraine patients, what is known as an aura occurs before the actual headache attack, which can last up to an hour. This leads to visual disturbances, abnormal sensations or even speech disorders and paralysis. The most common form of aura are visual sensations. Typical is the appearance of flashes of light or a jagged ring in the field of vision. After the aura symptoms have subsided, the headache occurs.


Diagnostics: this is how we track down your headache

Our experienced neurologists can diagnose more than two-thirds of all headache disorders just through a detailed discussion with you and a thorough physical examination.

Additional technical examinations are always necessary if there is a suspicion of a secondary form of headache. Sometimes, however, we also arrange for further examinations for primary headache syndromes - whenever the type or frequency of known headaches changes noticeably or if a migraine has set in at an unusual time. Additional examinations can also be useful for people with headaches for the first time in order to rule out similar clinical pictures with a different cause.

Detailed conversation

In conversation with you, we will get to the bottom of your headache. We will ask you about:
  • the nature of your pain (for example: pressing, throbbing / pulsating, stabbing, tearing, electrifying)
  • the duration of your pain attacks (seconds, minutes, hours, days)
  • the location of your pain (for example: whole head, one side, behind the eye, upper jaw)
  • reinforcing or weakening factors (for example: change of position, intake of substances, times of day, female cycle)
  • the pain intensity between "0" (pain-free) and "10" (strongest imaginable pain)

Additional examinations for headaches

An additional examination can also relieve you of the worry of suffering from a serious illness such as a brain tumor or a stroke. The results of the imaging procedures computed tomography and magnetic resonance tomography contribute to mental relief.
A CT scan of the head provides tomograms of the brain, bones and blood vessels. The X-ray doctor can use this technique to detect a circulatory disorder or cerebral haemorrhage, for example. For the exact diagnosis of headaches, however, there are more precise methods.
Magnetic resonance imaging (MRI)
The MRI provides more detailed slices of the brain and blood vessels. Generated by a strong magnetic field, these can make even the smallest changes, such as inflammation, small swellings or pathological vascular sacs, visible.
In some cases it is necessary to take nerve water from the lumbar spine area. In the laboratory, it can then be proven relatively quickly whether, for example, there is a cerebral hemorrhage or meningitis. This examination is hardly painful, practically harmless and only takes a few minutes.
Sometimes a simple blood sample can be used to determine several values ​​that show typical changes in certain types of headache. Every headache patient should have undergone a laboratory examination at least once. The focus is on the blood count, the inflammation values, the thyroid values ​​and the kidney values.

Additional examinations for migraines

If symptoms are typical, a diagnosis of migraine can be made based on the description of the attack alone. In the case of atypical symptoms, on the other hand, we usually carry out additional examinations, such as magnetic resonance imaging or CSF puncture, in order to rule out other diseases. The first occurrence of an attack after the age of 40 also gives rise to further clarification, since migraines usually begin in adolescence or young adulthood. Differentiation from the other primary headache disorders is also important for treatment.