Headaches and the nervous system: why do we get headaches and when should we worry?

Headaches and the nervous system: why do we get headaches and when should we worry?

In this new episode of Pirates of Pain, our Medical Director, Dr. Jorge Orduña, welcomes Dr. Irina Dachesky, a specialist in neurology. Together they explore the intricacies of the nervous system, that complex wiring that allows us to feel but which, at times, becomes our greatest enemy. From the most common migraines to wrenching facial pain, we discuss how to identify and treat each condition.

Warning signs: when to go to the emergency room (red flags)

Not all headaches are the same. Our Medical Director, Dr. Jorge Orduña, and Dr. Dachesky stress the importance of identifying the “red flags” that require immediate medical attention:

  • Sudden headache: A pain that reaches its maximum intensity within seconds (possible subarachnoid hemorrhage).

  • Neurological symptoms: loss of strength on one side of the body, slurred speech or double vision (signs of a possible stroke).

  • Stiff neck and fever: May indicate infectious processes such as meningitis.

  • Change of pattern: A new headache in oncologic or immunosuppressed patients.

Migraine vs. tension headache: more than just pain

It is vital to differentiate primary headaches in order to apply the correct treatment:

  • Tension headache: Generally associated with stress and poor posture. It is an oppressive pain, often at the end of the day, which responds well to common analgesics and postural measures.

  • Migraine: It is a disease of a “hyperexcited” brain. It manifests with throbbing pain, nausea, photophobia (discomfort to light) and sometimes aura (lights or zigzags in the vision).

For migraine, we are experiencing a paradigm shift. Our Medical Director, Dr. Jorge Orduña, highlights the arrival of monoclonal antibodies and gepants, specific drugs that block the CGRP peptide responsible for the attacks, allowing patients to be “disease-free” for long periods.

Trigeminal neuralgia and cluster headache (cluster)

We are talking about the most intense pain known to medicine. Trigeminal neuralgia is described as “electric whiplash” to minimal stimuli such as brushing the teeth. On the other hand, cluster or “suicide” headache is an excruciating unilateral pain that wakes the patient up at night. In both cases, the approach must be specialized, combining modulating drugs with interventional techniques such as blocks or radiofrequency.

The danger of painkiller abuse

A key point addressed in the podcast is drug-overuse headache. Exceeding 10 or 15 monthly doses of painkillers can chronify the pain, creating a loop where the medication itself perpetuates the headache. Self-awareness and recording in a headache diary are essential for the specialist to be able to adjust the treatment without falling into this vicious circle.

Central sensitization: when the brain learns to hurt

Sometimes, the wiring of the nervous system becomes “miscalibrated” due to persistent or poorly treated pain. This is known as central sensitization. The brain amplifies signals that should not be painful, turning a brush into torture. This condition requires a multidisciplinary approach including neurology, pain units, psychology and rehabilitation.

Conclusion

As our Medical Director, Dr. Jorge Orduña, reminds us, we should not put up with pain or resign ourselves to it. Modern neurology offers an arsenal of tools so that pain does not become the protagonist of our lives. The first step is always self-knowledge and timely consultation with a specialist.