Pain

Definition and Frequency

Pain is an unspecific, physiological bodily reaction and can occur in any part of the body. The most common chronic headache-causing disease as well as the pain associated with nervous system injury will be outlined here.

Everyone has experienced a headache. More than half of all Germans suffer from one every now and then and a visit to the doctor is not necessary each and every time one occurs. You can treat the headache yourself if there is no known serious illness causing it. If, however, an acute headache with pain you have never experienced before suddenly appears, this is reason enough to go to the emergency room.

Migraines

The most common type of headache is the migraine. Approximately 1 in every 10 suffers from migraines in Germany with the majority experiencing their first attack in childhood or as a teenager. Migraines can affect people of all ages, most commonly occuring between the ages of 25 and 55. More women suffer from migraines than men and there are plenty of famous migraine patients throughout history such as Van Gogh, Napoleon, Elvis Presley and Elizabeth Taylor. 

A single migraine attack is defined as a prodromal phase, in which you are tired or moody as well as experience heightened sensitivity to light and noise. Next comes the so called aura phase, where it is possible to perceive flashes of light or zig zags, as well as speech problems, sensitivity disturbances, and even paralysis of one side of the body. The aura phase can last as long as an hour. Finally, the headache phase develops in which the pain is usually throbbing, often on one only side and becomes worse when moving around. Typical symptoms include light and sound sensitivity, nausea, and at times, vomiting. During the headache phase, migraine patients can be so sensitive that they prefer to lay in a dark, sound proof room without moving. After the headache phase comes the improvement phase where the patient is free of pain.

Migraine therapy is divided into 3 parts:
1. General measures
2. Migraine attack therapy
3. Migraine prevention

Alcohol and smoking can cause migraines. Red wine in particular is difficult for migraine patients. Stress is also a factor that cause trigger a migraine. What has been proven to reduce migraine are endurance sports such as jogging or Nordic Walking. During the actual migraine attacks, analgetics and Triptans are proven to help. Medicinal migraine prevention is recommended when a patient is experiencing more than 3 or 4 migraines a month or suffers from migraines that directly impact their professional and personal lives. 

Tension headaches

The most important differential diagnosis in migraines is the tension headache, which is often dome-shaped and occurs daily. As opposed to mirgraines, tension headaches often feel like dull pressure and pulling. Therapeutically, analgetics are often used as well as antidepressants in small dosages. Because tension headaches are connected to mental and physical stress, pyschotherapy treatment is often helpful.

Neuropathic Pain

Another important neurological pain group is neuropathic pain. There is a difference between pain caused agitation of pain receptors and pain caused by injury to the nervous system, which is neuropathic pain. 

Therapeutic options include medication (antiepileptics, antidepressants, antispastic, or strong pain medication). Non-medicinal therapy options include endoscopic sympathetic block (ESB), transcutaneous electrical nerve stimulation (TENS), and near spinal cord electrostimulation. Psychotherapy is also quite helpful in helping patients learn how to cope with pain.

Further Information

http://www.i-h-s.org/ (International Headache Society)
http://www.bash.org.uk/ (British Association for the Study of Headache)
http://www.americanheadachesociety.org/ (American Headache Society)