When a headache results from a structural alteration (nerves, muscles and blood vessels) or occurs following a medical pathology, such a headache is said to be secondary, for example, headaches due to a head injury or sinusitis. Other examples of secondary causes are headaches associated with infections, High Blood Pressure (systolic BP> 160 mmHg and / or diastolic> 120 mmHg), giant cell arthritis, sleep apnea, and excessive symptomatic medication for headache (more than 10 to 15 days per month, depending on the medication), for more than 3 months.


  • New onset of headaches, after the age of 40
  • “The worst headache ever” with the intensity reaching a peak in seconds or in a few minutes
  • A headache that starts or worsens significantly with exertion, Valsalva maneuvers, coughing or sneezing
  • When associated with mood changes or consciousness
  • When associated with vomiting without nausea
  • When associated with visual alterations
  • Associated with systemic signs or symptoms, e.g. fever, cold shivers, stiff neck, weight loss
  • When associated with neurological symptoms, e.g. loss of strength in the hand or leg, or neurological alteration detected during an examination
  • Alterations in the characteristics of a pre-existing headache
  • Headaches associated with posture changes e.g., Significant increase of pain when moving from a lying down position to a standing up position or vice versa
  • A headache that starts early in the morning or wakes the patient up during the night.


Treatment involves establishing the correct diagnosis of the type of headache in question, identifying and altering possible exacerbation factors (including medication), developing a plan for treating the headache during the acute phase, and determining whether there is a need for preventive treatment and what it should be.

More general measures can be recommended to prevent headaches:

- Avoid triggers: certain foods, sleep deprivation, fasting

- Altering eating habits

- Regular physical exercise.

During the acute phase of the headache the patient should have his/her "SOS Kit" already well defined. In addition to medication, it is also possible that rest in a quiet and dark room is recommend in the acute phase (in the case of migraines), learning to deal with stress (eg yoga practice). A crisis calendar is recommended to facilitate a more global approach to the type and profile of the headache in question.

There are other, specific and targeted treatments for more particular headaches, such as occipital nerve block, application of botulinum toxin, or the latest treatment for migraine prophylaxis monthly injection of monoclonal antibody of the CGRP receptor. All these treatments are available at the Headache Consultation of the HPA.