In the headache awareness month, neurologist Leandro Calia, a member of the SBC (Brazilian Society of Headaches) and the clinical staff of Hospital Albert Einstein, warned that people who usually have a headache, called headache in medical language, should look for medical help and not believing that the disease has no treatment. “It has control”, assured Calia, in an interview with Agência Brasil.
The neurologist explained that headache (pain) that occurs for more than 15 days a month for more than three months is called chronic headache. “This is called chronic daily headache.” Of the four types of chronic daily headache, the most common are chronic migraine and chronic daily tension-type headache. “Any one that lasts more than 15 days a month, for more than three months.”
According to Leandro Calia, the big difference between chronic headaches and episodic headaches is the greater impairment in quality of life in people who have chronic headaches. The term migraine should also not be used as a synonym for headache, warned the neurologist. “Is not the same thing.”
Calia points out that headache can be secondary, when it is a symptom of some disease, such as a tumor, meningitis, Covid-19, for example. But it can be primary, when it is a disease by itself, that is, there is no other disease causing the pain. “There, there are hundreds of types of headache.” Primary headaches include migraine and tension-type headache, cluster headache (frequent attacks). Calia warned that, like other diseases, such as diabetes, for example, primary migraine can be treated. “It has control,” she reiterated.
According to the specialist, the first cause of loss of a day of work, study or quality of life is migraine, under 50 years of age. “It’s not just any disease. It is a disease that greatly limits the quality [de vida] of people. In chronic migraine, the pain lasts for more than 15 days a month.”
He emphasizes that the person who has migraine should not deal with the disease as if it were something banal, simple, something or an excuse not to go to work. “People confuse a mild headache with a chronic migraine, which is hell.” According to Calia, only 30% to 40% of people who suffer from chronic migraine have a formal contract, because they can’t keep a job with pain that lasts more than 15 days a month.
The importance of raising awareness on the subject can be assessed by the following data, said Leandro Calia. Migraine alone affects 16% of women and between 4% and 5% of men, which means that 20% of the world population has migraine. Considering chronic migraine, which lasts more than 15 days a month, for at least three months or more, the number reaches between 1% and 2% of the world population. This means that for every 100 people, one or two suffer from this disease.
Calia stated that there is a stigmatization, or prejudice, in relation to migraine, against women, because migraine attacks the female population more. She also recalled that the first cause of disability in people who stop going to work or study, in the world, is low back pain. “But low back pain is a condition that comes from several diseases. Hundreds of diseases cause low back pain in any age group.” The second cause is migraine. But, considering people under 50 years old, migraine becomes the first cause, with economic impacts. “This is a worldwide problem.”
In Brazil, 2% of the population has chronic migraine, while 20% to 25% have migraine that does not last 15 days a month, for more than three months. “If it’s 10 to 12 days, it’s not called chronic,” Calia warned. To relieve the patient’s pain on the day it appears, specialists perform a rescue treatment with analgesics.
He explained, however, that “to treat is to have no pain. To treat migraine is to control the headache attacks so that they do not occur”. This is called preventive treatment. “It is the only treatment that would deserve the name.” You have to treat it so the pain doesn’t occur.
“Today, there are injectable drugs, administered at points in the frontal, occipital (posterior of the head), temporal and posterior regions of the neck, which relax the muscles. In this way, neurotransmitters are prevented from taking pain signals to the muscle, reducing perception by the central system”, added the neurologist and neuropediatrician Thais Villa, director of the Brazilian Headache Society, head of the Brazilian Academy of Neurology and member of the Advisory Board of the Committee on Headaches in Childhood and Adolescence of the International Headache Society.
Leandro Calia explained that the patient can use injectable drugs once a month to reduce the frequency of pain. This is control, that is, decreasing the frequency of days with pain, decreasing the duration of each pain, the intensity of pain, increasing the positive effect of analgesic drugs when the person is in pain.
“Even when we can’t stop the pain, having control like this, patients are eternally grateful. They come out of hell. Today there are several treatments.” The big warning of awareness is to show people that they should not fall into the assumption that there is no treatment for chronic migraine. “See the doctor and get treated,” recommended Calia.
Anxiety, stress, depression, inadequate sleep routine are some conditions that can trigger migraine attacks, which last for up to 72 hours. Other important causes are insomnia, prolonged fasting, low water intake, sedentary lifestyle and excessive consumption of caffeine and alcoholic beverages.