What are the risk factors for cephalalgia (headaches)?

From the Guidelines

Risk factors for headaches include stress, poor sleep quality, and menstruation, as well as lifestyle factors such as physical activity and poor physical fitness, which can increase susceptibility to headache development. According to a recent study published in Nature Reviews Neurology 1, predisposing factors and triggers are of limited importance in migraine, but menstruation is a notable exception, as some women's migraine attacks are exclusively or frequently menstruation-related. Other factors such as poor sleep quality, poor physical fitness, and stress can also contribute to headache development.

Key Risk Factors

• Stress
• Poor sleep quality
• Menstruation
• Physical activity
• Poor physical fitness
• Genetic predisposition, especially for migraines
• Medical conditions such as high blood pressure, infections, head trauma, and certain medications
• Environmental factors like strong smells, bright lights, and loud noises

Lifestyle Modifications

Lifestyle changes can benefit patients with poor sleep quality or physical fitness, and any changes should not result in unnecessary avoidance behavior, which can itself damage quality of life 1. Regular sleep schedules, stress management techniques, proper hydration, regular meals, and moderate exercise can reduce headache frequency. For those with recurring headaches, avoiding known triggers and maintaining consistent daily routines is essential for prevention.

Management and Prevention

Identifying personal triggers through keeping a headache diary can help manage and prevent headaches. Recognized risk factors for chronic migraine, such as female sex, high headache frequency, inadequate treatment, overuse of acute medications, and comorbidities like depression, anxiety, and obesity, should be addressed to prevent transformation to chronic migraine 1. Preventive medications like topiramate, onabotulinumtoxinA, and CGRP monoclonal antibodies can be effective in managing chronic migraine.

Clinical Considerations

When evaluating patients with headaches, it is essential to consider their medical history, lifestyle, and environmental factors to identify potential triggers and develop an effective management plan. Questions to ask patients about their headaches include frequency, time of day, character of pain, accompanying symptoms, and potential triggers like stress, sleep patterns, and food intake 1. By taking a comprehensive approach to headache management, healthcare providers can help patients reduce headache frequency and improve their quality of life.

From the Research

Risk Factors for Headaches

• Headaches are a common health issue, affecting approximately 90% of people during their lifetime 2
• Primary headache disorders, such as migraine, tension-type headache, trigeminal autonomic cephalalgias, and other primary headache disorders, are defined as headaches that are unrelated to an underlying medical condition 2
• Secondary headache disorders are defined as headaches due to an underlying medical condition, and are classified according to whether they are due to vascular, neoplastic, infectious, or intracranial pressure/volume causes 2

Symptoms and Diagnosis

• Patients presenting with headache should be evaluated to determine whether their headache is most likely a primary or a secondary headache disorder 2
• Evaluation should include symptoms or signs that suggest an urgent medical problem, such as:
  • Abrupt onset
  • Neurologic signs
  • Age 50 years and older
  • Presence of cancer or immunosuppression
  • Provocation by physical activities or postural changes 2

Treatment Options

• Acute migraine treatment includes:
  • Acetaminophen
  • Nonsteroidal anti-inflammatory drugs
  • Combination products that include caffeine 2, 3
• Migraine-specific treatments, such as triptans, can eliminate pain in 20% to 30% of patients by 2 hours, but are accompanied by adverse effects such as transient flushing, tightness, or tingling in the upper body in 25% of patients 2
• Other treatment options, such as gepants and lasmiditan, are also available for acute migraine treatment 2
• Preventive treatments, such as antihypertensives, antiepileptics, antidepressants, calcitonin gene-related peptide monoclonal antibodies, and onabotulinumtoxinA, can reduce migraine by 1 to 3 days per month relative to placebo 2

Treatment Guidelines

• The American Headache Society (AHS) recommends the use of triptans, acetaminophen, and non-steroid anti-inflammation drugs (NSAIDs) for the treatment of acute migraine attacks 4
• The Taiwan Headache Society published its treatment guideline for acute migraine attack in 2007, which recommends the use of migraine-specific triptans and migraine-nonspecific nonsteroidal antiinflammatory drugs (NSAIDs) as first-line medications for acute migraine attacks 4
• The use of acute treatment should be limited to a maximum of ten days a month to prevent medication-overuse headache 4, 5