Dores de Cabeça (Cefaleias) - Tratamento em Lisboa

HEADACHES - Treatment in Lisbon

Specialised assessment and treatment for Migraine, Cluster Headache and Chronic Daily Headache in Lisbon - diagnosis, pharmacotherapy and neuromodulation

WHAT ARE HEADACHES?

Avaliação neurológica de Cefaleias e Enxaqueca — NeuroPsyque Lisboa

Headaches: when should you worry?

Headaches are very common, affecting children and around half of all adults. But not all of them are the same. They can arise from acute causes, such as infections, dehydration or sleep disorders, or from pain mechanisms related to the activation of nerves and structures in the brain, such as migraines or cluster headaches. It is therefore essential to identify the cause in order to choose the most appropriate treatment.

Signs and symptoms that warrant specialised assessment

Intense, pulsating and recurring pain
Episodes of moderate to severe pain, usually unilateral, pulsating, aggravated by physical activity and associated with nausea, vomiting or photophobia (intolerance to light).
Aura - temporary neurological symptoms
Visual, sensory or speech changes that can appear before or during the headache. They occur in around 30% of migraine cases.
Intense pain around the eye
Very strong pain on one side, near the eye, with tearing and a runny nose. This is typical of cluster headaches, one of the most intense pains there is.
Headache present 15 or more days per month
When the headache becomes chronic and daily, with frequent overuse of analgesics - requiring an even more careful approach to prevention and rehabilitation.

TYPES OF HEADACHE AND CLINICAL ASSOCIATIONS

Migraine - With and Without Aura

The most prevalent form of disabling primary headache. It doesn't have an acute cause - tissue damage or inflammation. Rather, it results from alterations in the brain itself - in the pain receptors. Migraine with aura is associated with greater cardiovascular risk and requires a specialised therapeutic approach.

Primary Headache

Cluster Headache - The Most Intense Pain

A rare but extremely intense type of headache that comes in attacks, often at the same time of day. It causes severe pain around one eye, with tearing and a runny nose. It is more common in men and requires specific treatment, both to relieve the pain and to prevent further attacks.

Trigemino-Autonomic Headache

Chronic Daily Headache and Analgesic Abuse

Present more than 15 days a month for more than 3 months. Often associated with excessive use of analgesics or triptans, creating a cycle of chronification that is difficult to break without a specialised multidisciplinary approach and a structured weaning strategy.

Chronic Headache

Secondary Headaches - Warning Signs

Headaches that signal an underlying pathology - intracranial hypertension, venous thrombosis, subarachnoid haemorrhage, meningitis, neoplasia, among others. Identifying warning signs (sudden onset, progression, fever, other neurological signs) is a priority in the initial assessment of any headache.

Diagnostic Alert

Cefaleias e enxaqueca — mecanismos neurológicos e tratamento

Migraine affects around 15% of the world's population and is the 2nd leading cause of disability globally - more than 50% of patients have never received adequate preventative treatment.

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CEFALEIAS: IMPACT, PREVALENCE
AND RESPONSE TO TREATMENT

Global and clinical data showing the burden of headaches and the benefit of specific treatments

34.6%

is the estimated global prevalence of headache disorders in 2023, confirming its enormous weight in public health

90%

of years lived with disability attributed to all headaches are caused by migraine - making it the 2nd leading cause of disability in adults under 50, according to GBD 2023

64%

of clinically significant reduction of headache index in chronic tension headache with combination therapy

-4.4days

of monthly migraine reduction with anti-CGRP antibodies, with evidence in more than 15,000 patients, and with excellent tolerability

Sources: clinical data, GBD 2023 Headache Collaborators - https://pmc.ncbi.nlm.nih.gov/articles/PMC12612381/, Holroyd et al. (2001), JAMA - https://pubmed.ncbi.nlm.nih.gov/11325322/, Cohen et al. (2009), JAMA - https://pubmed.ncbi.nlm.nih.gov/19996400/

TECHNOLOGY AND THE THERAPEUTIC ENVIRONMENT

tDCS - Estimulação Eléctrica Transcraniana

IMPORTANCE OF SPECIALISED CONSULTATION

Headache is the most frequent neurological complaint in health services, but also one of the most under-treated. Chronic self-medication with over-the-counter painkillers - simple analgesics, triptans, NSAIDs - is both a cause and a consequence of the perpetuation of headache, creating a vicious cycle that only specialised intervention can break. The absence of adequate preventive treatment results in years of disability, absenteeism from work, deterioration in quality of life and progression to chronic daily headaches.

Migraine and cluster headache have effective treatment - including state-of-the-art therapies such as anti-CGRP antibodies and EMT protocols - which can radically transform a patient's life when prescribed correctly.

At NeuroPsyque, the Headache consultation includes a structured neurological assessment with detailed characterisation of the headache pattern, identification of triggering factors and chronification, and the development of an individualised therapeutic plan combining acute treatment, pharmacological preventive therapy and non-invasive neuromodulation with EMT to reduce cortical excitability. Complete, integrated monitoring and adjustment of the plan according to the response are central components of our care model.

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Frequently Asked Questions

FAQ's on Headaches and Headaches

What should I expect at the first headache assessment appointment?

The first consultation includes a detailed characterisation of the headache pattern - frequency, duration, location, intensity, associated symptoms (nausea, photophobia, phonophobia, aura), triggering and relieving factors, and history of medication used. It is essential to bring a headache diary, if available. The neurologist will carry out a full neurological examination and assess the need for additional tests - neuroimaging, laboratory analyses or others - depending on the warning signs identified.

How do you distinguish migraines from other headaches?

Migraine is characterised by the presence of at least 5 episodes of pain lasting between 4 and 72 hours, of moderate to severe intensity, usually unilateral and pulsatile, aggravated by physical activity and accompanied by nausea/vomiting or photophobia (light) and phonophobia (sound). The presence of aura - transient neurological symptoms (visual, sensory or language) before the pain, confirms the diagnosis of migraine with aura. The neurologist uses the ICHD-3 criteria for the formal diagnosis.

What is medication abuse headache and how is it treated?

Drug abuse headache occurs when analgesics, triptans or opioids are overused (usually more than 10 to 15 days a month for more than 3 months), perpetuating and worsening the headache in a vicious cycle. Treatment requires a structured weaning process - progressive or abrupt withdrawal depending on the drug involved - under neurological supervision, often combined with preventive therapy and behavioural support to manage the transition period.

What treatment is available for chronic migraine?

Treatment is multidimensional: (1) acute treatment of crises - triptans, anti-inflammatories, anti-emetics; (2) oral preventive therapy - topiramate, valproate, propranolol, amitriptyline, candesartan; (3) state-of-the-art preventive therapy - anti-CGRP monoclonal antibodies (erenumab, fremanezumab, galcanezumab) with superior efficacy in refractory cases; and (4) non-invasive neuromodulation - single pulse EMT or rTMS, supraorbital neurostimulation - as an alternative or pharmacological complement. The plan is always individualised.

What role does EMT play in the treatment of headaches?

A Transcranial Magnetic Stimulation has an approved indication for various forms of headache. Single pulse EMT is effective in the acute treatment of migraine with aura. Low-frequency rTMS protocols on the occipital or motor cortex have demonstrated a significant reduction in the monthly frequency of attacks in chronic migraine. It is a non-invasive, safe treatment without the systemic side effects of pharmacotherapy.

What are anti-CGRP antibodies and for whom are they indicated?

CGRP is a substance involved in migraine pain. Anti-CGRP antibodies are drugs that block this mechanism and help prevent attacks. They are indicated for patients with high-frequency episodic migraine (≥4 days/month) or chronic migraine (≥15 days/month), who have not responded adequately to at least two oral preventive treatments.

Can migraines get worse with age? Is it a progressive disease?

Migraine has a variable course. In some patients, the frequency of attacks increases progressively over the years - especially in the absence of preventive treatment and with excessive use of painkillers - and can develop into chronic migraine. In other cases, the frequency tends to decrease after the age of 50-60, particularly in women after the menopause. Appropriate preventive treatment is the main modifiable factor in avoiding progression and chronicity.

When should a headache lead to a hospital emergency?

There are warning signs that require urgent assessment: (1) headache with sudden onset and maximum intensity (may indicate a haemorrhage); (2) new headache in a patient over 50 or with a known neoplasm; (3) progressive and persistent headache; (4) headache associated with fever, neck stiffness, altered consciousness or focal neurological signs; (5) headache following traumatic brain injury. In any of these scenarios, you should go to the emergency room or contact your doctor immediately.

Does NeuroPsyque monitor headaches on a recurring basis?

Yes. We follow people from the first diagnostic assessment through to treatment, including patients with episodic migraine, chronic migraine, cluster headache, medication abuse headache and other types of primary headache. The initial assessment is carried out at the Neurology. The therapeutic plan is adjusted according to the clinical response, with access to all available therapeutic options, including the latest generation. Contact us to book your assessment or request a second neurological opinion.

HEADACHES - Treatment in Lisbon

WHAT ARE HEADACHES?

Headaches: when should you worry?

Signs and symptoms that warrant specialised assessment