Headache Doctor Berlin

Migraine is characterised by unilateral, pulsating pain of moderate to severe intensity, often with nausea, vomiting, photophobia and phonophobia. Movement worsens it. Some patients experience aura – visual disturbance, sensory changes, very rarely paresis – preceding the pain phase.

Tension-type headache is bilateral, dull-pressing, mild to moderate, often increasing during the day, without nausea. Movement usually does not worsen it. Triggers include stress, sleep deprivation, neck tension, screen work.

Cluster headache is rare but very distinctive: strictly unilateral around eye and temple, extremely severe, with tearing, nasal congestion and conjunctival redness. Attacks last 15 to 180 minutes and often occur daily for weeks. These patients belong in specialist neurological care.

Sudden, devastating headache – thunderclap headache – is subarachnoid haemorrhage until proven otherwise. Every minute counts, 112 is the only correct response. Headache with neurological deficit such as paresis, speech disturbance, unilateral visual loss is also emergency (suspected stroke).

Fever with neck stiffness, photophobia and severe illness raises meningitis suspicion. This requires rapid inpatient diagnostics with lumbar puncture and imaging. A new-onset headache after age fifty also warrants careful workup.

Further warning signs: headache that progressively worsens; headache with seizure; headache with altered consciousness; headache after trauma; headache in immunosuppression or active cancer. In these situations rapid hospital evaluation is appropriate.

We start with structured history: onset, character, location, intensity, accompanying signs, triggers, frequency, medication intake. The throughline is recognising red flags – this gets particular attention.

Neurological examination covers consciousness, pupils, cranial nerves, sensation and motor function of extremities, coordination, meningismus testing, blood pressure and pulse. With abnormalities we organise CT or MRI in a Berlin hospital or private radiology practice.

For classic migraine or tension-type headache the diagnosis is clinical. We discuss acute therapy, provide rescue medication where useful, advise on trigger factors and issue a private prescription. For recurrent attacks we facilitate outpatient neurological follow-up.

For migraine attacks triptans such as sumatriptan, rizatriptan or zolmitriptan are first line. They work best when taken early in the attack. Antiemetics such as metoclopramide or domperidone complement when nausea is prominent. NSAIDs such as ibuprofen or naproxen are also effective and often combined.

Tension-type headache usually responds to paracetamol 1000 mg or ibuprofen 400 to 600 mg. Restricting intake to a maximum of 10 to 15 days per month is important to prevent medication-overuse headache.

For cluster headache, oxygen via mask (12–15 L/min for 15 minutes) and subcutaneous sumatriptan are the acute therapy. We can advise on site, but specialist neurological care is essential because prophylaxis with verapamil or other agents may be needed.

With frequent migraine attacks (4 or more per month or severe disability) prophylaxis is sensible. First-line options often include beta blockers such as metoprolol or propranolol, alternatives are topiramate or flunarizine. For refractory courses CGRP antibodies (erenumab, galcanezumab, fremanezumab) are a modern option, initiated in specialist hands.

For tension-type headache the non-pharmacological approach is central: regular exercise, stress management, sleep hygiene, ergonomic workstation design, physiotherapy. These measures often outperform any tablet and are gentler long term.

At the first house call we discuss lifestyle factors at length and facilitate contact with Berlin physiotherapists, osteopaths or the Reiche private practice for longitudinal follow-up. Medication prophylaxis is usually initiated in specialist neurological care.