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Mi scoppia la testa… La risposta del Neurologo al mal di testa

Dottore ho spesso mal di testa e il medico di base mi ha consigliato di fare una serie di accertamenti. Quali sono i principali esami che si devono fare? Grazie Tiziana.

Risposta:
Sono poche le persone al mondo che possono affermare di non aver mai sofferto, almeno una volta , di mal di testa. Per molti però la frequenza e l’intensità degli attacchi di cefalea sono talmente elevati da compromettere e limitare sensibilmente la qualità della vita, un po’ come avviene, con le debite differenze, nel disturbo da attacchi di panico. Se trattata adeguatamente questa malattia migliora notevolmente, da evitare assolutamente è l’uso o meglio l’abuso sconsiderato di antidolorifici, abitudine purtroppo diffusissima, che non fa che peggiorarne le manifestazioni cliniche. Ma l’argomento è complesso e può essere oggetto di successivi approfondimenti. Relativamente al quesito posto, la prima cosa da dire è che la diagnosi della cefalea è essenzialmente clinica. L’anamnesi, l’insieme cioè di tutte le informazioni cliniche necessarie alla diagnosi, raccolta da un neurologo, deve essere completa e specifica. L’esame neurologico e l’esame obiettivo completano la fase di valutazione necessaria per la formulazione della corretta diagnosi che non è sempre così facile se solo si pensa che, secondo la IHS, la Società Internazionale delle Cefalee, esistono più di 200 tipi diversi di cefalea. In genere non sono necessari esami strumentali particolari, soprattutto quando il paziente soffre di mal di testa da anni. Quali le condizioni che invece richiedono la prescrizione di esami strumentali?
Esame neurologico positivo, che evidenzia cioè segni di chiaro significato patologico
Insorgenza improvvisa di una cefalea grave, la peggiore mai sofferta in passato e comunque diversa da quella consueta o progressivo e non giustificabile peggioramento di una cefalea preesistente.
Cefalea di elevata intensità insorta dopo i 40 anni
durata eccessiva dell’aura di emicrania con aura. Il termine aura si riferisce ai sintomi neurologici che precedono la fase del dolore ed ha in genere una durata media di 20-30 minuti
Comparsa del dolore dopo sforzi fisici, colpi di tosse o attività sessuale
Allo specialista il compito di stabilire le modalità di intervento. Sulla base della mia personale esperienza tendo a richiedere la risonanza magnetica cerebrale di routine solo nel caso di diagnosi “ex novo” di emicrania con aura, in soggetti molto giovani.

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