A man in his 60s visited a doctor for a checkup due to frequent headaches. The test results were normal. Still worried, he visited another hospital, but the results were the same. "I'm sick, and I don't understand how CT and MRI show nothing wrong," he said.

Headaches, experienced by more than 90 percent of the population, are divided into two types -- primary and secondary headaches. If you have a normal CT-MRI scan of your brain and no brain disease to explain your headaches, you have primary headaches.

Primary headache means that the headache is both a symptom and a disease. This includes conditions such as migraines, tension headaches, and occipital neuralgia. These can be treated with medication, lifestyle changes, and understanding headaches.

On the other hand, secondary headaches are caused by brain disorders, including cerebral hemorrhage, brain tumors, and meningitis. They are diagnosed with a brain imaging test, and treating the problematic condition will resolve the headache.

Different types of primary headaches require different medications

Many types of primary headaches, including migraines and tensional headaches, are diagnosed based on the characteristics of the headache (frequency, duration, location, intensity, and accompanying symptoms). Primary headaches are classified because different medications work for different types of headaches.

Migraines, for example, are not just headaches but show a wide range of accompanying symptoms. They often come with dizziness, tension, numbness in the back of the neck, unilateral sensory disturbances, loss of balance, frequent motion sickness, digestive problems, vomiting, nausea, and vision changes.

Migraine is also not just a headache but a syndrome, a collection of symptoms that affect the nervous system of the brain. Like migraines, most headaches are characterized by symptoms that can be diagnosed in more than 90 percent of cases by taking a detailed history and planning a treatment plan accordingly.

Migraines, the most common primary headache, are most often genetic. When this condition is combined with chronic stress, overwork, and lifestyle issues, the headaches become more frequent and severe.

Lifestyle habits include posture, rapid weight loss, alcohol consumption, smoking, lack of sleep, and even dietary habits.

Treatment consists of preventive and acute phase treatment depending on the severity and frequency of the headaches. Preventive treatments include medications that reduce the activation of headache-related neurotransmitters in the brain.

Currently, magnesium, high-dose vitamin B2, antiepileptic drugs, beta-sympathetic blockers, calcium antagonists, antidepressants, and Botox injections are prescribed. Recently, anti-CGRP (calcitonin gene-related peptide) receptor blockers and antibodies have been introduced.

"In the case of mild headaches, painkillers can relieve symptoms, but overdose can turn into a 'drug overdose headache' that does not respond to medication," said Dr. Choi Young-bin, professor of neurology at GangNeung Asan Hospital. "When that occurs, it is important to stop all medications and give the body a period to eliminate the drug."

Another option is the occipital nerve block, performed in combination with pain medication or injections. Most often used to treat occipital neuritis, occipital nerve blocks are effective for various headache symptoms.

It also involves using an ultrasound to locate the occipital nerve and injecting a local anesthetic or steroid mixture between the muscle layers and around the nerve. This can relieve nerve compression and block over-activation of the occipital nerve.

Besides, it is known to induce a temporary nerve block but shows a lasting decrease in neuroactive substances in the brain. Despite these different treatment options, the most important aspect of treating primary headaches is understanding them.

For this reason, Choi recommends that patients keep a “headache diary.” That’s because they can see how their headaches relate to their daily lives.

"If you write down what happened to you when you had a headache, whether you were stressed or what you ate, and analyze it, you can identify certain patterns related to your headaches," Professor Choi said.

"Taking painkillers is not the only solution to headaches," Professor Choi said. "It is important to understand your headaches and go to the nearest hospital for proper diagnosis and treatment to improve your quality of life and to avoid fear, anxiety, and unnecessary tests by thinking it is a serious disease of the brain."