Recurring headaches

Introduction Recurrent headaches: Headaches are one of the most common clinical symptoms. They are usually limited to the upper part of the skull, including the upper part of the brow arch, the upper edge of the ear wheel, and the area above the occipital kyphosis. There are recurrent heads.

Cause

Emphasis should be placed on the characteristics of the headache itself, such as the cause of the headache, the course of the disease, the time, location, nature, extent, and causes of exacerbations and alleviations, which may provide some clues or directions for the cause. Such as superficial acupuncture-like sharp pain, multi-cranial neuropathic pain, pulsating pain or pain in one side is vascular pain, and contraction pain and pain in the neck occipital, frontal, etc. are muscle contraction Headache and so on. Among them, it is especially important to find out whether the headache is paroxysmal (with a period of complete painlessness) or persistent (may be sometimes light and sometimes heavy), because once it is clear that it is a naive headache, if you understand the cause of the attack at the same time, You can greatly narrow down the scope of the cause and find out the direction of diagnosis as soon as possible. Such as:

1 Attack headache induced by head position and position change: may have low intracranial pressure syndrome, transient ischemic attack, cervical migraine, hypotension, intracranial mass, especially ventricular system mass.

early morning or night headaches made the author: You can have high blood pressure (after a long time lying brain vasodilation), early increased intracranial pressure (poor venous return after a long time lying), cardiac insufficiency (op. Cit.) And forehead sinusitis (poor drainage after supine), epilepsy, etc.

3 related to emotions, fatigue, etc. or incentives are unknown: there may be migraine, cluster headache, epilepsy, rickets and so on.

4 Short-term sharp pain after cold or injury: mostly neuralgia.

an examination

Related inspection

Brain CT examination of brain MRI

The examination should focus on the key points, that is, after considering the most likely one or several diseases according to the consultation materials, first check them to confirm or deny certain diagnoses as soon as possible. For example, patients with headache and vomiting should consider intracranial lesions if their medical history does not meet migraine, glaucoma, epilepsy, gastrointestinal lesions, etc., and a series of nervous systems and related laboratory tests should be performed as soon as possible until clarification diagnosis until.

Differential diagnosis

First, migraine, more common in young women, about 2 / 3 of patients have a family genetic background; 10% of patients have obvious visual dysfunction, aphasia and other aura symptoms before the onset; pain is more on one side, periodic Attack, each time the nature is similar, accompanied by sweating, dizziness, palpitation, pale or flushing, and even abdominal pain, diarrhea and other symptoms of autonomic dysfunction, vasoconstrictor ergotamine after use is significant, most patients experience years Symptoms gradually diminish or disappear after ten years to menopause.

Second, cluster headache, more common in middle-aged men, no aura symptoms before the attack, sudden at night or sleep, the pain is intensely intensive, and quickly reach the peak, starting from one side of the eye or a single side, The rapid expansion even spreads to the ipsilateral shoulder and neck, which is a pain or burning pain. The standing can be relieved, accompanied by pains such as flushing, tearing, and stuffy nose in the ipsilateral eye. It lasts for 10 minutes to 2 hours without obvious nervous system. Positive signs, if necessary, a histamine test can assist in diagnosis.

Third, the pain of sinusitis, often located in the forehead and nasal roots, morning exacerbation with nasal congestion, purulent sputum, etc.; some patients with neck muscle pain and post-headache due to secondary muscle contraction, examination of nasal discharge with purulent discharge lesions, The tenderness of the sinus is obvious.

Fourth, neurosis headache, is a common clinical manifestation, the part is not fixed, generally manifested as tight head, heavy pressure, numbness, pain, tingling and other levels of mood fluctuations, fatigue, insomnia, etc. Closely related usually has a long course of disease, and the condition is fluctuating, often accompanied by symptoms of autonomic dysfunction such as palpitations, muscle fibrillation, excessive sweating, flushing, and numbness in the limbs. The examination should focus on the key points, that is, after considering the most likely one or several diseases according to the consultation materials, first check them to confirm or deny certain diagnoses as soon as possible. For example, patients with headache and vomiting should consider intracranial lesions if their medical history does not meet migraine, glaucoma, epilepsy, gastrointestinal lesions, etc., and a series of nervous systems and related laboratory tests should be performed as soon as possible until clarification diagnosis until.

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