Symptom >> Internal Medicine >> Neurology

Evening headache fixed on one eye and around the orbit

Introduction
Cause
Examine
Diagnosis

Introduction

Introduction The headache is fixed around one eye and around the eyelids. The episodes are mostly in the evening and are more common in cluster headaches. A cluster headache is one of the more serious headaches and is one of the vascular headaches. Named for the onset of headaches over a period of time. Previous textbooks have used this disease as a subtype of migraine. In recent years, it has been identified as an independent disease entity because of its different pathogenesis, clinical appearance and migraine.

Cause

Cause

The cause is unknown, and the traditional view is that the disease is associated with vascular dysfunction.

Examine

an examination

Related inspection

Brain ultrasound examination of brain CT examination of brain MRI

The following points are available for reference:

1 vascular source said: some vasodilator drugs, such as nitroglycerin, histamine, ethanol, etc. can induce seizures, and vasoconstrictor drugs, such as ergotamine, norepinephrine, etc. can ease. Some studies have found that the diameter of the middle cerebral artery in the cavernous sinus segment of the pain side is enlarged at the time of onset, and becomes smaller after the onset of the attack Transcranial Doppler examination showed that the average blood flow velocity of the middle cerebral artery in the pain side was significantly higher than that in the contralateral side and higher than the remission period, while the anterior cerebral artery velocity in the pain side was lower than the contralateral side. Thermal imaging examination revealed an increase in heat dissipation in the painful lateral sac area. It has been found that there are inflammatory changes in the supraorbital vein and cavernous sinus during the episode of the cluster, leading to ocular venous reflux disorder and activation of painful nerve fibers, causing eye pain, tearing, stuffy nose, runny nose and other symptoms.

2 neuronal sources: seizure pain occurs in the first and second branches of the trigeminal nerve, suggesting that it is related to the trigeminal nerve. It is possible that the trigeminal nerve is subjected to retrograde stimulation, which induces the release of substance P and other vasoactive peptides, causing vasodilatation and headache. The symptoms of autonomic nerves on the side of the pain suggest that the sympathetic nerve excitability is decreased and the parasympathetic nerve excitability is increased, indicating that autonomic dysfunction plays a role in the pathogenesis. It has been found that inflammation of the supraorbital vein and cavernous sinus may damage the sympathetic nerve fibers and cause autonomic symptoms. Therefore, it can be considered that vascular factors and neurological factors may play a role in the onset of headache. The seizures have obvious periodicity, and some are like a fixed clock, which occurs almost every day at a constant time. Therefore, it is suggested that there may be central nervous system dysfunction, such as neuronal dysfunction derived from the regulation of autonomic nerves in the posterior hypothalamus, hypothalamus. The anterior portion, such as the neurological dysfunction associated with the nucleus and the biological clock rhythm. The circadian clock is regulated by 5-HT, and some drugs that treat cluster headache can enhance 5-HT nerve conduction, suggesting 5-HT nerve dysfunction.

3 histamine said: histamine is a strong vasodilator, some patients with elevated histamine in the blood, subcutaneous injection of histamine can induce headache attacks, clinical symptoms are very similar to histamine response, the use of histamine desensitization treatment for some patients effective. In addition, it has been found that the patient's painful lateral skin mast cells increase, its activity is enhanced, the cells can synthesize and release certain vasoactive substances, such as histamine, 5-HT and so on. According to this, the pathogenesis of the disease is related to histamine, but the exact mechanism and causal relationship are not clear.

Diagnosis

Differential diagnosis

Differential diagnosis of night headaches fixed to one eye and around the eyelids:

1. Headaches that occur at night are mostly caused by cluster headaches. Cluster headache (CH) used to be called histamine headache, ciliary neuralgia, pterygopalatine, migraine neuralgia, and Horton syndrome. It is a type of headache that is more common in middle-aged men and has a periodic clustering episode that is fixed to one eyelid and its surroundings. Cluster headaches (cluster headaches) are a series of stinging headaches that often occur at night. Cluster headache can cause a strong tingling sensation near one eye of the patient. Each headache can last up to 4 hours with symptoms such as red eyes, tears and runny nose.

2, local headache This is an vascular nerve headache, a functional disease. Vascular headache: The pathogenesis of cluster headache is the expansion of the extracranial artery when the patient has a headache, so it is traditionally classified as a special type of vascular migraine. However, this headache has no obvious relationship with endocrine disorders, and the menopausal episodes are not reduced. The serotonin in the plasma does not decrease at the time of onset, and the histamine increases, which is caused by the hypersensitivity of the neck vessels to histamine. Stress, drinking, taking nitroglycerin can be stimulated, and some people think that hypoxia can also be induced.