Headache after traumatic brain injury

Introduction Headache after craniocerebral injury: Early headache of craniocerebral injury is related to soft tissue injury, cerebral edema, intracranial hemorrhage, hematoma, infection, etc. Late headaches are quite common, mostly debilitating, called "traumatic neurosis" or "post-traumatic syndrome." However, a large proportion of patients have other headaches either concurrently or separately, and the mechanism is very complicated. It is related to the damage of local nerve vessels, vascular movement center, scalp, cervical muscle, cervical nerve root or head and neck, and some are related to the transient ischemia of vertebral artery caused by concurrent cervical spine injury.

Cause

It is related to the damage of local nerve vessels, vascular movement center, scalp, cervical muscle, cervical nerve root or head and neck, and some are related to the transient ischemia of vertebral artery caused by concurrent cervical spine injury. A small number of headaches are caused by late complications of trauma, such as intracranial hematoma, traumatic brain arachnoiditis, low intracranial pressure syndrome, spontaneous gas brain, epileptic headache, late-onset brain abscess, meningitis and so on. Therefore, the medical history should be inquired in detail and relevant examinations should be made to clarify the nature and type of headache. It is not advisable to diagnose the sequela of brain trauma without further analysis.

The pathogenesis of headache is complicated, mainly due to the stimulation of pain receptors in the intracranial and extranodal pain-sensitive structures, which are caused by the transmission of pain-sensing pathways to the cerebral cortex. Intracranial pain-sensitive structures include sinus (such as the sagittal sinus), anterior and middle cerebral arteries, cranial base dura mater, trigeminal nerve (V), glossopharyngeal nerve (IX) and vagus nerve (X), proximal part of internal carotid artery And adjacent Willis ring branch, brain stem midbrain aqueduct gray matter and thalamic sensory relay nucleus; extracranial pain sensitive structures including skull periosteum, head skin, subcutaneous tissue, aponeurosis, head and neck muscles and extracranial Arteries, 2nd and 3rd cervical nerves, eyes, ears, teeth, sinuses, oropharynx and nasal mucosa. Mechanical, chemical, biological stimulation and biochemical changes in the body can cause headaches in both intracranial and extranodal structures. If the intracranial or external arteries are dilated or pulled, the intracranial veins and venous sinuses are displaced or pulled, the cranial nerves and the cervical nerves are compressed, pulled or irritated, cranial and cervical muscle spasms, inflammatory irritation or trauma Meningeal irritation caused by various causes, abnormal intracranial pressure, dysfunction of intracranial serotoninergic neuron projection system.

an examination

Related inspection

Craniocerebral ultrasonography CT examination of intracranial pressure monitoring of brain MRI

Electroencephalogram and brain evoked potential abnormalities associated with primary craniocerebral trauma can be detected. Head CT, gas cerebral angiography, etc. have different changes depending on the patient's brain injury.

In the diagnosis of headache, the first distinction should be primary or secondary. Primary headaches are mostly benign, and secondary headaches are caused by organic lesions. The diagnosis of any primary headache should be based on the exclusion of secondary headaches.

The cause of headache is complicated. In the history of headache patients, the onset of headache, frequency of attack, time of onset, duration, location of headache, nature, degree of pain, presence or absence of prodromal symptoms, and clear predisposing factors should be asked. , factors that increase headaches and alleviate headaches.

At the same time, in order to better identify the cause and nature of headache, we should also fully understand the age and gender, sleep and occupational status, past medical history and accompanying diseases, history of trauma, history of medication, history of poisoning and family history. . A comprehensive and detailed physical examination, especially the examination of the nervous system and the skull and facial features, helps to find the lesions of the headache. Appropriate use of neuroimaging or lumbar cerebrospinal fluid and other auxiliary examinations can provide a basis for diagnosis and differential diagnosis of intracranial organic lesions.

Differential diagnosis

Need to be differentiated from the following symptoms:

Epileptic headache: more severe pain, mostly deep pain, bursting pain, often accompanied by varying degrees of vomiting, signs of nervous system damage, convulsions, disturbance of consciousness, mental disorders and even changes in vital signs.

Functional headache: Functional headache is also called psychogenic headache. It mainly includes neurasthenia, rickets, concussion sequelae, depression, and menopausal syndrome. Headaches often recurrent, mainly pain, irregular parts, ambiguous nature, no regularity, often have a cap-like contraction at the top of the head, or pull pain from the forehead to the neck, and there are many bugs on the top of the head. The feeling of going. In addition, often accompanied by dizziness, fatigue, multiple dreams, insomnia, memory loss, lack of concentration and other symptoms, long course, when the time is good.

Migraine: Migraine is a kind of pulsating headache that is repeated and is a big family among many types of headaches. Before the onset, there are often signs of flashing, blurred vision, numbness of the limbs, and the pain of one side of the head jumps from about a few minutes to an hour or so, and gradually increases until there is nausea and vomiting. Better to relieve headaches in a quiet, dark environment or after sleep. It can be accompanied by neurological and mental dysfunction before or during a headache. At the same time, it is a disease that can gradually deteriorate, and the frequency of onset is usually higher and higher. According to research, patients with migraine are more likely to have local brain damage than normal people, which may lead to stroke. The more times you have a migraine, the larger your brain will be damaged.

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