Referred headache

Introduction In some internal organs, a phenomenon of hyperesthesia or painful sensation occurs in a certain area of the body surface, which is called pain. The headache is caused by the spread of pain in the original lesion, which is a "related headache." The structural basis for causing pain may be: (1) The primary sensory fibers of the diseased organ enter the spinal cord and terminate on the unique secondary neurons on the one hand, and finally the neurons that are connected to the somatosensory structure with the lateral branches on the other hand. (2) The diseased organ and the primary sensory fiber of the corresponding body structure are finally the same secondary neuron. (3) There are different lateral altars distributed around the internal organs and corresponding body structures around the primary sensory neurons. The original lesions include vasodilatation, vascular traction, compression or extensional displacement, stimulation of the meninges, nerve stimulation, spasm contraction of the head and neck muscles, and radioactive traction of organs near the head.

Cause

(1) Causes of the disease

Common causes of headaches are:

1. Brain lesions

(1) Infection with meningitis, meningoencephalitis, encephalitis, brain abscess, etc.

(2) vascular lesions: subarachnoid hemorrhage, cerebral hemorrhage, cerebral thrombosis, cerebral embolism, hypertensive encephalopathy, cerebral insufficiency, cerebral vascular malformation, thromboangiitis obliterans.

(3) Space-occupying lesions: brain tumors, intracranial metastases, intracranial leukemia infiltration, intracranial cysticercosis (cysticercosis) or hydatid disease (hydatidosis).

(4) craniocerebral trauma: such as concussion, brain contusion, subdural hematoma, intracranial hematoma, sequelae of brain trauma.

(5) Others: such as migraine, cluster headache (histamine headache), headache-type epilepsy.

2. Extracranial lesions

(1) Skull disease: such as skull base recession, skull tumor.

(2) cervical spondylosis and other neck diseases.

(3) neuralgia: such as trigeminal nerve, glossopharyngeal nerve and occipital neuralgia.

(4) Headache caused by eye, ear, nose and tooth diseases.

3. Systemic diseases

(1) Acute infection: such as influenza, typhoid, pneumonia and other febrile diseases.

(2) Cardiovascular diseases: such as hypertension, heart failure.

(3) Poisoning: such as lead, alcohol, carbon monoxide, organic phosphorus, drugs (such as belladonna, salicylic acid) and other poisoning.

(4) Others: uremia, hypoglycemia, anemia, pulmonary encephalopathy, systemic lupus erythematosus, menstrual period and menopausal headache, heat stroke, etc.

4. Neurosis neurasthenia and snoring headache.

(two) pathogenesis

The main pathogenesis is:

1 vascular factors, intracranial and extracranial vasoconstriction, dilation and vascular traction or extension caused by various causes (intracranial space-occupying lesions on blood vessels, extrusion);

2 the meninges are stimulated or pulled;

3 The cranial nerves with pain (V, VI, X three pairs of cranial nerves) and the cervical nerves are stimulated, squeezed or pulled;

4 head, neck muscle contraction;

5 facial pain caused by facial features and cervical lesions;

6 biochemical factors and endocrine disorders;

7 neurological disorders.

an examination

Related inspection

Blood routine brain CT examination

Laboratory inspection

1. Blood biochemistry, electrolytes and cytology

Learn about changes in blood cells and biochemistry and their relationship to headaches.

2. Cerebrospinal fluid examination

It is important for the diagnosis of diseases such as subarachnoid hemorrhage and intracranial inflammation.

Film degree exam

According to the specific situation, EEG, brain ultrasound, radionuclide brain scan, cerebral blood angiography and other examinations. The rapid development of imaging diagnostic technology provides an important basis for the diagnosis of brain diseases. For example, CT scan and MRI have strong resolution on brain tissue, so vascular lesions (such as vascular malformations, cerebral aneurysms) and The diagnosis of space-occupying lesions (brain and malignant tumors) is of great help. It can show the location of the lesion, the size, the structural changes of the affected part and the degree of cerebral edema around it, and the pressure on the ventricles. Magnetic resonance imaging is better than CT in the diagnosis of cerebrovascular disease. Transcranial Doppler ultrasonography (TCD) can penetrate the skull and directly obtain intracranial blood flow information, which is of great significance for the diagnosis of cerebrovascular diseases and blood circulation in the brain. CT, MRI and TCD are non-invasive methods and are easy for patients to accept. They are an important means for diagnosing brain lesions.

Differential diagnosis

Differential diagnosis of headaches involved:

1. A headache accompanied by severe vomiting suggests an increase in intracranial pressure. Headaches can be seen in migraine after vomiting.

2. Headache with vertigo is seen in cerebellar tumors and vertebrobasilar insufficiency.

3. Headache with fever is common in systemic infectious diseases or intracranial infections.

4. Chronic progressive headache with psychiatric symptoms should pay attention to intracranial tumors.

5. Sudden increase in chronic headache and conscious disturbance suggest that cerebral palsy may occur.

6. Headaches with visual impairment can be seen in glaucoma or brain tumors.

7. Headache with meningeal irritation suggests meningitis or subarachnoid hemorrhage.

8. Headache with epilepsy can be found in cerebral vascular malformations, intracerebral parasitic diseases or brain tumors.

9. A headache with a neurological disorder may be a neurological headache.

10. Cluster headaches are more common in middle-aged men. There are no aura symptoms before the attack. When they are suddenly at night or during sleep, the pain is intense and intense and peaks quickly. It starts from the side of one eye or the side of the eye and expands rapidly. Even spread to the shoulder and neck of the same side, it is a pain or burning pain, standing can be relieved, accompanied by flushing, tearing, stuffy nose, runny nose, etc., the pain lasts for 10 minutes to 2 hours, no obvious nervous system Positive signs, if necessary, a histamine test can assist in diagnosis.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.