Forehead headache

Introduction The pain in the forehead is caused by the proliferation of pituitary adenomas in the forehead and the compression of nearby tissues. Sometimes it is cold and the wind can cause pain in the forehead. Because the forehead belongs to the Yangming Classic in the meridian theory of traditional Chinese medicine, the forehead pain is also called Yangming headache. 1 typhoid Yangming disease see headache. "Lan Room Secrets · Headache": "Yangming headache, spontaneous sweating, aversion to cold, slow and slow pulse, cohosh, pueraria, plaster, white peony." 2 headache in the Yangming meridian line. "Cold and sorrowful words and headaches": "A person who belongs to Yangming, who has eyes on his eyes and is in front of his forehead."

Cause

The proliferation of pituitary adenomas oppresses nearby tissues. Pay attention to the law of life, avoid excessive fatigue, excessive stress, and prevent sub-health status.

an examination

Related inspection

Endocrine function test of brain CT

1. Endocrinology examination:

Direct measurement of pituitary growth hormone, prolactin, adrenocorticotropic hormone, thyroid stimulating hormone, melanin stimulating hormone, follicle stimulating hormone, luteinizing hormone, etc. by endocrine radioimmunoassay, which has a very early diagnosis of pituitary adenoma Great help.

2. Radiological examination:

(1) Sella image: one of the basic inspections. In the case of pituitary tumors, the saddle can be unchanged. As the tumor grows, it can cause enlargement of the sella, bone destruction, erosion of the saddle back.

(2) CT scan: After enhancement with intravenous contrast agent, it can show pituitary adenoma of 5 mm size. Smaller tumors still show difficulty.

Differential diagnosis

Differential diagnosis of forehead headache:

First, migraine:

Migraine is a common chronic recurrent disease caused by episodes of intracranial and extracranial vascular movements and neurological dysfunction. The clinical features are sudden onset of severe head pain. The headache can be relieved automatically or after medication. Frequent recurrent attacks, intermittent No headaches and sequelae. The disease is quite common at home and abroad, and the prevalence rate accounts for about 10% of the population.

The cause of migraine may be related to genetic, neurological and endocrine disorders. Some migraine patients, especially those with aura migraine, have a family history. Many migraine patients have unstable autonomic nerve function, mental stimulation, environmental changes, Excessive fatigue, lack of sleep, etc. can easily cause headache attacks. The occurrence of migraine is often affected by endocrine. Many patients have migraine that begins in adolescence. Female migraine is often associated with changes in the menstrual cycle. Headaches can be stopped after amenorrhea, but there have been reports of increased seizures.

(1) Clinical features:

The first onset is mostly in the early stage of youth or adulthood, and there are more women than men. The incidence of children is not uncommon. The frequency of seizures varies from 1 time per month to several times a month, several times a year, occasionally as many as every Up to twice a week. The performance of migraine can be divided into the following five types:

1. Common migraine: The most common type, accounting for 80% of migraine, has no obvious genetic history, and the prodromal symptoms are not obvious. The headache is often: 1. bilateral, or start at one side and affect the opposite side. There are also bilateral episodes; 2. pulsation; 3. Severe patients can affect daily activities; 4. Stairs or similar daily activities can aggravate headaches, often accompanied by nausea, vomiting, photophobia and phobia. Headache time is generally longer, lasting 1-3d, often induced by mental stress and fatigue.

2, typical migraine: this type of migraine accounts for about 10% of migraine, 60%-80% have a genetic history, often starting from puberty, the incidence from 1 to several times a day to several times a month Wait, the interval is uncertain. The seizure is divided into three phases: 1. Prodromal phase: About half an hour before the onset of headache, the main manifestation is that there is a flashing dark spot on the contralateral side of the pain, sometimes it appears to be unilaterally hemophilic, and there may be speech disorders, lips, fingers numbness, Dizziness, pale complexion, general discomfort, etc. 2. Early stage of headache: sudden onset of pulsating headache after the disappearance of prodromal symptoms, mostly on one side of the face or top. 3. Headache period: Headache period: The headache gradually subsides and migrates to sleep, sometimes showing excitement and euphoria.

3, eye muscle spasm type migraine: patients with or without a history of migraine. The eye tendon of this side occurs when the headache gradually subsides after a migraine attack for 1-2 days. Most of the affected nerves are oculomotor nerves, followed by nerves. Resume after several days to several weeks. Unscheduled attacks, mostly on the same side. After multiple episodes, you may not heal for a long time. And can exclude the parasitic lesions.

4, retinal migraine: repeated blind spots in one eye or single eye blindness lasted less than 1h, after the appearance of eye symptoms to the headache interval of no more than 1h, but headache can appear before eye symptoms; and can rule out eye or vascular lesions.

5, childhood periodic syndrome (migraine allergies): may be a migraine aura or accompanied by migraine. It can be divided into:

(1) benign childhood seizures: often a very serious vertigo episode in healthy children, with short duration, with balance disorder, anxiety, nystagmus, vomiting. Other neurological examinations were normal and EEG was normal.

(2) Childhood alternating hemiplegia: infants with alternating hemiplegia, mental retardation and other paroxysmal symptoms such as tonic seizures, abnormal muscle tone, dancing hand and foot movements, or other abnormal eye movements, autonomic disorders .

(2) Auxiliary inspection:

1. Cerebral blood flow map: The main changes in the cerebral blood flow map of the migraine patients during the attack period and intermittent period are asymmetric amplitude on both sides, one side is high or one side is low.

2. Transcranial Doppler Ultrasound Scan (TCD):

(1) Intermittent seizure period: TCD can not identify typical and common headaches, and can only provide some basis for rheological changes, such as increased blood flow velocity, asymmetric flow velocity on both sides, vascular noise and unstable blood flow velocity. .

(2) migraine attack period: the average peak flow velocity (Vm) of patients with generalized migraine decreased, and the vascular murmur disappeared.

diagnosis:

1, medical history

General physical examination, neurological examination does not suggest organic diseases.

2, headache repeated attacks at least 5 times, each last for 4-72h, there are signs of sensation, movement or vision before the attack.

3, headache is limited to one side or both sides, showing a pulsating headache, moderate or severe, affecting daily life.

4, accompanied by nausea and (or) vomiting and other autonomic symptoms.

Second, tension headache:

The headache of persistent contraction of the head and neck muscles is called tension headache. There are two general conditions, namely, the contraction of the head and neck muscles causes headaches and reflex muscle contractions caused by neck diseases, such as cervical osteoarthrosis, neck trauma or cervical disc disease. Tension headache is a common disease caused by depression or anxiety in the head, face, neck and shoulder muscles and/or vasoconstriction ischemia. A few are caused by bad posture or other diseases of the head and neck. The onset age is more than 30 years old, more women, non-pulsating, long-term and frequent pain. This disease sometimes coexists with migraine, called mixed headache, and is more common in migraine attacks. No other findings were found except for the occasional discovery of muscle spasms.

There are several theories about the pathogenesis of tension headache:

1. Potassium ion pathogenesis theory.

2, the theory of increased sympathetic excitability.

3. Spiritual theory.

4, posture, tobacco and alcohol, etc., especially in a certain position for long-term work, such as desk workers, long bowed, bending neck, causing chronic, long-lasting neck muscle contraction, causing pain.

Clinical manifestations: more common in young adults, longer duration, characterized by persistent symptoms, light and heavy. The degree of headache is mostly mild to moderate pain. It is a constant pressure, heavy feeling, tightness, pressure on the back neck and scapular muscles, and sometimes one or more indurations can be reached. Myalgia nodules are caused by long-term muscle contraction, and these patients do not need to rest in bed. Headache episodes are often persistent after waking up, and some patients cannot fall asleep because of pain. Pain is more common in the posterior part of the occiput, the neck, sometimes on the ankle or top of the head, on the upper side or on both sides, sometimes accompanied by local pain. Often accompanied by photophobia, shame, and nausea, some patients may be accompanied by a brief flash and amblyopia. Psychological factors such as anxiety, depression, and poor mood are the main triggers. In addition, postures and positions defined by special occupations are also common causes of illness. The medical history should be asked in detail. Differential diagnosis of migraine and tension headache.

Third, cluster headaches:

Cluster headaches are also called mass headaches, histamine headaches. It is a neuro-vascular dysfunction disease characterized by headache, which is characterized by a weekly headache. The seizures appear to be in groups, characterized by repeated dense hair. More common in boys, the incidence can be related to histamine, prostate and so on.

(1) Clinical manifestations

The clinical manifestations are mainly headaches, starting from the side of the iliac crest, radiating to the sacral area on both sides, the forehead, the lower jaw (a few reach the neck). Most of each episode is on the same side. The nature of the headache is severe pain, deep, no volatility, explosive, and occasionally pulsating. A few are acupuncture-like or ice-like pain. The pain is mostly periodic, and each clustered episode is almost at the same time, and the duration is basically similar. More occurs from 10 am to 9 pm. Most last for 30min to 2h, the frequency of attacks is several times a day to once per cycle, an average of 1 to 3 times a day.

(two) accompanying symptoms

1, blood pressure, heart rate slowdown, arrhythmia, corneal tooth pulsation is significantly enhanced, especially on the pain side.

2, eye and nose irritation, pain, side of the eyes, tears, conjunctival congestion, nasal congestion and runny.

3, incomplete Horner syndrome pain side of the eye showed ptosis, pupil diminution. Increased sweating, such as: sweating on the forehead and face, eyelid edema.

4, a very small number of patients with headaches accompanied by flash illusion, flashing dark spots, facial numbness, dizziness and so on.

5, cluster headache - painful convulsion syndrome. Most of the two diseases occur simultaneously, and a few can occur sequentially.

(3) Auxiliary inspection

1, cerebral blood flow: common external carotid artery dilation, increased blood flow.

2. Hematological examination: 5-HF showed a moderate increase in the onset period, and the 5-HF level of whole blood decreased during the pain interval and remission period. Erythrocyte choline concentrations are reduced, manifested in acute attacks and remission periods.

3, EEG: a small number of patients may have abnormal changes.

4, ocular artery ultrasound Doppler examination: manifested as decreased blood flow to the eye artery.

5. Corresponding auxiliary inspection.

(4) Diagnostic basis:

A headache with a specific site, nature, and periodic attack. It has accompanying symptoms and signs of eyes, nose, face, etc. On the basis of the above symptoms, blood pressure and heart rate changes are accompanied.

Fourth, headache after brain trauma:

Headaches caused by traumatic brain injury involve organic factors and psychological factors. Organic factors such as head and neck soft tissue injury, skull fracture, intracranial hematoma, increased or decreased intracranial pressure, recurrent contraction of the head and neck muscles, dysfunction of the head vasomotor dysfunction can cause headaches.

1, acute traumatic brain injury: acute brain trauma in addition to coma patients can not complain, have varying degrees of headache. For example, patients with brain contusion and laceration, in addition to changes in brain function after traumatic headache, there are brain tissue edema, hemorrhage, tear, most of which are accompanied by traumatic subarachnoid hemorrhage. The patient had a longer coma after injury, and the headache was severe and lasted for a long time after waking, accompanied by high intracranial pressure, showing nausea and vomiting. Neurological examination may have localized signs. CT scans may show images of intracranial hemorrhage and skull fractures. Lumbar cerebrospinal fluid is bloody or microscopic with red blood cells. Severe patients may have cerebral palsy symptoms and signs.

2, chronic brain outside the country's headaches: chronic brain traumatic headache refers to headaches after brain trauma or headaches after brain trauma once eased and gradually worsened. Mostly due to subdural hematoma or effusion formed after traumatic brain injury. Clinical manifestations have varying degrees of history outside the brain, headaches have once eased or disappeared, and headaches gradually worsened after 3 weeks; nausea and vomiting occurred when the headache was severely cracked; There are positioning signs.

Five, headache type epilepsy:

Headache-type epilepsy is a special type of epilepsy, also known as vegetative seizures. It is a special type of epilepsy, although it is caused by different causes of hypothalamic dysfunction, with episodes of headache and autonomic symptoms. , generally no body twitching. Headache-type epilepsy is a simple partial seizure according to clinical seizures. With the progress of examination methods and research of water methods, it is simply divided into primary and secondary features that can not reflect the complex nature of epilepsy, genetic predisposition and epilepsy in the brain. Sexual pathological changes are its main pathogenic factors.

1, clinical manifestations: episodes of severe headache as the main symptoms, may be associated with nausea, vomiting, palpitations, excessive sweating, complexion changes, diarrhea and other autonomic symptoms. Headache is mostly in the forehead, sacral or unilateral ankle, occipital, top, a few full headaches; headache duration is 10min to half an hour, very few are more than 1h; generally no obvious aura, individual cases combined with epileptic seizures (Strong and clonic seizures); the age of onset is between 5 and 25 years old, and the typical case has a family history; the use of ergotamine is ineffective and the antiepileptic effect is obvious.

2, auxiliary examination: EEG mostly shows paroxysmal high amplitude or rhythm on both sides, paroxysmal or sporadic spikes, sharp-slow waves, spine-slow waves, a few are limited to sacral, apical, occipital The spine-slow wave is released, and in each case, each lead appears 6 times/second, and the positive phase spikes indicate that there is a dysfunction in the deep midline of the brain. Brain CT can detect primary lesions of secondary epilepsy.

3, diagnosis points: recurrent episodes of severe headache, self-remission, often accompanied by autonomic dysfunction. There were no positive signs in the onset or intermittent neurological examination. Conventional electroencephalography or induction tests show epileptic discharge waves. The general analgesics are ineffective, and the antiepileptic drugs are effective.

Six other headaches:

1. Headache caused by intracranial aneurysm: Most of them have similar migraine attacks after middle age. The pain is fixed on one side, no periodicity. Some patients may have oculomotor nerve paralysis or other cranial nerve symptoms, and may have arachnoid History of inferior vena cava, cerebral angiography can be diagnosed.

2, cerebral vascular malformations: more often in the beginning of headache, may have seizures or subarachnoid hemorrhage or cerebral hemorrhage history, cerebral angiography can be diagnosed.

3, intracranial tumors: early headache can be biased to one side, more persistent, may have focal symptoms and increased intracranial pressure such as headache, vomiting, papilledema, brain CT or MRI can confirm the diagnosis.

4, epilepsy: focal seizures in the type of sensory seizures, aphasia and motor seizures, the time course is far shorter than the migraine aura, and constantly headache. For episodes such as migraine that are not typical, it must be considered in combination with medical history.

In children with occipital lobe epilepsy, characterized by visual hallucinations, paroxysmal headaches, and disturbances of consciousness, the change in consciousness may be short and not obvious. In addition, EEG recordings of some migraine attacks can present focal slow activity, even sharp waves, spikes, especially hemiplegic and basilar artery type migraine. The difference is that there is no local abnormality or epileptic activity on the EEG when the migraine does not occur.

5, neurosis: neurosis headache rarely occurs from puberty; the onset time is not the same. Neurosis headaches, often accompanied by other complaints such as insomnia, memory loss, inability to focus, etc., are often present rather than seizures.

6. Chronic paroxysmal unilateral headache: This type of headache is similar to cluster headache. The difference is: duration is shorter 2-15min; seizure is more frequent; common in women; indomethacin is effective.

7. Headache caused by facial features: The lesions in the eyes, ears, nasal paranasal sinus, teeth, etc. can spread or reflect the radiation pain caused by the head and face. There are generally positive findings of local examination of the corresponding organs, such as local tenderness and purulent sinusitis in acute paranasal sinusitis.

8, psychogenic headache: When the external environment of the bad mental stimulation, the patient can cause anxiety, anxiety and other emotional reactions, such as neurasthenia, rickets or depression, often have headaches, called psychogenic headache.

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