Dull head pain, no pulsation

Introduction The head is dull and painless, and pulsation is one of the clinical features of tension headache. Dull pain: slow pain, persistent, is a generalization of a variety of pain (such as pain, tenderness, etc.), more common in chronic diseases caused by headache, caused by insensitive pain tissue. Tension headache (TTH) is the most common type of headache, which is generally considered to be higher than migraine, accounting for about half of outpatient headaches. TTH is a diagnosis developed by the International Headache Society (IHS) in 1998 on the criteria for classification and diagnosis of headache, brain neuralgia and facial pain. The name is now widely used internationally. TTH included the content of muscle contraction headaches and psychiatric headaches classified by the AdHoc Committee in 1962. In the new classification, TTH is further subdivided into two subtypes based on the time of headache attack and periorbital muscle disease: 1 episodic tension-type (ETTH). 2 chronic tension-type (CTTH).

Cause

It is generally believed that tension headache is associated with cranial muscle disease or mental headache in a new classification, and TTH is subdivided into two subtypes based on the time of headache attack and cranial muscle disease:

1. episodic tension-type headache (episodictension-type, ETTH)

(1) Paroxysmal headaches associated with craniocerebral muscle disorders.

(2) Paroxysmal tension headaches that are not associated with craniocerebral muscle disorders.

2. Chronic tension-type headache (CTTH)

(1) Chronic tension-type headaches associated with cranial muscle disease.

(2) Chronic tension-type headaches that are not associated with craniocerebral muscle disorders.

an examination

Related inspection

Brain MRI examination EEG examination

The diagnosis of tension-type headache depends mainly on the patient's description of the location, nature and frequency of the headache. There were no abnormalities in general physical and neurological examinations. It is not difficult to confirm the diagnosis if the course of the disease has been more than 1 year and the brain has no abnormal CT or MRI. If the patient has a short course of headache, attention should be paid to the identification of various organic diseases in the brain.

The disease is more common in young and middle-aged children, and children can also get sick. There is no difference between men and women. The symptoms at the beginning of the disease were lighter and gradually increased. The clinical features of tension-type headache are dull pain in the head, no pulsation, headache in the top, valgus and occipital sometimes in the above-mentioned parts, all have pain or mildness, which is mild or moderate, and is not aggravated by physical activity. It is often complained that the top of the head is pressed tightly or the head is tight with a hoop. It is especially noticeable when the neck of the pillow is tight and stiff, and there is no fear of fear or fear. A small number of patients have mild irritability or depression. Physical examination included no positive signs of neurological examination. Cranial muscles such as the neck and occipital muscles, the top of the head and the muscles of the upper shoulders often have tenderness. Sometimes, the patient feels relaxed and comfortable. The CT or MRI of the brain should be free of abnormalities without hypertension and obvious ENT.

Differential diagnosis

1. Migraine: It is a vascular headache. It is common in young and middle-aged children and children. The headache is located on the side of the forehead. It is pulsating and jumping, often accompanied by nausea and vomiting. It can be visually impaired before a headache. There are blind spots or hemianopia and other auras in the blurred field of vision. It can also start a partial headache without any warning. It usually lasts for hours or days and relieves a very small number of patients with migraine persistence. A small number of patients with migraine may coexist with a tension headache, making it difficult to distinguish between the two.

2. Cluster headache: This type of headache may be vascular and associated with hypothalamic dysfunction. The headache is located on one side of the forehead and the full head headache is intense and without aura. The headache is rapid and can suddenly stop the episode with conjunctival hyperemia, tears and sputum and sweaty few hangs and sag every day and can occur several times in sleep. Each episode lasts for several tens of minutes to several hours, and can be consecutive Its a few weeks. However, the remission period can be as long as several months to several years. It is not difficult to identify the patient's history and seizures in detail.

3. Trigeminal neuralgia: a paroxysmal short-term pain in the distribution area of the facial trigeminal nerve. Each pain is only a few seconds, and it occurs several times a day to dozens of times. Pain, such as knife cutting, burning or acupuncture, is often induced by brushing, talking, and chewing. Patients often point to a location that induces pain, called a "trigger point." The disease occurs in middle-aged and elderly people, with more than 2, 3 branches of the trigeminal nerve. If the first branch is affected, it should be noted that it should be distinguished from ETTH.

4. Intracranial space-occupying diseases: headaches caused by such diseases include intracranial tumors, intracranial metastases, brain abscesses and brain parasitic diseases. Such headaches are often accompanied by jet vomiting and fundus edema due to increased intracranial pressure, but can be misdiagnosed as tension-type headaches in the early stage. For patients with short-term headaches, in addition to paying attention to fundus changes, careful nerves System checks are extremely important. If signs such as pathological reflexes are found, it is often indicated that it is not a tension-type headache, and brain CT or MRI should be used in time to help identify.

5. Intracranial chronic infection: caused headaches such diseases include tuberculous meningitis, fungal meningitis, cysticercosis (cysticercosis) meningitis and syphilitic meningitis. These meningitis are all early symptoms of headache, usually accompanied by fever, but some patients with atypical, low fever at the beginning and negative meningeal irritation are easily misdiagnosed as tension headache. Therefore, when asking about medical history, as long as there has been a history of "cold" or a suspicious pathological reflex in the past, the lumbar puncture should be considered in time to examine the pressure, cytology, biochemical tryptophan and ink staining of cerebrospinal fluid. . When necessary, blood and cerebrospinal fluid anti-tuberculosis antibodies, cysticercosis (cysticercosis) immunoassay and syphilis test should be tested to help confirm the diagnosis.

6. Autoimmune meningoencephalitis: headaches caused by such diseases include neurobehavioral disease, Vogt-Koyanagi-Harada syndrome, and central nervous system sarcoidosis. These diseases can cause inflammatory reactions and headaches when they involve the meninges or brain. They are not necessarily accompanied by fever, so they are easily misdiagnosed as tension-type headaches. The elimination of such diseases mainly depends on detailed medical history inquiry, comprehensive examination and examination. Brain CT or MRI examination. Meningoencephalitis type of neurobehavioral disease (Neuro-Behcet's disease) should have basic symptoms of the disease such as oral or external genital mucosal ulcers. Vogt-Koyanagi-Harada syndrome, also known as uveal meningoencephalitis, should have eye damage. Patients with a course of more than a few weeks often have white hair, hair loss and leukoplakia. Clinical manifestations of central nervous system sarcoidosis (neurosarcoidosis) often have brain Focal signs and brain CT or MRI showed granulomatous lesions.

7. Headache caused by abnormal intracranial pressure: such diseases include benign intracranial hypertension of intracranial hypotension syndrome and normal intracranial pressure hydrocephalus. Such patients are mainly headache-like headaches, and intracranial hypotension syndrome is caused by excessive absorption or decreased secretion of cerebrospinal fluid. Dehydration and infection may be the cause. Benign intracranial hypertension is often associated with visual impairment. Taking too much tetracycline or vitamin A, empty sella and may induce during pregnancy. Normal intracranial pressure hydrocephalus is common in the recovery period after traumatic brain injury or subarachnoid hemorrhage, and its pathogenesis may be related to cerebrospinal fluid absorption disorder. Such diseases can be identified by lumbar puncture to measure intracranial pressure and brain CT examination.

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