Headache

Introduction Headache is one of the most common symptoms in the clinic. It is common in various departments, especially in nervous system diseases. The incidence is high. Almost 90% of the people in the population have headaches in their lifetime. Some people call headaches only. In the common cold disease, headache is actually a symptom, not a disease. It is usually limited to the upper part of the skull, including the eyebrow arch, the upper edge of the ear wheel, and the pain above the occipital bulge connection. There are many causes of headache, such as neuralgia, intracranial infection, intracranial space-occupying lesions, cerebrovascular diseases, extracranial head and face diseases, and systemic diseases such as acute infections and poisoning. The age of onset is common in young, middle-aged and old age.

Cause

First, physical and chemical factors

Intracranial and extracranial pain tissue is caused by inflammation, injury or compression, traction, stretching, displacement and other factors of the tumor.

(1) Headache caused by compression, traction, stretching or displacement of blood vessels:

Common in:

1, intracranial space-occupying lesions: such as tumors, abscesses, hematomas, etc., the blood vessels are compressed, pulled, stretched or displaced.

2, increased intracranial pressure: such as hydrocephalus, cerebral edema, venous sinus thrombosis, brain tumors or cerebral cysticercosis compression blockage.

3, intracranial hypotension: such as lumbar or spinal anesthesia or surgery, trauma, cerebrospinal fluid loss, leading to intracranial hypotension.

(2) Headache caused by expansion of intracranial and external arteries for various reasons:

Such as intracranial and extracranial acute infection, pathogen toxin can cause arterial dilatation; metabolic diseases such as hypoglycemia, hypercapnia and hypoxia; toxic diseases such as carbon monoxide poisoning, alcoholism, etc.; brain trauma, epilepsy, acute Hypertension (pheochromocytoma, acute nephritis, etc.).

(C), the meninges are chemically stimulated:

1. Bacterial meningitis: such as meningococcus, pneumococci, streptococci, staphylococcus, Escherichia coli, Pseudomonas aeruginosa, Curvularia, Neisseria gonorrhoeae, Aerobacter aerogenes, Klebsiella pneumoniae, Mycobacterium tuberculosis, Brucella Wait.

2, viral meningitis: such as enterovirus, herpes virus, arbovirus, epidemic mumps virus.

3, other biological infective meningitis: such as cryptococcus, leptospira, rickettsia, toxoplasmosis, amoeba, cysticercosis, schistosomiasis.

4, blood cerebrospinal fluid: such as subarachnoid hemorrhage, lumbar puncture wounded blood vessels and brain trauma caused by hard, soft meningitis and arachnoid inflammatory reaction.

5, cancerous meningitis: such as cancer meningeal metastasis, leukemia, lymphoma meningeal infiltration.

6, reactive meningitis: such as secondary to systemic infections, poisoning, and ear and nose infections.

7, ventricle or intrathecal injection of drugs or contrast agents: whether it is deep or non-deep as a chemical factor, animal tests have confirmed meningitis response.

(4) Long-lasting contraction of the head and neck muscles:

Such as head and neck muscles continue to contract, neck disease caused by reflex neck muscle contraction, such as cervical osteoarthrosis, neck trauma or stiff disc disease.

(5) Compression or inflammation of the cranial nerve, cervical nerve and ganglion:

Common trigeminal neuritis, occipital neuritis, tumor compression and so on.

(6) Radioactive pain caused by lesions in the eyes, ears, nose, paranasal sinus, teeth, etc., which may spread or reflect to the head and face.

Second, endocrine factors

Commonly seen in women, the first onset of migraine is often in adolescence, with a good menstrual period, a gestation period, and a tendency to stop menopause. Tension headaches tend to increase during menstruation and menopause. Menopausal headache, the use of sex hormones can stop the seizure.

Third, spiritual factors

Common in neurasthenia, rickets or depression.

an examination

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First, medical history

Headache is a common symptom of the nervous system. When inquiring about medical history should include:

1. The speed of headache.

2, the location and nature of the headache, is the whole headache or is limited to one side, is the forehead, the top area or the occiput or change. The nature of the headache can be pain, jumping pain, drilling pain, splitting pain, knife-like pain or dull pain.

3. The time and duration of the headache.

4, whether the headache has regularity, is continuous, volatility, or periodicity, must pay attention to the time position, head position and the action that causes the cerebrospinal fluid pressure to temporarily increase (such as exertion, sneezing, cough, defecation, etc.) .

5, the degree of headache, the degree of headache is affected by factors such as the location of the lesion, the degree of damage and individual reactions. The degree of headache does not reflect the severity of the disease, and there is no parallel relationship between the two. Whether the degree affects work and sleep.

6, headache induced aggravation and relief factors.

7, systemic diseases and head and face localized diseases such as eyes, ears, paranasal sinuses, teeth and mental factors.

8, accompanying symptoms of headache, with or without nausea, vomiting, blurred vision, flash, double vision, tinnitus, aphasia, convulsions, syncope and so on.

9, whether to treat, which drugs are effective, which drugs are invalid.

Second, physical examination

When there is no abnormality in physical examination, there should be a reasonable examination according to the medical history, such as fundus examination, head, ear, sinus, oral examination and presence or absence of signs of nervous system positioning. Students and elderly patients should pay attention to check their vision.

Third, auxiliary inspection

1, cerebral blood flow map or transcranial Doppler ultrasonography: timely migraine, cluster headaches.

2, brain CT or MRI examination: for suspected tumor, abscess, hematoma, increased intracranial pressure, hydrocephalus, cerebral edema, venous sinus thrombosis, cerebral cysticercosis.

3, lumbar puncture examination: for suspected intracranial inflammation such as meningitis, hemorrhagic diseases such as subarachnoid hemorrhage.

4, internal tiller examination: for migraine, headache caused by internal factors.

5, paranasal sinus flat: for sinusitis and so on.

6, EEG examination: for headache epilepsy, encephalitis and other diagnostics.

Differential diagnosis

Repeated headache

Headache epilepsy refers to the only manifestation of epileptic seizures with recurrent episodes. It accounts for 3.8% of epilepsy. It is more common in children and adolescents, and there is no significant difference in gender. From a sudden onset headache, some have aura before the attack, such as emotional anger, dizziness, nausea, gold flowers in front of the eyes. The frontal part of the headache area is more common, followed by the temporal area, the top area, and the eyelid area. The nature of pulsating pain is the most common, also manifested as pain, tingling.

2. Moderate or mild headache

Intracranial tumors, also known as brain tumors, are still unknown. Tumors originate from the brain, meninges, pituitary gland, cranial nerves, cerebrovascular and embryonic residual tissues, and are called primary intracranial tumors. A malignant tumor organized by other organs of the body is transferred to the intracranial, called a secondary intracranial tumor. Brain tumors are diseases that cause moderate or mild headaches.

3. Epileptic headache

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.

4. Intracranial headache

Intracranial headache refers to cerebrospinal fluid or lumbar puncture after trauma, so that the cerebrospinal fluid continues to exude too much from the puncture site to the outside of the meninges, resulting in a decrease in intraspinal pressure, and the posterior fossa pain sensitive tissue is pulled downward. The headache caused. Headaches are common after lumbar puncture.

5. Functional headache

Functional headaches are also known as psychogenic headaches. 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.

6. Migraine

Migraine is a kind of pulsating headache that is repeated and is a "big family" among many headache types. 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.

7, chronic daily headache

Referred to as CHD, it refers to frequent headaches that occur more than 15 days a month, and headaches last for more than 4 hours a day. Primary and secondary, primary CHD refers to headaches for more than 15 days per month without organic or systemic disease, a survey showing 4-5% of the total population in the United States, Europe and Asia Primary CHD, chronic tension headache (ie, neurological headache) is the first in CHD, and the main clinic visit is chronic vascular migraine.

8, intractable headache

Symptoms of persistent headaches that persist for many years.

9, local headache

This is an vascular neuropathic headache and is a functional disease. The examination should focus on the key points, that is, after considering the most likely one or several diseases according to the consultation materials, first check them to confirm or deny certain diagnoses as soon as possible. For example, patients with headache and vomiting should consider intracranial lesions if their medical history does not meet migraine, glaucoma, epilepsy, gastrointestinal lesions, etc., and a series of nervous systems and related laboratory tests should be performed as soon as possible until clarification diagnosis until.

10, cluster headache

Most of the headaches that occur at night are 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.

11, sudden and severe headache after sitting up

Often accompanied by nausea and vomiting, the intracranial pressure is further reduced, and the intracranial pain sensitive tissue loses the cerebrospinal fluid holding and is pulled, so it is a traction headache.

12, involved in headache

It spreads from the pain in the original lesion. 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.

13, diffuse headache

It is one of the clinical symptoms of vascular headache. Vascular headache is the most common type of headache in outpatients, because the cause of such headaches comes from blood vessels, so it is collectively called vasogenic headache. Angiogenic headaches are divided into two major categories: primary and secondary. Headache caused by vasomotor dysfunction of the head, called primary vascular headache; headache caused by clear cerebrovascular disease (such as stroke, intracranial hematoma, cerebrovascular disease, etc.), called secondary Sexual headache.

14, headache after head injury

Early headache of brain injury is related to soft tissue injury, cerebral edema, intracranial hemorrhage, hematoma, infection and so on. 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.

15, cervical headache

Headache caused by cervical bone lesions and soft tissue manipulation is called cervical headache or referred to as neck headache. The head and neck are inclined to one side, the head and neck are stiff and the neck is restricted, the body is cold, especially the lower limbs, headache is accompanied by face or chest and back sweating, dizziness, and dizziness. Some patients have alternating headache and dizziness, and the onset A typical trigeminal neuralgia episode.

16, tension headache

Also known as muscle contraction headache. A tight, compressed or dull pain of the head, more typically a banding sensation.

17, emotional headache

It is a common clinical manifestation. The part is not fixed. It is usually characterized by tightness of the head, feeling of pressure, numbness, pain, tingling, etc. It is closely related to mood fluctuations, fatigue and insomnia. The condition is fluctuating, often accompanied by symptoms of autonomic dysfunction such as palpitations, muscle twitching, sweating, flushing, numbness and weakness in the limbs. If the patient is generally in good condition and has a long course of disease, it may be understood from the most common aspects of depression, mental fatigue or rickets.

18, intermittent headache

It is one of the clinical manifestations of non-functional pituitary adenomas. Headache is one of the most common symptoms in the clinic. It is usually limited to the upper part of the skull, including the eyebrow arch, the upper edge of the ear wheel and the pain above the occipital kyphosis. There are many reasons for headaches, some of which are serious fatal diseases, but the diagnosis of the cause is often difficult.

19, neurological headache

Mainly refers to tension headache, functional headache and vascular nerve headache, mostly caused by mental stress and anger, Chinese medicine belongs to headache, brain wind, head wind category, belongs to qi and blood deficiency, liver yang sputum, blood stasis Caused by illness.

20, vascular headache

It refers to the clinical syndrome of vasomotor dysfunction and cerebral cortex dysfunction, or temporary changes in certain body fluids. It is characterized by paroxysmal pulsating jump, pain or drilling in one or both sides of the ankle. It may be accompanied by symptoms of vascular autonomic dysfunction such as visual hallucinations, photophobia, hemianopia, nausea and vomiting. It includes headaches caused by migraine, cluster headache, hypertensive headache, cerebrovascular disease (such as subarachnoid hemorrhage, cerebral hemorrhage, arteriovenous malformation, temporal arteritis, etc.).

21, menstrual headache

It is one of the common diseases of women and belongs to the category of "premenstrual tension syndrome" in modern medicine. The clinical manifestation is a headache episode 3 to 7 days before the menstruation, which is relieved or disappeared after passing or passing.

22, deep headache

More common in brain abscess, encephalitis, brain tumors, and radiate to the same side external.

23, postpartum headache

Postpartum headache is the main symptom, called "postpartum headache." Chinese medicine believes that it is excessive blood loss after childbirth, Western medicine believes that it is related to changes in hormone secretion.

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