Throbbing headache

Introduction Before the onset of a headache, 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 about one hour, and gradually increases until there is nausea and vomiting. Get better, relieve headaches in a quiet, dark environment or after sleep. Since about 60% of patients have epilepsy in their families, the disease is genetically related. Endocrine factors, dietary factors and mood changes such as anxiety, anxiety, etc., as well as external environmental climate changes can also induce migraine.

Cause

(1) Genetic factors, because about 60% of patients can ask for family history, some patients have epilepsy in the family, so experts believe that the disease is related to heredity, but there is no consistent genetic form.

(2) Endocrine factors, vascular migraine is more common in adolescent women, frequent episodes during menstruation, seizures during pregnancy, recurrence after childbirth, and gradually reduce or disappear after menopause.

(3) Dietary factors, people who regularly eat cheese, chocolate, irritating food, or smoke or drink are susceptible to vascular migraine.

(4) Other factors, emotional stress, trauma, anxiety, anxiety, hunger, insomnia, poor external environment and climate change can also induce migraine.

an examination

Related inspection

EEG examination of brain CT

The patient's symptoms can be diagnosed.

Differential diagnosis

(1) Migraine (universal migraine) without aura is the most common. Paroxysmal moderate to severe pulsatile headache with nausea, vomiting or photophobia. Physical activity exacerbates headaches. At the beginning of the attack, there is only mild to moderate dull pain or discomfort, and severe pulsating or jumping pain is reached after a few minutes to several hours. About 2/3 of them are side headaches, but also bilateral headaches, sometimes painful to the upper neck and shoulders. The headache lasts for 4 to 72 hours and is usually relieved after sleep. There is a clear normal gap period between attacks. If 90% of the attacks are closely related to the menstrual cycle, it is called migraine during menstruation. At least 5 episodes of the above episodes can be made, except for various organic diseases inside and outside the skull.

(2) Migraine with aura (typical migraine) can be divided into two phases: aura and headache:

1. Aura: The most common visual symptoms, such as photophobia, flashing eyes, sparks, or complex visual hallucinations, followed by visual field defects, dark spots, hemianopia, or brief blindness. A small number of patients may have numbness, mild hemiparesis or speech impairment. Most of the precursors last for 5 to 20 minutes.

2. Headache period: often occurs when the aura begins to subside. The pain starts from one side of the jaw, the back of the ankle or the frontal area, gradually increasing to the half of the head, or even the entire head and neck. The headache is pulsating, jumping or drilling, and the degree gradually increases to a persistent severe pain. Often accompanied by nausea, vomiting, photophobia, and timidity. Some patients have facial flushing, a large number of sweaty conjunctiva congestion; some patients pale, apathetic, anorexia. An episode lasts for 1-3 days, and the headache is usually relieved after going to bed, but it is weak for several days after the attack. Everything is normal during the episode. The above typical migraine can be divided into several subtypes:

(1) Migraine with typical aura: including ocular migraine, hemiplegic migraine, and aphasia. At least 2 occurrences of the above-mentioned typical episodes have occurred, and the diagnosis can be established after the exclusion of organic diseases.

(2) Migraine with a prolonged aura (complex migraine): Symptoms are the same as (1). Threats persist in the onset of headaches, lasting more than an hour and less than a week. Neuroimaging examination revealed no intracranial structural lesions.

(3) Basal migraine (formerly known as basilar artery migraine): There are aura symptoms that are clearly derived from the brainstem or bilateral occipital lobe, such as blindness, bilateral temporal and nasal visual visual symptoms, dysarthria , dizziness, tinnitus, hearing loss, diplopia, ataxia, bilateral paresthesia, bilateral palsy or insanity. It disappeared within a few minutes to an hour, and then a pulsating headache in the bilateral occipital area was discovered. Everything is normal during the gap period.

(4) Migraine aura (with migraine allelic attack) without headache: There are various aura symptoms that are seen in migraine attacks, but there is time and no headache. When the patient ages, the headache can completely disappear and there is still a paroxysmal aura, but the symptoms are completely aura and there are fewer headaches. For the first time after the age of 40, an in-depth examination is required, except for thromboembolic TIA.

(3) Eye muscle paralysis migraine is rare. Most of the onset age is under 30 years old. There is a history of headaches fixed on one side. After a severe headache (eyelid or post-temporal pain), the ipsilateral ophthalmoplegia appears. The above face is most common. Paralysis resumes after several days or weeks. The onset of paralysis was completely restored several times, but some eye muscle paralysis could be left without recovery after multiple episodes. Neuroimaging does not exclude the intracranial organic lesions.

(D) Childhood benign vertigo (migraine isotopic) has a family history of migraine but the child has no headache. It is characterized by multiple, short-lived vertigo episodes, as well as episodic balance disorders, anxiety, with nystagmus or vomiting. The nervous system and EEG examinations were normal. Everything is normal during the gap period. Some children can turn into migraine when they are adults.

(5) Migraine persistence state: Migraine episodes have a duration of more than 72 hours (may be less than 4 hours of remission).

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