Headache at night

Introduction Headaches that occur at night are mostly 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. This type of headache can be described as a splitting headache. "Bundle headaches are said to be the most severe pain humans can bear," Paul Shanahan said. "Sometimes, patients can end their lives because they can't stand this intense, uninterrupted pain. So cluster headaches." Also known as 'suicidal headache'."

Cause

The cause of headache at night:

(1) Causes of the disease: The etiology of CH is unknown. The traditional view is that CH is associated with vascular dysfunction.

(B) pathogenesis: the pathogenesis of CH is not fully understood, there are several views for reference:

1. Vascular source said: Some vasodilator drugs, such as nitroglycerin, histamine, ethanol, etc. can induce CH attacks, and vasoconstrictor drugs, such as ergotamine, norepinephrine, etc. can alleviate. Some studies have found that the diameter of the middle cerebral artery in the cavernous sinus segment of the pain side of the CH is enlarged and becomes smaller after the onset of the attack. Transcranial Doppler examination showed that the average blood flow velocity of the middle cerebral artery in the pain side was significantly higher than that in the contralateral side, and higher than the remission period, while the anterior cerebral artery velocity was lower than the contralateral side. Thermal imaging examination revealed an increase in heat dissipation in the painful lateral sac area. It has been found that there is an inflammatory change in the supraorbital vein and cavernous sinus during the episode of CH cluster, which causes ocular venous reflux disorder and activates painful nerve fibers, causing eye pain, tearing, stuffy nose, runny nose and other symptoms.

2. The source of the nerve said: CH pain occurred in the first and second branches of the trigeminal nerve, suggesting that it is related to the trigeminal nerve. It is possible that the trigeminal nerve is subjected to retrograde stimulation, which induces the release of substance P and other vasoactive peptides, causing vasodilatation and headache. The symptoms of autonomic nerves on the side of the pain suggest that the sympathetic nerve excitability is decreased and the parasympathetic nerve excitability is increased, indicating that autonomic dysfunction plays a role in the pathogenesis of CH. It has been found that inflammation of the supraorbital vein and cavernous sinus may damage the sympathetic nerve fibers and cause autonomic symptoms. Therefore, it can be considered that vascular factors and neurological factors may play a role in the onset of headache. CH episodes have obvious periodicity, and some, like a clock, occur almost every day at a constant time. Therefore, it has been suggested that CH may have central nervous system dysfunction, such as neuronal dysfunction that regulates autonomic nerves from the posterior hypothalamus. The anterior part of the hypothalamus, such as the neurological dysfunction associated with the apparent nucleus and the biological clock rhythm. The circadian clock is regulated by 5-HT, and some drugs that treat CH can enhance 5-HT nerve conduction, suggesting a 5-HT nerve dysfunction.

3. Histamine says: Histamine is a strong vasodilator. Some patients with CH have elevated histamine in the blood. Subcutaneous injection of histamine can induce headache attacks. The clinical symptoms of CH are like histamine reaction, and histamine desensitization is applied. Treatment is effective for some patients. In addition, it has been found that CH patients have increased skin mast cells in the pain side of the ankle, and their activity is enhanced. The cells can synthesize and release certain vasoactive substances such as histamine and 5-HT. According to this, it is suggested that the pathogenesis of CH is related to histamine, but the exact mechanism and causal relationship are not clear.

an examination

Related inspection

Brain CT examination of the skull

Examination and diagnosis of headache at night:

The diagnosis of CH is mainly based on the history of its repeated cluster attacks and typical clinical symptoms. There is no positive neurological signs in the remission period, and there is no basis for laboratory and other auxiliary examinations.

Clinical manifestations: The disease is more common in young people (20 to 40 years old), males are 4 to 5 times female, and generally have no family history.

CH is divided into paroxysmal and chronic. There is no aura in paroxysmal CH. The headache is fixed around one eye and around the eyelid. The seizures are mostly in the evening, and the feeling of sensation or pressure around the eye and the eyelids is first developed. After a few minutes, it develops rapidly into severe pain or pain, and spreads to the ipsilateral frontal and occipital parts, accompanied by pain side. Conjunctival congestion, tearing, salivation, sweating, mild edema of the eyelids, and low vomiting. 60% to 70% of patients had Horner's sign on the disease side. The patient is very painful when he is having a headache. He is restless and rests for 15 to 180 minutes. After that, the symptoms disappear quickly and the original activities can still be carried out after the relief. The episodes are clustered, that is, one to several episodes per day, occurring at about the same time every day, some like a clock, almost at a constant time, and the symptoms and duration of each episode are almost the same. Cluster episodes can last for several weeks or even months, usually 1 or 2 episodes per year. Some patients have obvious seasonality, which is more common in spring and autumn. The CH remission period can last from several months to several years, and patients with symptoms above 60 years old are rare, suggesting that their course of disease has a tendency to relieve themselves.

Chronic cluster headaches are rare, accounting for less than 10% of CH. They can be converted from seizure CH to chronic, or they can be delayed into persistent episodes after seizures. The clinical symptoms of chronic CH are the same as the clinical symptoms of paroxysmal CH. Symptoms persist for more than 1 year, or although there are intermittent periods, but not more than 14 days.

Differential diagnosis

Symptoms of confusing symptoms at night:

(A) identification with migraine: cluster migraine attacks and typical migraine are easy to identify, but with atypical migraine (such as common migraine, facial migraine, etc.) is often difficult to identify. In the case of common migraine attacks, some patients have visual impairment or other vasospasm. Headaches are often universal and not limited to one side, nor are they characterized by continuous and intensive episodes. Facial migraine, although some patients have headaches on the face or in the same area as cluster headaches, but the pain is generally lighter and lasts longer. Of course, examinations of histamine can help with further diagnosis.

(B) Identification of vascular headache: The pathogenesis of cluster headache is the expansion of the extracranial artery during headache, so it is traditionally classified as a special type of vascular migraine. However, this headache has no obvious relationship with endocrine disorders, and the menopausal episodes are not reduced. The serotonin in the plasma does not decrease at the time of onset, and the histamine increases, which is caused by the hypersensitivity of the neck vessels to histamine. Stress, drinking, taking nitroglycerin can be stimulated, and some people think that hypoxia can also be induced.

The diagnosis of CH is mainly based on the history of its repeated cluster attacks and typical clinical symptoms. There is no positive neurological signs in the remission period, and there is no basis for laboratory and other auxiliary examinations.

Clinical manifestations: The disease is more common in young people (20 to 40 years old), males are 4 to 5 times female, and generally have no family history.

CH is divided into paroxysmal and chronic. There is no aura in paroxysmal CH. The headache is fixed around one eye and around the eyelid. The seizures are mostly in the evening, and the feeling of sensation or pressure around the eye and the eyelids is first developed. After a few minutes, it develops rapidly into severe pain or pain, and spreads to the ipsilateral frontal and occipital parts, accompanied by pain side. Conjunctival congestion, tearing, salivation, sweating, mild edema of the eyelids, and low vomiting. 60% to 70% of patients had Horner's sign on the disease side. The patient is very painful when he is having a headache. He is restless and rests for 15 to 180 minutes. After that, the symptoms disappear quickly and the original activities can still be carried out after the relief. The episodes are clustered, that is, one to several episodes per day, occurring at about the same time every day, some like a clock, almost at a constant time, and the symptoms and duration of each episode are almost the same. Cluster episodes can last for several weeks or even months, usually 1 or 2 episodes per year. Some patients have obvious seasonality, which is more common in spring and autumn. The CH remission period can last from several months to several years, and patients with symptoms above 60 years old are rare, suggesting that their course of disease has a tendency to relieve themselves.

Chronic cluster headaches are rare, accounting for less than 10% of CH. They can be converted from seizure CH to chronic, or they can be delayed into persistent episodes after seizures. The clinical symptoms of chronic CH are the same as the clinical symptoms of paroxysmal CH. Symptoms persist for more than 1 year, or although there are intermittent periods, but not more than 14 days.

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