Headache
Introduction
Brief introduction Headache is one of the common clinical symptoms. It is usually limited to the upper part of the skull, including the eyebrow arch, the upper edge of the ear wheel and the occipital kyphosis. The cause is more complicated, and it can be caused by intracranial lesions, extracranial head and neck lesions. It is caused by physical diseases other than the head and neck, neurosis, and mental illness. basic knowledge The proportion of illness: 0.02% Susceptible people: no specific population Mode of infection: non-infectious Complications: dizziness, epilepsy, disturbance of consciousness
Cause
Headache
Brain lesions (35%):
(1) Infected meningitis, meningoencephalitis, encephalitis, brain abscess, etc.
(2) vascular lesions: subarachnoid hemorrhage, cerebral hemorrhage, cerebral thrombosis, cerebral embolism, hypertensive encephalopathy, insufficient blood supply to the brain, cerebral vascular malformation, thromboangiitis obliterans.
(3) Space-occupying lesions: brain tumors, intracranial metastases, intracranial leukemia infiltration, intracranial cysticercosis (cysticercosis) or hydatidosis (hydatidosis).
(4) craniocerebral trauma: such as concussion, brain contusion, subdural hematoma, intracranial hematoma, sequelae of brain trauma.
(5) Others: such as migraine, cluster headache (histamine headache), headache-type epilepsy.
Extracranial lesions (20%):
(1) Skull disease: such as skull base recession, skull tumor.
(2) cervical spondylosis and other neck diseases.
(3) neuralgia: such as trigeminal nerve, glossopharyngeal nerve and occipital neuralgia.
(4) Headache caused by eye, ear, nose and tooth disease.
Systemic diseases and neurosis (15%):
(1) Acute infections: such as influenza, typhoid, pneumonia and other febrile diseases.
(2) Cardiovascular diseases: such as hypertension, heart failure.
(3) Poisoning: such as lead, alcohol, carbon monoxide, organic phosphorus, drugs (such as belladonna, salicylic acid) and other poisoning.
(4) Others: uremia, hypoglycemia, anemia, pulmonary encephalopathy, systemic lupus erythematosus, menstrual period and menopausal headache, heat stroke and so on. Neurasthenia and snoring headaches.
Pathogenesis
The main pathogenesis includes: 1 vascular factors, intracranial and extracranial vasoconstriction caused by various causes, dilation and vascular traction or extension (intracranial space-occupying lesions on blood vessels, compression); 2 meninges stimulated or pulled; 3 cerebrospinal nerves (V, VI, X three pairs of cranial nerves) and cervical nerves are stimulated, squeezed or pulled; 4 head, cervical muscle contraction; 5 facial and pain caused by facial and cervical lesions; 6 biochemistry Factors and endocrine disorders; 7 neurological disorders.
Prevention
Headache prevention
First, headaches caused by functional headaches or extracranial diseases:
1. Correct understanding of diseases, establishing self-confidence, headaches encountered in clinical practice, or the majority of functionalities. After examination, excluding organic diseases, it is best to believe in science and establish a victory. The belief in disease, actively cooperate with treatment, and eliminate the bad hints of the self;
2. Advocate regular living and working, adequate sleep, reasonable diet structure, quit bad hobbies; actively participate in interesting cultural and sports activities;
3. Actively treat the primary disease;
4, the correct role of drug prevention.
Second, for ordinary tension headaches, the best way is to avoid the nervous situation and any behavior that may lead to tension, which is easier said than done, but it is difficult to do it. Sometimes it is difficult to recognize a nervous situation; It is also difficult to avoid. If it is necessary to submit a report to the supervisor, be assigned to do typing for three consecutive hours, and the children at home are not obedient, etc., in some occasions, try to take certain precautions.
Don't stay in the same position for a long time, for example, avoid sitting on the desk for a long time, standing up and stretching your limbs, moving your muscles, talking to others about things that are not related to the current troubles or difficulties, relaxing, lying down and taking a break. Or wash a warm water bath to relax yourself. If this self-help therapy has no effect, you may want to seek medical advice. Consider other non-drug therapies that prevent headaches, such as biofeedback, relaxation therapy and other muscles that make the head and Vascular relaxation therapy.
Summer headache prevention and care
Headache is a common symptom of many diseases. There are three main types: neurological headache, infectious disease headache, and intracranial extracranial disease headache. The first two types of headaches are caused by the proportion of physical weakness or wind evil invasion. Most of them have a certain relationship with weather conditions. Clinical practice and modern medical research have shown that high temperatures, suffocating, thunderstorms, strong winds, and sudden changes in the weather often cause or aggravate headaches in summer, and summer diet and sleep often lead to headaches.
According to the specific impact of climate on headaches, common headaches in summer can be divided into three categories:
First, summer headache, this is a typical seasonal headache, it will occur in the summer, after the fall, the cure will be cured, the summer climate is hot, especially in the early summer when the temperature rises suddenly and the hot summer temperature exceeds 37 °C People with a history of summer are generally difficult to adapt, so the autonomic nerve function begins to disorder, loss of appetite, lack of sleep, fatigue of the whole body, headache often accompanied by low fever, the main cause of summer headache is weakness, lack of blood, should According to the summer treatment, in the summer to improve diet, eat more fruits and vegetables, while doing a good indoor cooling, to ensure a certain amount of sleep.
Second, cold drink headache, summer weather is hot like steamer, ice watermelon, ice beer, ice cream and other cold food and beverage products have become people's "pets", but when imported cold drinks, it will give a strong stimulation to the oral mucosa, which may make The nerves of the ankle skin produce radioactive pain that is not obvious to some people, but may cause acute exacerbations in some patients with a history of headaches (such as migraine), which often become tight after eating cold drinks. Closed, headache is unbearable, and even tinnitus or mild nausea may occur. Therefore, people with a history of headaches must eat less or not eat cold drinks. When a headache occurs, if it is not very serious, you can repeat partial massage with your hands to relieve Pain, if the headache is particularly severe, you should seek medical advice promptly.
Third, low-cranial headache, summer temperature is often higher than human body temperature, so sweat evaporation is the main way of heat dissipation, when the sweat evaporates too much, the human body is easy to dehydrate; in addition, because of the climate, summer food is easy to deteriorate, people eat The spoiled food is prone to acute gastroenteritis or bacterial dysentery, which causes vomiting and diarrhea, causing dehydration. After dehydration, when the body is dehydrated, when there is a change in body position, especially when standing, headache symptoms may occur, and when a headache occurs, bed rest should be performed, but No pillows are needed to keep the head low, and a certain amount of physiological saline can be input in order to eliminate and reduce dehydration.
Complication
Headache complications Complications, vertigo, epilepsy, consciousness
Increased intracranial pressure with severe vomiting; cerebellar tumor, vertebral-basal artery insufficiency often accompanied by vertigo; systemic infectious disease or intracranial infection with fever; intracranial tumors may be associated with seizures, mental symptoms and visual impairment; Patients with cerebral palsy may have disturbance of consciousness; meningitis or subarachnoid hemorrhage is often accompanied by meningeal irritation.
Symptom
Headache symptoms Common symptoms Tension headache Sunburn pain and pressure, tightness... Back pain, temple pain, intermittent headache, dizziness, chronic headache, neck headache, menstrual headache
Patients with headache should consult the medical history in detail, and conduct a comprehensive physical examination, pay attention to whether the blood pressure is increased, whether the cardiopulmonary function is normal, whether the body temperature is elevated, and suspected craniocerebral diseases should also be subjected to detailed neurological examination and fundus examination, if necessary, determination Intraocular pressure, in addition to glaucoma, check the head for trauma, scars, neck or not.
1. Incidence: Acute onset and fever are often caused by infectious diseases, sharp headaches, persistent, and varying degrees of disturbance of consciousness without fever, suggesting intracranial vascular disease (such as arachnoid Lower back bleeding), long-term recurrent headache or pulsating headache, mostly vascular headache (such as migraine) or neurosis, chronic progressive headache and symptoms of increased intracranial pressure (such as vomiting, slow pulse, optic disc) Edema should pay attention to intracranial space-occupying lesions, chronic headaches in young adults, but no intracranial increase, often due to anxiety, emotional stress, mostly muscle contraction headache (or muscle tension headache).
2. Headache area: Find out whether the headache area is unilateral, bilateral, forehead or occipital, partial or diffuse, intracranial or extracranial, which is of great value in the diagnosis of the cause. Migraine and cluster headache are on one side. The headache of intracranial lesions is often deep and diffuse. The headache area of deep intracranial lesions is not necessarily consistent with the lesion, but the pain is mostly radiated to the ipsilateral side of the lesion. The headache caused by hypertension is mostly in the forehead or the whole head. Department, general or intracranial infectious disease headache, mostly for head pain, subarachnoid hemorrhage or meningitis. In addition to headache, there is neck pain, eye-based headache is shallow and limited to eyelids Forehead or ankle, nasal or odontogenic is also superficial pain.
3. The degree and nature of headache: The degree of headache is generally light, medium, and heavy, but there is no parallel relationship with the severity of the disease. Trigeminal neuralgia, migraine and meningeal irritation are the most severe pain, and brain tumor pain is moderately moderate. Or mild, hypertensive, vascular and febrile diseases, headaches, often with pulsation, sometimes neurological headaches are also very intense, neuralgia is mostly electric shock or tingling, muscle contraction headache is mostly heavy pressure Feeling, tightness or jaw-like pain.
4. Time and duration of headache: Some headaches can occur at specific times, such as intracranial lesions often worsen in the morning, headaches of sinusitis often occur in the morning or morning, cluster headaches often occur at night, women Migraine is often associated with menstrual periods. Headaches of brain tumors are mostly persistent and may have remission periods ranging from length to length.
5. Factors that aggravate or relieve headaches: coughing, sneezing, shaking your head, leaning over can cause intracranial high-pressure headache, vascular headache, intracranial infectious headache and brain tumor headache, cluster headache when standing upright Can relieve, headache caused by acute inflammation of the neck muscle can be aggravated by neck movement; headache caused by chronic or occupational cervical tendon can be gradually relieved by activity, massage the neck muscle, migraine can be obtained after application of ergotamine ease.
Examine
Headache check
Laboratory inspection
1. Blood biochemistry, electrolytes and cytology: understand the changes in blood cells and biochemistry and its relationship with headache.
2. Cerebrospinal fluid examination: It is of great significance for the diagnosis of subarachnoid hemorrhage and intracranial inflammation.
Film degree exam
According to the specific situation, EEG, brain ultrasound, radionuclide brain scan, cerebral angiography, etc., the rapid development of imaging diagnostic technology provides an important basis for the diagnosis of brain diseases, such as CT scan, MRI and other brain Tissues have strong resolution, so it is important for the diagnosis of vascular lesions (such as vascular malformations, cerebral aneurysms) and space-occupying lesions (brain, malignant tumors), which can show the location, size, and location of the lesion. Structural changes and the degree of cerebral edema around the brain, ventricular pressure, etc., magnetic resonance imaging of cerebrovascular disease is better than CT, transcranial Doppler ultrasonography (TCD) can penetrate the skull and directly obtain intracranial blood flow information It is of great significance for the diagnosis of cerebrovascular diseases and blood circulation in the brain. CT, MRI and TCD are non-invasive methods and are easy for patients to accept. It is an important means for diagnosing brain lesions.
Diagnosis
Headache diagnosis
Differential diagnosis
1. A headache accompanied by severe vomiting suggests an increase in intracranial pressure, and a headache can be seen in migraine after vomiting.
2. Headache with vertigo is seen in cerebellar tumors, and vertebral-basal artery is insufficiently supplied.
3. Headache with fever is common in systemic infectious diseases or intracranial infections.
4. Chronic progressive headache with psychiatric symptoms should pay attention to intracranial tumors.
5. Sudden increase in chronic headache and conscious disturbance suggest that cerebral palsy may occur.
6. Headaches with visual impairment can be seen in glaucoma or brain tumors.
7. Headache with meningeal irritation suggests meningitis or subarachnoid hemorrhage.
8. Headache with epilepsy can be found in cerebral vascular malformations, brain parasitic diseases or brain tumors.
9. A headache with a neurological disorder may be a neurological headache.
10. Cluster headaches are more common in middle-aged men. There are no aura symptoms before the attack. When they are suddenly at night or during sleep, the pain is intense and intense and peaks quickly. It starts from the side of one eye or the side of the eye and expands rapidly. Even spread to the ipsilateral shoulder, neck, jumping or burning pain, standing can be relieved, with ipsilateral eye flushing, tearing, stuffy nose, runny, etc., pain lasts for 10 minutes to 2 hours, no obvious nervous system Positive signs, if necessary, a histamine test can assist in diagnosis.
11. Sinusitis pain is often located in the forehead and nasal roots, increased in the morning, with nasal congestion, purulent sputum, etc. Some patients have neck pain and post-headache due to secondary muscle contraction, and purulent discharge can be seen in the nasal cavity. The tenderness of the lesioned sinus is obvious.
