chronic headache
Introduction
Introduction Chronic daily headache (CHD) 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.
Cause
Cause
According to the classification criteria for international headaches, the classification of headaches is as follows:
(1) Migraine.
(2) Tension headache.
(3) Cluster headache and chronic paroxysmal side headache.
(4) Miscellaneous headaches unrelated to structural disorders.
(5) Headaches associated with head trauma.
(6) Headaches associated with vascular disorders.
(7) Headaches associated with non-vascular intracranial disorders.
(8) Headaches associated with certain substances or certain substance withdrawals.
(9) Headaches associated with non-head infections.
(10) Headaches associated with metabolic diseases.
(11) Headaches associated with the skull, neck, eyes, nose, paranasal sinuses, teeth, mouth or other facial or head structures.
(12) Cranial neuralgia, neural dryness or afferent pain.
(13) headaches that cannot be classified.
Examine
an examination
Related inspection
Brain CT examination, ophthalmoscopy, intracranial pressure monitoring, brain MRI
For acute sudden headaches, in addition to detailed medical history, detailed and comprehensive physical examination, relevant laboratory tests are also necessary, including fundus examination, CT scan, skull X-ray, cerebral angiography, EEG , Doppler ultrasound and transcranial Doppler ultrasound and blood routine tests and so on. The cause of chronic headaches is complex and must be taken seriously.
In general, patients with chronic headaches often need to do the following checks:
1 blood pressure and fundus examination.
2 erythrocyte sedimentation rate, C-reactive protein, blood routine (CRP).
3 radial artery biopsy.
4CT scan.
5 cerebral angiography.
6 EEG.
7 cervical X-ray film.
8 cerebrospinal fluid examination.
9 otolaryngology and dental examinations.
Diagnosis
Differential diagnosis
(1) neurological headache: headaches mainly caused by mental, emotional factors or various stresses, such as common neurosis headache, rickets headache, depression headache, tension headache (also called muscle contraction headache) Headaches caused by anxiety disorders, etc. These headaches are often accompanied by various neuropsychiatric symptoms such as palpitation, shortness of breath, anxiety, insomnia and forgetfulness. This kind of headache has a long course of illness, adulthood, and headache time is not painful, but the degree of headache is mild and moderate pain.
(2) Migraine: It is also a vascular headache. Migraine is a common group of headaches characterized by paroxysmal neurovascular dysfunction characterized by recurrent migraine or bilateral headache. About 60% of patients have a family history, and those with a history of adulthood have a low positive family history. The prevalence rate is more than 10% of the population, and more women than men. The frequency of attacks varies from one to several times a year to one to several times a month. In addition to genetic factors, migraine is related to cerebral blood flow, platelet and biochemical factors, diet, endocrine factors, etc., and emotional tension, hunger, lack of sleep, noise, glare and climate change can induce seizures. According to their performance, they can be divided into three types: typical migraine, common migraine and special types. Typical migraine is the most common type, with other symptoms, such as nausea and vomiting. Special types of migraine include eye muscle spasm, hemiplegia, and basilar artery.
(3) Cluster headache: Also known as histamine headache, it is a neuro-vascular dysfunction characterized by eyelids and head pain. Although it has something in common with migraine, it has more differences: the disease is mainly seen in male patients, and the age of onset is relatively late, mostly between 30 and 50 years old. And there is no warning of headaches. The headache suddenly starts, and it is a series of intensive headache attacks. It starts from one side of the eye socket and its surroundings. It spreads to the top of the ipsilateral iliac crest and the ear and nose. It can also spread to the occipital and top. The pain is pain or pulsation, especially severe. When the headache reaches a peak, the patient is often restless and can't sit or lie quietly, just walking around in distress. Some patients have conjunctival congestion, tearing, stuffy nose and runny nose, facial flushing, eyelid edema, nausea, anorexia, photophobia, etc. A small number of people (20%) may have ipsilateral Horner's sign (small angulation, eyeball invagination, pupil dilation, and no sweat on the same side). The most common episodes after nap and early morning can make patients wake up from sleep. Each headache lasts for half an hour to 2 hours, then disappears quickly, and most can immediately resume work before the headache. During the onset of a headache, it occurs almost once or several times a day, and the time and part are very fixed, so for several weeks to several months; after several months or years of remission, it can recur, and often on the original side. A headache attack can occasionally last for one to several years, which is called chronic cluster headache.
(4) Headache after traumatic brain injury: Headache is the main symptom, but there are dizziness, fatigue, insomnia, nervousness, excitement, inability to concentrate, and memory loss. Most of the headaches are on the injured side and can be accompanied by tenderness. The nature of the headache can be pulsating, or it can be a feeling of stress, mostly persistent pain, and is often reinforced by mental factors, physical labor, sound, loudness and light. The patient behaves much like an excited depression patient. The severity and duration of headaches are not parallel to the extent of head injury. The neurological examination was normal, and no abnormal findings were found on EEG, CT, and MRI scans. It may be related to fright, fear, and ideological concerns.
(5) Children's headache: children's recurrent headaches, mainly neurological headache, vascular headache, muscle contraction headache, headache, sinusitis headache, brain tumor, childhood epilepsy, decreased vision caused by traumatic brain injury Headaches, etc., but more common headaches caused by systemic diseases, see the children's headache page.
(6) other types of organic headache: headache caused by cerebral hemorrhage or subarachnoid hemorrhage: sudden headache with nausea, vomiting and disturbance of consciousness, cerebral hemorrhage or subarachnoid hemorrhage, more common in middle-aged people. Headache caused by glaucoma: The headache area is mostly in the upper part of the eyelid or around the eyeball, and often accompanied by visual impairment.
Headache caused by brain tumor: for blunt headache, progressive aggravation, accompanied by nausea, vomiting, diplopia and other manifestations of increased intracranial pressure, should be alert to the possibility of brain tumors.
Trigeminal neuralgia: A person with severe facial pain like a trigeminal neuralgia.
Caused by other causes: such as benign cough headache, cold irritating headache and "sexual headache" related to sexual activity, these headaches are mostly related to environmental, mental or emotional factors. For acute sudden headache, in addition to detailed inquiry In addition to medical history, detailed and comprehensive physical examination, relevant laboratory tests are also necessary, including fundus examination, CT scan, skull X-ray, cerebral angiography, EEG, Doppler ultrasound and transcranial Doppler Ultrasound and blood routine tests.
