Headache (headache) is not always caused by central nervous system diseases, but is more common due to systemic, local and psychiatric factors. According to the location of the lesion, it can be divided into.
① intracranial diseases, such as intracranial tumors, infections, vascular lesions, injuries and migraines.
(ii) extracranial diseases, such as cranial lesions, various neuralgia, tension headache, and caused by lesions in the ear, eye, teeth, nose and neck.
③ Systemic diseases, such as infections, cardiovascular diseases and neurological disorders.
According to the etiology, it can be divided into: ① vascular headache, such as migraine, fever, anemia, hypoxia, carbon monoxide poisoning, hypertension, etc.
(ii) neuropathy, such as trigeminal neuralgia, supraorbital neuralgia, glossopharyngeal neuralgia, etc.
(iii) cranial pressure changes, such as high or low cranial pressure due to various inflammatory conditions.
④ inflammation, such as meningitis.
⑤ trauma, such as cranial trauma, skull fracture.
(vi) Muscle contraction, such as those occurring after mental overstrain and exertion.
(vii) Psychogenic, as seen in neurosis.
(8) Involvement headache, such as headache caused by lesions in the eyes, ears, nose, mouth, etc.
[Diagnostic notes
(A) Medical history
1. The onset and duration of the disease.
2. Location, nature, severity, persistence or paroxysm of the pain, exacerbating and relieving factors, and whether it is related to menstruation in women.
3. Season and time of onset, whether there is any aura, whether there are similar episodes in the past, and whether there is periodicity.
4. Whether it is accompanied by nausea, vomiting, vision and hearing changes, dizziness, vertigo, inattention, memory loss, insomnia, fever and mental disorder.
5. Any history of other related diseases, such as hypertension, tuberculosis, etc. Any history of taking related drugs that can cause headache.
6. Any family history.
(ii) Physical examination.
A comprehensive and focused physical examination is helpful for diagnosis. Such as temperature and blood pressure measurement, understanding the mental status and mental state. Head examination: including scalp, skull, temporal artery palpation, and examination related to the five sensory departments. Neurological examination, etc.
(iii) Other tests: The following tests are optional according to the condition.
1. Blood, urine routine, biochemical and immunological examinations.
2. Cerebrospinal fluid.
3. Cranial X-ray examination including cranial plain film, sinus film, cervical spine film, CT, cerebral angiography, pneumoencephalography.
4. cranial MRI. 5. brain ultrasound, brain nuclear, EEG.
Differential diagnosis
(A) Acute onset, severe headache: seen in subarachnoid hemorrhage, encephalitis, meningitis, vasomotor headache, glaucoma, craniocerebral trauma, heat stroke, etc.
(ii) Chronic, intermittent headache: seen in migraine, epileptic headache, muscle contraction headache, trigeminal neuralgia, and hypertension.
(3) Chronic progressive headache: seen in intracranial tumor, tuberculous meningitis.
(iv) Chronic headache: seen in hypertension, neurosis, paranasal sinusitis, refractive error, and sequelae of traumatic brain injury.
(E) The site of headache is significant for diagnosis and differential diagnosis.
1. The frontal region is seen in sinusitis, intracranial hypertension, supratentorial occupying lesions, and fever.
2. The top part is seen in neurosis.
3. Occipital is seen in subscriptive lesions.
4. One side of the temporal region is seen in ocular lesions, migraine, neuralgia, temporal arteritis.
5. Neck is seen in epidemic meningitis, subarachnoid hemorrhage and acute cervical myositis
6. Diffuse hypertension, high fever, intracranial or extracranial infection, high cranial pressure, cerebral arteriosclerosis, and muscle contraction headache.
(F) The nature of headache is significant to the diagnosis and differential diagnosis of the disease.
1. pulsating vascular headache, such as hypertension, migraine, high fever, brain tumor and neurosis.
2. Dull pain with high fever and brain tumor.
3. Sharp pain is seen in otogenic and odontogenic.
4. Compression pain is seen in muscle contraction headache.
5. Indeterminate and variable in nature, seen in neurosis.
6. Distension pain is seen in vascular headache.
7. Electric shock-like neuralgia.
(vii) Long-term persistent pain: mostly organic diseases. If it lasts for a short time, it is more likely to be functional.
(H) Heavy pain in the morning is seen in sinusitis and high cranial pressure. Heavy pain in the afternoon, mostly seen in migraine. It is more severe in the evening and is seen in muscle contraction headache and cluster headache. It occurs after reading and is seen in oculogenic headache.
(ix) After exertion, such as defecation, coughing and headache, it is seen as increased cranial pressure and migraine. If it occurs after mental stress, it is seen as mental headache and muscle contraction headache.
(J) There is usually no parallel relationship between the degree of headache and the severity of the disease. Generally speaking, headache caused by trigeminal neuralgia, migraine, meningeal irritation is more severe, and sometimes headache of neurosis is also more severe.
(xi) The concomitant symptoms of headache are helpful for the etiological diagnosis.
1. Jet vomiting is seen in various causes of increased intracranial pressure. If it is accompanied by cervical tonicity, it is a sign of meningeal irritation. If it is accompanied by optic papilledema, it is a sign of increased cranial pressure. Vomiting when the headache reaches its peak and relieving the headache after vomiting is a migraine.
2. Fever is seen in inflammation caused by various infections, collagen disease, etc.
3. Vertigo is seen in inner ear lesions, cerebellar lesions, posterior circulation ischemia and vertebrobasilar migraine.
4. Convulsions are seen in high fever and epilepsy.
5. With cranial nerve palsy, seen in brainstem tumors.
6. with coma: seen in intracranial inflammation and intracranial hemorrhage.
7. With psychiatric symptoms: seen in frontal lobe tumor, neurosis and sequelae of traumatic brain injury.
8. With visual impairment: seen in glaucoma and certain brain tumors. Migraine may have aura such as flashing light, dark spot and hemianopia. The presence of diplopia and fever suggests tuberculous meningitis.