Pathological overview.
Headaches are mild to moderate in intensity and rarely cause bed rest or interfere with daily life. Some patients may have persistent headaches for years and years, and some patients may have symptoms that go back 10-20 years. Patients can have headaches all day long, with more time spent with headaches than without pain. The headache is often exacerbated by factors such as agitation, anger, insomnia, anxiety or depression. There are also some patients who have not only the characteristics of myotonic headache, but also the clinical manifestations of vascular headache, complaining of bilateral temporal pulsating headache. This kind of clinical manifestation of both tension headache and vascular headache is called mixed headache. Patients are mostly accompanied by dizziness, irritability, anxiety, panic, shortness of breath, fear, tinnitus, insomnia and dreaminess, back pain and neck stiffness, etc. Some patients have obvious pressure points on both sides of the neck and occiput or both temporal sides. It originates from the tension contraction of head muscles, with tight bundle or compression-like head, heavy feeling, often jumping and pulling pain, which will be aggravated by excessive smoking and drinking. This is mostly caused by irregular life, inordinate smoking and drinking, and lack of sleep.
Disease Causes.
The cause of the symptoms headache can be due to irritation, pulling or pressure on any tissue in the skull with pain sensation. There are many causes of headache, and treatment can only be effective if the cause is identified as soon as possible.
Neurogenic headache.
Hypertensive headache in middle-aged and elderly people are often in a state of tension and anxiety due to work and family problems, resulting in physical and mental haggardness and decreased physical strength, and hypertension creeps in without feeling it. Patients feel confusion, vague pain in the brain, and even sometimes fainting or experiencing weakness and numbness in the fingertips, all of which are due to hypertension at work.
Neuropathic headache is caused by tension and contraction of head muscles, with a tightly bound or pressure-like head, a heavy feeling, often a throbbing pain, which is aggravated by excessive smoking and drinking. This is mostly caused by irregular life, excessive smoking and drinking, and lack of sleep. Due to endocrine changes, the physiological functions of people are affected and there is often a change in personality. Patients show impatience and irritability, weakness and laziness, nervousness, low sexual desire and low menstrual flow.
Neuroleptic headache is mostly seen in brain workers, who often work day and night, lack of exercise, insufficient nutrition, and overexertion resulting in brain unsupported. Patients often have headache, insomnia, memory loss, and a sense of aging before aging. Headaches caused by brain tumors or other intracranial lesions usually occur recently, are intermittent, last for several hours a day, and may be caused or disappear with changes in position. Initially, the headache may be confined to the area where the tumor is located, but may become diffuse as the intracranial pressure increases.
Causes of headache.
The causes of headache with fever may include the following.
① Acute intracranial infection including meningitis, encephalitis and brain abscess caused by various pathogens.
② Acute paranasal sinusitis maxillary sinusitis and frontal sinusitis often cause pain in the maxillary sinus and frontal area with pus nasal discharge.
③ Acute intraorbital cellulitis is mostly caused by paranasal sinusitis, with distension and pain in the eye and the lateral part of the disease, protrusion of the affected eye, redness and swelling of the eyelid and conjunctiva, and a marked increase in intraocular pressure.
④ Acute cavernous sinus thrombosis is caused by head and facial infections, especially boils around the eyes or mouth, due to improper squeezing, resulting in bacterial entry into the cavernous sinus leading to infection and thrombosis. The onset of this disease is acute, with the patient experiencing severe intraocular and frontal pain, swollen eyelids, and protrusion of the eyeball and fixation in the central area.
⑤ Systemic infectious diseases are common in colds, acute tonsillitis, pneumonia, sepsis, etc., and cause headaches due to toxin stimulation and vasodilation during fever.
Periodic or episodic headache: ① Cluster headache is characterized by attacks mostly at night during sleep or at dawn and relieved after getting up and moving around. The headache is characterized by severe throbbing and drilling pain on one side of the head, congestion on the painful side, nasal congestion and tearing. The age of onset is usually 20 to 40 years old. ②Epileptic headache is mostly seen in children, with violent headache, accompanied by pale face, sweating, dizziness, panic and vomiting, which lasts for 3-5 minutes and then disappears. ③ Female patients with migraine account for 60%-70%, mostly in adolescence onset. Take 200 grams of white chrysanthemum, 2000 ml of water, decoct it, pour it into a basin and fumigate the head while it is hot. The method is: place your head at a suitable height from the water surface, cover your head with a towel (to prevent the heat from escaping from the basin), until the temperature of the medicine drops below body temperature is appropriate. After fumigation to prevent from getting cold, generally 1 time will be somewhat effective for neuropathic headache.
Diagnostic criteria.
(1) Severe hemiplegic upper orbital and temporal pain that lasts 15 to 180 minutes when left untreated.
(2) Headache accompanied by at least one of the following signs and must be on the same side as the headache: conjunctival congestion, runny nose, nasal congestion, forehead and facial sweating, miosis, ptosis, ptosis or eyelid edema.
(3) The frequency of attacks ranges from once every other day to eight times daily.
(4) There are at least five attacks that meet items 1 to 3 above, while excluding other intracranial and extracranial organic diseases that cause headache.
(5) The diagnosis is made by doing histamine test that can induce typical pain. If it lasts for more than one year, it is called chronic cluster headache; if two headache attacks last for more than one year and there is a 14-day remission period in between, it is called episodic cluster headache.
Disease treatment.
I. Comprehensive physical therapy.
”Comprehensive physical therapy” includes electric acupuncture therapy, neuromuscular electrical stimulation therapy, electrical excitation therapy, meridian guiding and leveling therapy, and massage and tui-na therapy, etc. The treatment is based on a course of treatment, generally one course of treatment for one month for cases, and one month of inpatient comprehensive treatment and then go home to continue medication treatment. In many chronic cases, the duration of the disease is more than 10-20 years, and the duration of hospitalization needs to be extended appropriately, and the treatment can be continuous for 2-3 months, and most patients can recover. Inpatient treatment in addition to the above comprehensive treatment measures relaxation treatment.
. In the inpatient environment, the doctor can talk with the patient in detail, discuss the causes of the disease and preventive and curative measures, and the patients can communicate with each other, encourage each other, and discuss the treatment process and the treatment effect, so that the treatment can achieve better results in a relaxed atmosphere. The inpatient environment of our headache specialist clinic is special, unlike the cluttered inpatient conditions of large hospitals, with a beautiful environment, a relaxed atmosphere and a cordial doctor-patient relationship.
Physiotherapy (physical therapy) is a medical specialty that is designed to prevent, treat, and manage movement problems caused by illness or injury. Physiotherapy is a non-invasive, non-drug treatment that uses physical factors (sound, light, water, cold, electricity and heat) and the principles of human physiology to treat local or systemic dysfunction or disease, and to restore the patient’s original physiological function as much as possible. Physiotherapy is a very important part of modern and traditional medicine. Physiotherapists specialize in the following areas: insomnia and pain management, muscle strength training, joint mobility, cardiopulmonary training, and pediatric physiotherapy. Physiotherapists can directly assist or support other medical specialties such as neurology, neurosurgery, orthopedics, cardiology, cardiac surgery, dentistry, obstetrics and gynecology, oncology, etc. to provide the most needed preventive medicine education and concepts as well as therapeutic training methods to patients.
For patients with neuropathic headache, there are many ways to treat the headache. In addition to the necessary emergency measures, physical therapy is recommended for patients with intractable neuropathic headache. Physiotherapy is usually used to treat headaches with magnetic therapy, which can play the role of blood circulation, anti-inflammatory and analgesic, and sedation and sleep. The pillow is often used in physical therapy, it is a high-tech biomagnetic therapy and far-infrared dual-effect treatment principle, by the permanent magnet and infrared liner two parts of the medical device products, it uses neodymium iron boron high-tech biomagnetic field and the dual role of nano far-infrared, can effectively treat stubborn insomnia. In addition, psychological counselling is also a good way to help relieve stress through professional talk, so that patients can relax physically and mentally and improve their sleep.
1.Electro-acupuncture therapy; 2.Electrical excitation therapy; 3.Meridian guiding and leveling therapy; 4.Massage and massage therapy; 5.Scraping and cupping therapy; 6.Biofeedback therapy.
II. Relaxation therapy for headache.
Relaxation therapy, as an auxiliary therapy to drug treatment, is a treatment method to reduce anxiety through subjective imagination and objective measures to make people achieve muscle relaxation and mental stability. Relaxation therapy, as an important part of psycho-behavioral therapy to reduce anxiety, can significantly relieve various neuropathic headaches, migraine, insomnia, anxiety, depression and neurasthenia caused by psychiatric factors. As we all know, thromboxane A2 mental anxiety, neuroexcitation and other factors can cause the scalp and back of the neck muscle spasm and cause the scalp tightness and produce headache and dizziness, which can be aggravated by tension or emotional stimulation, accompanied by anxiety, irritability, panic, excessive sweating, neck and back pain, tinnitus, inattention, memory loss and other symptoms, which can be complicated by other neurological symptoms such as depressive symptoms and compulsive symptoms. The pathogenesis is anxiety and muscle spasm, and these two factors are mutually beneficial, resulting in a vicious circle: anxiety – spasm – headache – insomnia. Its treatment is based on its pathogenesis: suppressing anxiety and relieving spasms. Non-pharmacological treatment is mainly relaxation therapy. Headache and sleep disorders have many causes. The key to treating headaches and sleep disorders is to regulate and restore the balance of excitation and inhibition of the human nervous system. Relaxation training can relax the bones, muscles, ligaments, blood vessels and nerves of the whole body, supplemented by relaxing music and suitable temperature, which can regulate the tension, adjust the balance of excitation and inhibition of the nervous system, achieve physical and mental relaxation, and transform the activity of the body’s autonomic nervous system in the direction conducive to relaxation and sleep, thus improving headache and sleep. Relaxation therapy is guided by a holistic view, and in addition to local muscle relaxation training, it also emphasizes the whole body relaxation training with deep breathing, so it makes it easier for patients to enter the relaxation state and achieve deeper level of relaxation at the same time, and patients reflect that the effect is fast. Another characteristic of mind-body relaxation method is that through benign language induction and special visual imagination training, it is easier for patients to have a pleasant peak experience after relaxation, so as to improve patients’ previous bad emotional experience. Therefore, the simultaneous relaxation of body and mind is the outstanding feature of mind-body relaxation therapy, which can be considered as a kind of psychophysiological therapy. Mind-body relaxation therapy has no drug side effects and is particularly suitable for headache and sleep disorder patients with emotional and behavioral disorders because it has both mental and physical effects. Relaxation therapy is effective in relieving stress and is a good treatment for stress-induced insomnia. The headaches of neurological patients are functional headaches, with a predominance of head heaviness and head pressure, and relaxation therapy has an unparalleled effect on such symptoms. It also has significant effects on psychosomatic disorders such as anxiety states, nervous tics, neurasthenia, hypertension, colitis, coronary heart disease, asthma, and gastric ulcers.
Patients are in a quiet environment, lying comfortably on a sofa or bed, resting quietly for 10-15 minutes, eliminating distractions, keeping the body and mind relaxed, training for 30 minutes each time, 1-2 times a day, preferably at noon or before going to sleep at night, naturally entering a completely relaxed sleep state after doing relaxation training, waking up with a clear mind and full of energy. You will wake up with a clear mind and full of energy. Generally 15-20 times for a course of treatment, as long as you adhere to the training will receive good results.
Third, drug treatment.
1.Vasoconstrictor: Ergotamine is a powerful vasoconstrictor, which is suitable for the prevention of migraine aura. Such as ergotamine caffeine, used before headache attack.
2.Magnesium preparation: Magnesium ion can reduce the excitability of central nervous system, block sympathetic ganglion, relax vascular smooth muscle and dilate blood vessels. Available 33% magnesium sulfate 15 ml, 1 day 3 times orally.
3, calcium orange antagonist: the main mechanism of action of these drugs is to block the slow channel of calcium ions, inhibit the release of platelets serotonin and thromboxane A2, lasting inhibition of vasoconstrictive substances and dilation of blood vessels, thereby improving the diastolic function of blood vessels. These drugs include cardiac painkillers, indololol, nimotepine, cerebrolysine and flunarizine hydrochloride.
4.Analgesics: The main purpose of applying this kind of drugs is to reduce or eliminate the pain of headache. Because the drug can combine with the opioid receptors in the brain, excite the anti-nociceptive system in the brain, improve the pain gateway, and thus present the analgesic effect. Commonly used drugs are aspirin, go to the sickness tablets (Somitol), cranial pain, withdrawal pain and carbamazepine.
5, anxiolytic and sedative: these drugs can reduce the patient’s mental tension and anxiety, and inhibit the excitability of the center. Such as cidefloat, fenalou, doxepin and clozaril.
Chinese medicine treatment for neuropathic headache.
Neuropathic headache mainly refers to tension headache, functional headache and vascular neuropathic headache, mostly caused by mental tension and anger, and the main symptoms are continuous dull head pain, pressure and heaviness, and some patients complain of “tightness” in the head. Most of the patients have bilateral headache, mostly on both temporal sides, posterior occipital region and top of the head or the whole head. The nature of the headache is dullness, swelling, pressure, numbness and band-like tightness. The intensity of headache is mild to moderate, rarely bedridden or affects daily life due to headache, many patients and doctors use western medicine for treatment, although this method works quickly, but the drug dependence and side effects are relatively large, so generally use Chinese medicine treatment such as Malai sleep, to avoid long-term use of western medicine to produce drug dependence and side effects.
Precautions.
Neuropathic headache and diet are closely related to.
Drinking water: A person’s body needs to drink at least ten glasses of water daily to make its physical performance reach its peak, and dehydration is a common cause of headaches.
Second, food: the time between eating a meal and a snack should not exceed five hours, between each meal, a person’s blood sugar will drop, leading to vasodilation.
Three, pay attention to the number of coffee and tea: too much or too little caffeine can cause headaches.
Take note of what you eat: chocolate, vinegar, frozen meat and many other foods contain substances such as tyramine and nitrates, these chemicals can cause headaches in people who are prone to allergies, so if you have a headache, you should pay attention to what you have eaten.
Red wine and brandy, like cheese and chocolate, contain tyramine, which can cause headaches.
Don’t take too many pain pills: overuse of medication can lead to “pain rebound” headaches. If you suspect that this is the cause of your headache, stop taking painkillers for a while and see if the headache stops.
Clinical studies.
Neuropathic headaches are dull, swelling, pressure, numbness and band-like tightness in nature. The intensity of the headache is mild to moderate, and rarely does the headache cause bed rest or interfere with daily life. Some patients may have persistent headaches for years and years, and some patients may have symptoms that go back 10-20 years. Patients can have headaches all day long, with more time spent with headaches than without pain. Because factors such as anxiety, insomnia or depression often exacerbate headaches, patients with neuropathic headache, due to the decline of internal inhibition of the cerebral cortex, are less likely to cause widespread spread of inhibition during sleep, have difficulty falling asleep or are not deep enough, easily wake up or sleep for too short a time, or wake up and have difficulty sleeping again. If this happens for a long time, it is bound to form stubborn insomnia. After insomnia, the patient suffers from dizziness and depression during the day, which makes learning and working efficiency low. At night, they worry about insomnia. Thus, insomnia due to anxiety, insomnia and anxiety, mutual cause and effect, repeatedly affected, and finally the insomnia of neuropathic headache. Insomnia-induced neuropathic headache, from the clinical application, if it is mild patients, can be controlled by taking Valium drugs appropriately, but avoid long-term use to avoid drug dependence and further deterioration of the condition. If the insomnia time is longer or more serious patients, clinical research shows that the use of Chinese and Western medicine for comprehensive treatment. In addition, patients with neurasthenia caused by insomnia should develop better habits, such as more walks after dinner, usually more exercise, etc., which are very helpful for the recovery of symptoms.
Ways to relieve headaches.
1, ice bag cold compress: put ice in an ice bag or wrap it in a towel and put it on the headache area. When the cooled head blood vessels are constricted, the symptoms will naturally be reduced. Lie down and rest for a while: If you have the conditions, when migraine attacks, you may want to rest for a while in a room with low light and quiet surroundings, generally speaking, as long as you sleep for half an hour, the headache will slow down.
2, massage the head: moderate massage of the head is an effective way to relieve migraine headaches. The temple is an important point for migraine massage, you can use your index finger to press, you can use your fist to gently turn back and forth massage from the temple to the hairline.
3.Drink green tea: The substances in green tea are effective in relieving migraine, so you can drink green tea in moderation to overcome a severe migraine.
4. Meditation: The use of yoga and meditation is a new way to treat migraines. You can buy a CD of this kind and meditate with your eyes closed for a while with the music when the headache strikes, so that the harmonious sounds of nature can make you forget about your illness.
5. Wrap a towel around your head: It may seem ridiculous, but this is indeed a good way to treat migraines. When in pain, use a towel or soft cloth loosely wrapped around the temples, so as to inhibit blood vessel dilation and relieve pain. There are many factors that can trigger a headache, so patients must not use medication at will, but must go to the hospital to confirm the diagnosis and use the medication under the guidance of a doctor to get a good effect.
Daily care methods.
Patients with neuropathic headache mostly have nervousness, emotional instability and easy to get angry, etc. When headache symptoms occur, patients can obviously feel a dull, oppressive and heavy feeling in their head. Therefore, in the daily care of neuralgia headache patients, the following points should be noted.
1, to arrange the time of work and rest reasonably, never work long hours, which will only aggravate the headache symptoms. In addition, headache patients should maintain a good mood every day, and mentally eliminate tension, anxiety and boredom. The diet should be light.
2.When a neuralgia headache strikes, self-observation of the headache should be made, preferably with a small notebook to record the time, degree and nature of each headache, and at the same time, attention should be paid to whether there is vomiting, nausea, reduced vision and twitching of the limbs when a neuralgia headache occurs. If you have the above symptoms, it is better to go to the hospital for examination in time.
3.When there is a mild neuropathic headache, it is best to treat the symptoms. Like some people have allergies after consuming eggs, meat, seafood, etc., thus triggering the symptoms of migraine, there are also some. When the situation is more serious, patients had better go to the hospital for a checkup and use drugs and other methods of symptomatic treatment.
4.In daily life, pay attention to the combination of labor and service, avoid the emergence of unstable emotions, do not overwork yourself, do not smoke, drink, and diet should also be moderate.
5.Pay attention to personal hygiene. Some disease infections can cause headache symptoms, like dental diseases.
6.Nervous headache caused by long-term depression should not be ignored. When the headache is accompanied by dizziness, it is better to have a CT examination.