Headache is a common clinical symptom, usually confined to the upper part of the skull, including the arch of the eyebrow, the upper edge of the ear and the occipital protuberance above the line collectively referred to as headache. There are many causes of headache, including neuralgia, intracranial infection, intracranial space-occupying lesions, cerebrovascular disease, extracranial head and face diseases, and systemic diseases such as acute infection and poisoning. The age of onset is common in youth, middle age and old age. Classification of headache diseases Clinically, headache can be divided into: 1, acute onset of headache: common such as subarachnoid hemorrhage and other cerebrovascular diseases, meningitis or encephalitis. 2, subacute onset of headache: common such as cerebrovascular diseases, meningitis or encephalitis. Subacute onset of headache: such as temporal arteritis, intracranial tumors, and so on. Chronic headache: such as migraine, tension-type headache, cluster headache, drug-dependent headache. The causes of headache are numerous, and can be roughly divided into two categories: primary and secondary. The former can not be attributed to a specific cause, also known as idiopathic headache, common as migraine, tension-type headache; the latter cause can involve a variety of intracranial lesions such as cerebrovascular disease, intracranial infections, craniocerebral trauma, systemic diseases, such as fever, internal environmental disorders, as well as the abuse of psychoactive drugs and so on. Infection: 1. Fever caused by craniocerebral infections or acute infections in other systems of the body. Cranial brain infections that often cause headaches such as meningitis, meningoencephalitis, encephalitis, brain abscess, intracranial parasitic infections (such as cysticercus, worm) and so on. Acute infections such as influenza, pneumonia and other diseases. 2.Vascular lesions: subarachnoid hemorrhage, cerebral hemorrhage, cerebral thrombosis, cerebral embolism, hypertensive encephalopathy, cerebral blood supply insufficiency, cerebral vascular malformations and so on. Occupying lesions: craniocerebral tumor, intracranial metastatic cancer, inflammatory demyelinating pseudotumor, etc. Headache caused by increased intracranial pressure. 4, Cephalo-facial and cervical neuropathy Cephalo-facial innervation neuralgia: such as trigeminal nerve, glossopharyngeal nerve and occipital neuralgia. Headache caused by head and face disorders such as eye, ear, nose and dental diseases. Cervical spondylosis and other neck diseases cause head and neck pain. 5, systemic diseases hypertension, anemia, pulmonary encephalopathy, heatstroke and other headaches. 6.Craniocerebral trauma, such as concussion, cerebral contusion, subdural hematoma, intracranial hematoma, sequelae of traumatic brain injury. 7, poison and drug poisoning, such as alcohol, carbon monoxide, organophosphorus, drugs (such as belladonna, salicylic acid) and other poisoning. Internal environment disorders and mental factors: Menstrual and menopausal headache. Neurotic somatization disorder and hysterical headache. 9, others, such as migraine, cluster headache (histamine headache), headache epilepsy. Headache pathogenesis The pathogenesis of headache is complex, mainly due to intracranial and extracranial pain-sensitive structures within the nociceptive receptors are stimulated, through the nociceptive pathway conduction to the cerebral cortex and caused. Intracranial pain-sensitive structures include venous sinus (such as sagittal sinus), anterior meningeal artery and middle artery, dura mater of the base of the skull, trigeminal nerve (V), glossopharyngeal nerve (IX) and vagus nerve (X), proximal portion of the internal carotid artery and adjacent to the branches of the Willis ring, the brainstem, midbrain conduit around the gray matter and thalamus, sensory relay nuclei, etc.; Extracranial pain-sensitive structures, including the periosteum of the skull, the skin of the head, the subcutaneous tissues, the capitellar tendon membrane, head and neck muscles and extracranial arteries, 2nd and 3rd cervical nerves, eyes, ears, teeth, sinuses, oropharynx and nasal mucosa. Mechanical, chemical, biological stimuli and biochemical changes in the body acting on the intracranial and extracranial pain-sensitive structures can cause headaches. Such as intracranial and extracranial arterial dilatation or traction, intracranial vein and venous sinus displacement or traction, cerebral and cervical nerve compression, traction or inflammatory stimulation, cranial and cervical muscle spasms, inflammatory stimulation or trauma, meningeal irritation due to various causes, intracranial pressure abnormality, intracranial 5-hydroxytryptophan neuron projection system dysfunction and so on. Pathophysiology of headache Head and facial blood vessels, nerves, meninges, venous sinuses, head and facial skin, subcutaneous tissue, mucous membranes, etc. constitute the head pain-sensitive structures, when they are subjected to mechanical tension, chemical, biological stimulation or changes in the body’s internal environment triggers head pain. Clinical manifestations of headache The degree of headache may be light or heavy, and the pain time may be long or short. Pain in various forms, common swelling, boring pain, tearing pain, electric shock-like pain, needle-like pain, partly accompanied by blood vessel pulsation and head tightening sensation, as well as nausea, vomiting, dizziness and other symptoms. Secondary headache can also be accompanied by other systemic disease symptoms or signs, such as infectious diseases are often accompanied by fever, vascular disease is often accompanied by hemiplegia, aphasia and other neurological deficits. Depending on the degree of headache, headache can cause different hazards, and the seriousness of the disease can cause the patient to lose the ability to live and work. Diagnosis of headache Headache diagnosis can be diagnosed according to the patient’s head pain site. In the process of headache diagnosis, should first distinguish between primary and secondary. Primary headache is mostly benign in nature, while secondary headache is caused by organic lesions. The diagnosis of any primary headache should be based on the exclusion of secondary headache. The etiology of headache is complex, in the history taking of headache patients should focus on the mode of onset of headache, the frequency of attacks, the time of attack, the duration, the location of the headache, the nature of the headache, the degree of pain, the presence of antecedent symptoms, and the presence of clear triggering factors, headache aggravating and mitigating factors, and so on. At the same time, in order to better identify the etiology and nature of headache, we should also comprehensively understand the patient’s age and gender, sleep and occupational status, past medical history and concomitant diseases, history of trauma, history of medication, history of intoxication and family history, and other general conditions that affect the onset of headache. A thorough physical examination, especially the examination of the nervous system, the skull and the five senses, can help to find the lesions of headache. The use of neuroimaging or lumbar puncture cerebrospinal fluid and other ancillary tests can provide the basis for diagnosis and differential diagnosis of intracranial organic lesions. Headache treatment Headache treatment includes medication and non-pharmacological physical therapy. The principle of treatment includes symptomatic treatment and primary treatment. Acute attack of primary headache and secondary headache whose etiology cannot be immediately corrected can be given symptomatic treatment such as analgesia to terminate or alleviate the symptoms of headache, and at the same time can also be accompanied by symptoms of headache such as vertigo, vomiting to be appropriate symptomatic treatment. For secondary headache with clear cause, the cause should be removed as soon as possible, such as intracranial infection should be treated with anti-infection therapy, intracranial hypertension should be dehydrated to lower the cranial pressure, and intracranial tumors need to be surgically removed. Medications Painkillers include: non-steroidal anti-inflammatory painkillers, central painkillers and narcotic painkillers. Non-steroidal anti-inflammatory painkillers are the most commonly used painkillers for headache, including aspirin, ibuprofen, anti-inflammatory painkillers, paracetamol, propofol, rofecoxib, celecoxib, and so on, because of their precise efficacy and non-addictive advantages. Tramadol as the representative of central painkillers, belonging to the second category of psychotropic substances, non-narcotic painkillers, pain relief effect than the general antipyretic painkillers to be stronger, mainly used for moderate and severe degree of headache and a variety of postoperative and cancerous lesion pain, and so on. Narcotic painkillers represented by opioids such as morphine and dulcolax have the strongest pain-relieving effect, but long-term use can be addictive. These drugs are only used for advanced cancer patients. In addition to this, there are some herbal compound headache painkillers, which are helpful in relieving and preventing headaches. Non-pharmacological physical therapy Non-pharmacological physical therapy for headache includes: physical magnetic therapy, local cold (hot) compresses, oxygen inhalation and so on. Chronic headache is recurrent authors should be given appropriate treatment to control frequent headache attacks. Headache prevention The prevention and treatment of headache should reduce all possible causes of headache, including avoiding soft tissue injury of the head and neck, infection, avoiding contact with and intake of irritating food, avoiding emotional fluctuations, etc., and should also timely diagnose and treat the primary diseases secondary to headache. Sedative drugs, antiepileptic drugs and tricyclic antidepressants are effective in preventing migraine, tension headache and other primary headache attacks. Headache Disease Care Headache patients should reduce chocolate, cheese, alcohol, coffee, tea and other easy to trigger pain foods. At the same time taste diet should be light, avoid spicy stimulation, cold food, headache attack period should be prohibited to eat ham, dry cheese, preserved too long game and other foods.