1.What is headache? Headache is one of the most common symptoms in people’s life, a manifestation of many diseases and a protective response issued by the body after being stimulated by injury. According to statistics, 80% of people will experience headache in their lifetime. Headache generally refers to the pain in the upper part of the skull (i.e., above the line connecting the arch of the eyebrow, the upper part of the auricle, and the external occipital ridge), but some facial pain and neck pain are sometimes difficult to distinguish from headache in detail because they are closely related to headache. There are many causes of headache, the degree of headache varies, and the duration of headache is long or short, most of them are not serious so-called functional long-term chronic headache, there is no serious organic lesion in the brain of these headache patients, it does not cause serious consequences, but it affects people’s quality of life. When a headache is accompanied by stiff neck and fever, or when a headache is sudden and severe, like one second it is fine and the next it is very severe, accompanied by vomiting, stiff neck and unconsciousness, or when a headache is accompanied by hemiplegia, weakness or vomiting, it is not only necessary to see a physician, but also to see a physician quickly. see a physician, but also see a physician quickly; the former may be meningitis, the latter may be subarachnoid hemorrhage (especially in young people), and the last may be intracranial hemorrhage. Another problem worth noting is the headache caused by chronic subdural hemorrhage, whose symptoms are as varied as a lady with a thousand faces. If an elderly person has a traumatic brain injury, or even just accidentally falls, or has his head hit by a car door or even his own door or bed, within three months, if he has abnormal phenomena such as headache, hemiplegia, dementia, or imbalance, all of these may be symptoms of chronic subdural hemorrhage, and he should seek medical attention as soon as possible. You should seek medical attention as soon as possible to avoid danger. 2.How do headaches occur? Most headaches are caused by the action of pain-causing factors (physical or chemical, such as acetylcholine, 5-HT, histamine, bradykinin, etc.) on the injury receptors in the pain-sensitive tissues of the skull, which are analyzed by the nociceptive transmission pathways (lateral thalamic tracts of the spinal cord, trigeminal thalamus) to the central nervous system (ventral posterior thalamic nucleus, first sensory area of the postcentral gyrus) and integrated to produce nociception. Of course, headaches due to psychogenic (psychiatric) factors are purely subjective to the patient’s experience. Various extracranial structures such as the scalp, subcutaneous tissues, muscles, periosteum, blood vessels and peripheral nerves are more sensitive to painful stimuli. The intracranial structures sensitive to pain are mainly the dura, blood vessels and cranial nerves. However, the sensitivity of the above structures to pain varies depending on the location of the structure. The skull, brain parenchyma, ventricular canal, and choroid plexus, however, are not sensitive to painful stimuli. The main mechanisms of headache are: (1) expansion of intracranial and external arteries (vascular headache); (2) traction or displacement of intracranial pain-sensitive tissues (traction headache); (3) inflammation of intracranial and external pain-sensitive tissues (e.g., meningeal irritation headache); (4) contraction of extracranial muscles (tension or muscle contraction headache); (5) direct damage or inflammation of cranial and cervical nerves that conduct pain (neuritis headache); and (6) diffusion of pain in the five sensory lesions (involvement headache), etc. Pain-causing neurological mediators are involved in the process of the above headache. In addition, psychological factors can also cause headache and may be associated with a decrease in the threshold of pain tolerance. As with any pain, the severity of headache varies from person to person, and headaches in the same patient can vary depending on the physical and mental status at the time. In addition, the mechanism of headache in some diseases is often not caused by a single factor. For example, hypertensive headache has both vascular headache directly related to blood pressure and muscle contraction headache related to emotional tension, and the headache can be relieved when blood pressure is restored to normal. It is important to understand these factors for the prevention and treatment of headache. 3.What are the causes of headache? The causes of headache are very complicated, such as headache caused by common cold and fever, headache caused by “headache”, headache caused by poor sleep, headache caused by problems with organs in the head, such as glaucoma, otitis media, sinusitis, etc. Of course, encephalitis, meningitis, brain tumor, brain hemorrhage, etc. can cause headache, and most of them are more intense. Some headaches can be relieved without treatment. Some headaches can be relieved without treatment, and some headaches that persist for a long time are not serious, but some headaches are often danger signs of serious diseases and may be life-threatening if not treated in time. There are many classifications of headache, and scholars from different countries classify them differently, generally divided into 14 categories, amounting to more than 250 kinds. Primary headache includes tension headache, migraine, cluster headache and cervical migraine, which are the most common ones in clinical practice. Secondary headache has four categories, including headache caused by intracranial lesions: meningoencephalitis, hemorrhagic cerebrovascular disease, ischemic cerebrovascular disease, brain tumor, brain abscess, intracranial hematoma, cyst (arachnoiditis), cerebral parasites, low cranial pressure syndrome, epileptic headache, headache after cranial injury, etc.; headache caused by extracranial head and neck lesions: such as large occipital nerve, supraorbital nerve and auriculotemporal neuralgia, as well as head and neck skin, muscle, cranial bone, five senses, etc. Headache caused by systemic diseases: such as infection, poisoning, high fever, hypertension, various hypoxic states (cerebral blood supply, cardiopulmonary insufficiency, anemia, plateau reaction) and hypoglycemia, etc.; headache caused by neurosis and psychosis, etc. 4.How to tell the doctor about headache? Although headache is a very common term, sometimes the symptoms reflected by the patient may be different from the actual meaning. In order to facilitate the doctor’s understanding of the patient’s condition, headache patients should clearly describe their condition when they visit the doctor, which is very helpful to the doctor’s diagnosis. For the doctor, taking medical history is an indispensable means for diagnosis, and it is especially important in headache diagnosis. Especially some headache patients have no abnormal findings in physical examination, laboratory examination and imaging examination, then the description of medical history and condition is more important, such as migraine, cluster headache, epileptic headache and hysterical headache, etc. The headache patient should describe the headache in terms of time, location, degree, nature, aggravating and relieving factors, accompanying symptoms, diagnosis and treatment. What time does the headache start; when is the headache the heaviest, such as whether it is the heaviest in the morning or in the afternoon after work, or whether it is worse at night; whether the headache is persistent or paroxysmal, and if it is paroxysmal, how long it lasts each time; what part of the headache is the most painful, specifying the headache area and stating whether it radiates to other parts; what is the nature of the headache, such as cutting, burning, stabbing, throbbing, swelling, or bursting pain; whether the headache is aggravated or relieved; and what is the nature of the headache? The factors that aggravate and relieve the headache. The symptoms accompanying the headache should also be provided, i.e. the symptoms of various primary diseases, such as nausea, vomiting, impaired consciousness, neurological symptoms (limb weakness, numbness, convulsions, visual impairment), etc., which cause serious intracranial lesions, the symptoms of the five senses (lacrimation, nasal obstruction, runny nose), etc., which cause head and neck lesions, the symptoms of systemic diseases such as fever, insomnia, dreaminess, anxiety, fear, depression, etc. Patients with headache should also provide information about their visits to the clinic. Patients with headache should also provide information about their medical treatment, which hospital they have visited since the onset of the disease, what kind of tests have been done, what are the results, what is the diagnosis, what medications or other treatments are being taken, and what are the results. For non-first-time sufferers: the diagnosis, treatment and efficacy of previous headaches should also be provided for the doctor’s reference. 5.What tests are likely to be done by the doctor on the headache patient? After a detailed history, the doctor will carefully examine the headache patient and make a preliminary judgment: Is the headache functional or organic? What is the severity of the headache? To determine whether there are brain tumors, cerebrovascular disease, encephalitis, traumatic brain injury and other serious diseases, cranial CT is often required, and sometimes enhanced cranial CT is also required, which is an intravenous injection of enhancing drugs to make the lesions appear clearer. These imaging methods are very advanced and can make correct diagnosis for more than 90% of headache patients, but it can be seen that it is not a panacea. EEG is helpful for the diagnosis of epileptic headache, encephalitis and brain tumor, transcranial Doppler ultrasound can provide information on cerebral blood flow, and cerebrospinal fluid examination has a diagnostic value that cannot be replaced by other methods for encephalitis and subarachnoid hemorrhage, and it is generally safe. To rule out head and neck and systemic diseases the doctor may also ask the patient to take sinus films, cervical spine films and blood tests. In short, doctors will choose reasonable and targeted examination methods for different headache patients. 6.What are the manifestations of common headaches in clinical practice? (1) Tension headache: Headache is not new to us, and tension headache is the most common among chronic headache. People (including most doctors) generally call tension headache as neuropathic headache. Along with the rapid development of society, people are living and working at a significantly faster pace in order to adapt to the competitive environment, and the pressure of work and study is increasing, so headaches are more prominent and common. Tension headache is more common among young employees and students in the “white-collar” class, especially among young and middle-aged women, and among students, it is more common among senior high school students. Patients often complain of pain in the front and sides of the head, the back of the head, and the neck, usually a persistent dull pain, sometimes patients also complain of a feeling of tightness or pressure in the head, or spasmodic pulling headache, mostly bilateral, persistent, and also manifesting neurological symptoms such as tension, anxiety, irritability, dizziness, insomnia, memory loss, agitation, etc. Generally speaking, the headache often occurs in the morning after waking up or getting up. In general, headaches often occur in the morning after waking up or shortly after waking up, and then gradually worsen or persist for years without relief. If left untreated, tension headaches can lead to physical and mental imbalance, increased insomnia, and even mental breakdown. This has led to numerous cases of withdrawal from school or work. Therefore patients must strive for an early and definitive diagnosis and prompt and aggressive treatment. From the medical point of view, the continuous contraction of the muscles of the head and neck and mental tension can cause tension headache, and the “tension” of this tension headache can also be understood as physical and mental tension, and physical and mental tension affect each other. There are several reasons for the contraction of head and neck muscles: ① Excessive anxiety or depression, accompanied by mental tension, stressful work and study, and long hours of mental work without relaxation. ② Caused by contraction spasm of the five senses or neck muscles. ③It is caused by poor posture of the head, neck, shoulders and scapula when sitting or standing, and the muscle contraction can cause a decrease in blood flow to the area and local ischemia causing headache. (2) Migraine: It often develops in adolescence, some patients have family history, and is mostly triggered by exertion, emotional factors and menstruation. In typical cases (ophthalmic migraine), the headache is preceded by ocular aura, such as flash, black haze, foggy vision, hemianopia, etc. There may also be numbness of face, tongue and limbs, which is related to intracranial vasospasm. About 10-20 minutes later, followed by extracranial vasodilatation, there is severe throbbing pain or distension on one or both sides, mostly accompanied by pallor, cold limbs, drowsiness, etc., and there may be changes in mood and behavior, nausea and vomiting after the headache reaches its peak, which lasts for several hours to a day. The frequency of attacks varies. Those who do not have the above-mentioned aura are called “common migraine”. Common migraine is more common, and the attacks can last for several days. A small number of headaches with recurrent attacks followed by transient motoneural palsy are called “oculomotor palsy migraine”, but the oculomotor palsy does not return after a long time. Interestingly, some migraine patients have no headache symptoms, but other manifestations are very typical, which is called migraine equivalence. (3) Headache caused by intracranial lesions: Headache caused by meningoencephalitis, hemorrhagic cerebrovascular disease and ischemic cerebrovascular disease is often accompanied by signs of neurological damage, arteriosclerotic signs in the fundus and heart, and increased blood lipids. Intracranial masses and increased intracranial pressure: Headaches caused by brain tumors, brain abscesses, intracranial hematomas, cysts (arachnoiditis), brain parasites, etc. are progressively aggravated and have signs of neurological limitations, and are aggravated by sudden increases in cranial pressure after coughing and exertion, and are accompanied by vomiting, optic papilledema, retinal hemorrhage, psychiatric symptoms, epilepsy, etc. The headache caused by the above causes is more serious and even life-threatening, so we should be highly alert and consult the doctor in time. (4) Other headaches: low cranial pressure headache mostly occurs after lumbar puncture; epileptic headache is mostly seen in adolescents and children, with severe throbbing pain or blast pain, with sudden onset and termination; headache after cranial injury early headache is related to soft tissue injury, cerebral edema, intracranial hemorrhage, hematoma, infection, etc., and late headache is quite common, mostly with debilitating manifestations, called “traumatic neurosis” or “post-traumatic brain syndrome”; a few headaches are caused by late complications of trauma, such as intracranial hematoma, traumatic cerebral arachnoiditis, low cranial pressure syndrome, spontaneous pneumocephalus, epileptic headache, and late onset brain abscess and meningitis. Headaches caused by extracranial head and neck lesions have symptoms of corresponding organ damage; neurosis is one of the most common causes of headaches, but it can only be diagnosed when various organic diseases mentioned above are excluded and there are clear manifestations of neurological weakness, headaches may be related to the patient’s lowered threshold of pain tolerance, headaches in anxiety disorders are mostly accompanied by obvious manifestations of anxiety and restlessness, depressed patients also often have headaches, depressive symptoms are counter-ignored and should be The headache of hysteria is variable in location and nature, and there are other hysterical manifestations, such as emotional factors of the onset and various other discomforts of the body, etc. Sometimes there can be acute headache attacks with exaggerated symptoms, often crying, rolling and calling, and there is no other abnormality in physical examination and nervous system except for disorganized sensory disorders and bilateral hyperactive tendon reflexes, and the headache can be significantly reduced after history and physical examination to attract their attention. The headache can be significantly reduced after the history and physical examination to attract the attention of the patient, and can be quickly cured by implication treatment. 7.Treatment of common headache? First of all, it is to actively prevent and treat various primary diseases. For symptomatic treatment, pain relieving drugs other than morphine can be used, such as various antipyretic and analgesic agents, which can be taken for a short time or 2-3 times/d according to the condition, and codeine, cranial pain or dihydroetorphine can be taken in small amounts for severe cases. Various sedatives or tranquilizers can be added as appropriate, especially for anxious and irritable people. For those with depressive manifestations, antidepressants may be added. In terms of treatment, we can also address the mechanism of headache occurrence, for example: ① Correcting intracranial pressure: for example, dehydration and diuretics for high intracranial pressure; for low cranial pressure, intravenous isotonic fluids, etc. (2) Constriction of dilated blood vessels: for example, early use of ergot preparations during migraine attacks. For non-migraine vascular headache, compound antipyretic and analgesic drugs containing caffeine, such as APC, Somitone and Brain Clear tablets, are often used to improve vascular tone. ③Relaxation of contracted muscles: For muscle contraction headache, such as massage, heat therapy, painful point procaine closure, etc., or taking weak tranquilizers such as Valium and Advil, etc., which can help to relax muscles and also help to release mental tension. ④Closure of the affected cranial surface nerve: for cranial surface neuralgia. ⑤ “Renewing” the cerebrospinal fluid of the lesion: For example, for severe headache after subarachnoid hemorrhage, 5-10 ml of hemorrhagic cerebrospinal fluid can be released or an equal amount of oxygen can be injected to promote the absorption of cerebrospinal fluid for “renewal” after the condition is stabilized and the cranial pressure is not high. The headache can often be relieved rapidly. This method is also applicable to the headache of plasmacytic meningitis. First of all, to prevent tension headache, patients should cooperate closely with doctors to find the cause of the headache, which may involve medical, biological, psychological, ethical, social and other factors. Only when the cause is really found can we find out the psychological and emotional countermeasures, which is a very important link and the way to cure the root of the problem. Most of them are caused by work environment, interpersonal relationship, social competition, marriage and family and life trivialities, etc. We must correctly distinguish and treat them differently, correctly treat and solve the conflicts in work and life, and do our best to avoid tension headache caused by emotional tension, anxiety and impatience. In addition to paying attention to your own psychological adjustment, you can also adjust the human body from the perspective of environment and physiology to reduce headache attacks. Pay attention to the prevention and correction of various bad postures to avoid causing continuous contraction of the muscles of the head, neck and back of the shoulder, such as long-term low head ambulation work, etc. Pay attention to your own regulation every day. Taking a warm bath in the morning or at night before going to sleep, taking a walk or trotting in the fresh air, hot compresses on the neck and back, gentle massage on the scalp and neck muscles, pressing acupuncture points with fingers, etc. These methods allow the patients themselves to personally experience that their own relaxation can reduce the spasm and contraction of local muscles, thus alleviating headache. Relaxation training is the most common and effective method to prevent tension headache. Treatment of tension headache can be conventional treatment: such as acupuncture, massage, hot compress, electric excitation therapy. If the headache is caused by cervical spine hyperplasia or injury, cervical traction should be added and a cervical brace should be used to consolidate the effect of traction. The headache caused by curvilinear light should be corrected, or do eye care exercises. Relaxation training can be performed: Since the continuous contraction of the muscles in the head and neck is the direct cause of tension headache, as long as the contraction of the muscles in the head and neck is relieved and the muscles are completely relaxed, the tension headache can be completely cured. Relaxation therapy, as an adjunct to medication, is a treatment method that enables a person to achieve muscle relaxation and mental stability to reduce anxiety through subjective imagination and objective measures. Relaxation training, as an important part of psycho-behavioral therapy to reduce anxiety, can significantly relieve tension headache caused by mental and psychological factors. As we all know, mental anxiety and nervous excitement can cause scalp and neck and back muscle spasm and cause scalp tightness and 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, and its pathogenesis is anxiety-muscle spasm. The pathogenesis is anxiety and muscle spasm, and these two factors are mutually causal, resulting in a vicious circle: anxiety – spasm – headache – insomnia. The treatment is based on the pathogenesis: suppressing anxiety and relieving spasms. Pain relievers, sedatives, antidepressants, and anti-anxiety drugs can also be given as described before.