Headache is not always caused by central nervous system diseases, but is more common due to systemic, local and mental factors.
According to the location of lesions, headache can be divided into: (1) intracranial diseases, such as intracranial tumors, infections, vascular lesions, injuries and migraine; (2) extracranial diseases, such as cranial lesions, various neuralgia, tension headache, and lesions in the ear, eye, teeth, nose and neck; (3) systemic diseases, such as infections, cardiovascular diseases and neurosis.
According to the etiology, it can be divided into: ① vascular headache, such as migraine, fever, anemia, hypoxia, carbon monoxide poisoning, hypertension, etc.; ② neuropathy, such as trigeminal neuralgia, supraorbital neuralgia, glossopharyngeal neuralgia, etc.; ③ cranial pressure change, such as high or low cranial pressure caused by various inflammatory diseases; ④ inflammation, such as meningitis; ⑤ trauma, such as craniocerebral trauma, skull fracture; ⑥ muscle contraction, such as mental overstrain, after exertion; ⑦ psychogenic, such as mental stress and stress. (6) Muscle contraction, such as those occurring after mental overstrain and exertion; (7) Psychogenic, 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.
(B) Physical examination: A comprehensive and focused physical examination is helpful for diagnosis. For example, temperature and blood pressure should be taken, and the mental status should be understood. Head examination: including scalp, cranium, temporal artery palpation, and examination related to the five senses. Neurological examination, etc.
(iii) Other examinations: The following examinations 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 magnetic resonance.
5. Brain ultrasound, brain nuclide, 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.
(C) 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. Frontal See in sinusitis, intracranial hypertension, supratentorial occupying lesion, fever.
2. Top See neurosis.
3. Occipital See sub-screen lesions.
4. Temporal region on one side: ocular pathology, migraine, neuralgia, temporal arteritis.
5. Neck See epidemic meningitis, subarachnoid hemorrhage and acute cervical myelitis
5. Diffuse Hypertension, high fever, intracranial or extracranial infection, high cranial pressure, cerebral arteriosclerosis, and muscle contraction headache.
(F) The nature of headache has significance for 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 High fever, brain tumor.
3. Sharp pain Seen in otogenic, odontogenic.
4. Compression pain See in muscle contraction headache.
5. Indeterminate and variable in nature, seen in neurosis.
6. Swelling pain See 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 due to trigeminal neuralgia, migraine, meningeal irritation is more severe, and sometimes headache of neurosis is also more severe.
(X) The concomitant symptoms of headache are helpful for the diagnosis of the cause.
1. with jet vomiting It 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 papilloedema, it is a sign of increased cranial pressure. Vomiting when the headache reaches its peak and the headache is relieved after vomiting is a migraine.
2. With fever See inflammation caused by various infections, collagen disease, etc.
3. With vertigo See inner ear lesions, cerebellar lesions, posterior circulation ischemia and vertebrobasilar migraine.
4. With convulsions See high fever, 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 some brain tumors. Migraine may have aura such as flashing light, dark spot and hemianopia. The presence of diplopia and fever suggests tuberculous meningitis.