Introduction
Headache is a common clinical symptom and is usually referred to as pain confined to the upper part of the skull, including the brow arch, the upper edge of the ear chakra and the area above the line of the external occipital ridge. There are many causes of headache, including neuralgia, intracranial infection, intracranial occupying lesions, cerebrovascular disease, extracranial head and facial diseases, and systemic diseases such as acute infection and poisoning. The age of onset of headache is common in young, middle-aged and old people.
Disease classification
The clinical classification of headache can be based on the mode of onset: (1) acute onset of headache: such as subarachnoid hemorrhage and other cerebrovascular diseases, meningitis or encephalitis; (2) subacute onset of headache: such as temporal arteritis, intracranial tumor; (3) chronic onset of headache: such as migraine, tension-type headache, cluster headache, drug-dependent headache, etc.
The International Classification of Headache Disorders 2nd Edition (ICHD-II) in 2004 divided headache into three major categories: ① the primary headaches: including migraine, tension-type headache, cluster headache, etc.; ② the secondary headaches: including head and neck trauma, craniocervical vascular factors, intracranial non-vascular diseases, infection, drug withdrawal, psychogenic factors, etc. ③ cranial neuralgia, central and primary facial pain, and other headaches caused by other facial structural lesions and other types of headaches.
Causes
There are many causes of headache, which can be broadly divided into two categories: primary and secondary. The former can not be attributed to a specific cause and can also be called idiopathic headache, such as migraine and tension-type headache; the latter can involve various intracranial pathologies such as cerebrovascular disease, intracranial infection, cranial trauma, systemic diseases such as fever, internal environmental disorders and abuse of psychoactive drugs. The details are as follows.
l Infection
Febrile illnesses caused by cranial infections or acute infections in other body systems. Cranial infections that often cause headache such as meningitis, meningoencephalitis, encephalitis, brain abscess, intracranial parasitic infections (e.g., cysticercus, encapsulated worm), etc. Acute infections such as influenza, pneumonia and other diseases.
l Vascular lesions
Subarachnoid hemorrhage, cerebral hemorrhage, cerebral thrombosis, cerebral embolism, hypertensive encephalopathy, cerebral blood supply deficiency, cerebrovascular malformation, etc.
l Occupational lesions
Headache caused by increased intracranial pressure due to craniocerebral tumor, intracranial metastatic cancer, inflammatory demyelinating pseudotumor, etc.
l Cephalofacial and cervical neuropathy
Head and facial innervation neuralgia: e.g. trigeminal nerve, glossopharyngeal nerve and occipital neuralgia. Headache caused by cephalofacial neurological disorders such as eye, ear, nose and dental diseases. Cervical spondylosis and other neck disorders that cause head and neck pain.
l Systemic diseases of the whole body
Headache caused by hypertension, anemia, pulmonary encephalopathy, heat stroke, etc.
l Cranio-cerebral trauma
Such as concussion, cerebral contusion, subdural hematoma, intracranial hematoma, and sequelae of traumatic brain injury.
l Poison and drug poisoning
Such as alcohol, carbon monoxide, organophosphorus, drugs (such as belladonna, salicylic acid) poisoning, etc.
l Internal environmental disorders and mental factors
Menstrual and menopausal headaches. Neurosomatization disorder and hysterical headache.
l Other
Such as migraine, cluster headache (histamine headache), headache epilepsy.
Pathogenesis
The pathogenesis of headache is complex, but it is mainly caused by the stimulation of nociceptive receptors in intracranial and extracranial nociceptive structures, which are transmitted via nociceptive transmission pathways to the cerebral cortex. Intracranial nociceptive structures include venous sinus (such as sagittal sinus), anterior and middle meningeal arteries, dura mater at the base of the skull, trigeminal nerve (V), glossopharyngeal nerve (IX) and vagus nerve (X), proximal part of internal carotid artery and adjacent branches of Willis ring, gray matter around the midbrain conduction ducts of the brainstem and thalamic sensory relay nuclei, etc.; extracranial nociceptive structures include periosteum of the skull, skin of the head, subcutaneous tissue, capillary tendon membrane, and the head and neck muscles and extracranial arteries. The extracranial pain-sensitive structures include the periosteum of the skull, the skin of the head, the subcutaneous tissue, the capillary tendons, the muscles and extracranial arteries of the head and neck, the 2nd and 3rd cervical nerves, the eyes, the ears, the teeth, the sinuses, the oropharynx and the nasal mucosa. Headache can be caused by mechanical, chemical, biological stimuli and biochemical changes in the intracranial and extracranial pain-sensitive structures. For example, dilatation or traction of intracranial and external arteries, displacement or traction of intracranial veins and venous sinuses, compression, traction or inflammatory stimulation of cerebral and cervical nerves, muscle spasm, inflammatory stimulation or trauma of cranial and cervical muscles, meningeal irritation caused by various reasons, abnormal intracranial pressure, dysfunction of intracranial 5-hydroxytryptaminergic neuronal projection system, etc.
Pathophysiology
Head and facial vessels, nerves, meninges, venous sinuses, head and facial skin, subcutaneous tissues, mucous membranes, etc. constitute the pain-sensitive structures of the head, which cause head pain when they are subjected to mechanical strain, chemical or biological stimulation or changes in the internal environment.
Clinical manifestations
The degree of headache varies from mild to severe, and the duration of pain varies from long to short. There are various forms of pain, such as distension, dullness, tearing pain, electric shock pain, pins and needles pain, some of which are accompanied by vascular pulsation and tightness of the head, as well as nausea, vomiting and dizziness. Secondary headache may also be accompanied by other systemic disease symptoms or signs, such as infectious disease often accompanied by fever, vascular disease often accompanied by hemiplegia, aphasia and other symptoms of neurological deficits. Depending on the severity of the headache, the patient may lose the ability to live and work.
Diagnosis
The diagnosis of headache is based on the location of the pain in the head of the patient. In the process of headache diagnosis, it is important to distinguish whether the headache is primary or secondary. The diagnosis of primary headache should be based on the exclusion of secondary headache, as primary headache is mostly a benign process, while secondary headache is caused by organic lesions. Since the etiology of headache is complex, in the history taking of headache patients, the focus should be on the mode of headache onset, frequency of attacks, time of attacks, duration, location, nature and degree of pain of headache, the presence of antecedent symptoms, and the presence of clear triggering factors, factors that aggravate and reduce headache, etc. At the same time, in order to better identify the cause and nature of headache, a comprehensive understanding of the patient’s age and gender, sleep and occupational status, past medical history and concomitant diseases, history of trauma, history of medication, history of poisoning and family history should be obtained to determine the effect of general conditions on the onset of headache. A thorough physical examination, especially the examination of the nervous system, cranium and five senses, can help to detect the lesions of headache. Timely and appropriate use of neuroimaging or lumbar cerebrospinal fluid examination can provide the basis for diagnosis and differential diagnosis of intracranial organic lesions.
Disease treatment
Treatment of headache includes both pharmacological and non-pharmacological physical therapy. The principles of treatment include symptomatic management and treatment of the primary disease. For acute attacks of primary headache and secondary headache whose etiology cannot be immediately corrected, symptomatic treatment such as pain relief can be given to terminate or alleviate the headache symptoms, and appropriate symptomatic treatment can be given for the accompanying symptoms of headache such as vertigo and vomiting. For secondary headache with clear causes, the causes should be removed as soon as possible, such as anti-infection treatment for intracranial infection, dehydration to lower cranial pressure for intracranial hypertension, and surgery to remove intracranial tumors.
Drug treatment
Analgesic drugs include: non-steroidal anti-inflammatory analgesics, central analgesics and narcotic analgesics. Non-steroidal anti-inflammatory analgesics have the advantages of precise efficacy and no addiction, and are the most commonly used analgesics for headache, including aspirin, ibuprofen, anti-inflammatory pain, paracetamol, pautazone, rofecoxib and celecoxib. Tramadol as the representative of central painkillers, belongs to the second class of psychotropic drugs, non-narcotic painkillers, the pain relief effect is stronger than the general antipyretic painkillers, mainly used for moderate and severe degree of headache and various post-operative and cancerous lesions pain, etc. Opioids such as morphine and dulcolax represent narcotic painkillers, which have the strongest pain-relieving effect, but long-term use can lead to addiction. These drugs are only used for patients with advanced cancer. In addition, there are some herbal compound headache painkillers, which are helpful in relieving and preventing headache.
Non-pharmacological physiotherapy
Non-pharmacological physical therapy for headache includes: physical magnetic therapy, local cold (hot) compress, oxygen absorption, etc. Appropriate treatment should be given to those who have chronic headache with recurrent attacks to control frequent attacks of headache.
Disease prevention
Prevention and treatment of headache should reduce all possible causes of headache, including avoiding soft tissue injury of head and neck, infection, avoiding contact with and intake of irritating food, avoiding mood swings, etc. At the same time, primary diseases secondary to headache should be diagnosed and treated in a timely manner. Sedatives, antiepileptics and tricyclic antidepressants are effective in preventing primary headache attacks such as migraine and tension headache.
Disease care
Headache patients should reduce pain-inducing foods such as chocolate, cheese, wine, coffee and tea. Also taste diet should be light, avoid spicy and stimulating, raw and cold foods, and foods such as ham, dried cheese, and long-preserved game should be prohibited during headache attacks.