Clinically, headaches can be classified according to the mode of onset.
① Acute onset headache: common such as subarachnoid hemorrhage and other cerebrovascular diseases, meningitis or encephalitis, etc.
(2) Subacute onset of headache: such as temporal arteritis, intracranial tumor, etc.
(③) Headache with chronic onset: such as migraine, tension-type headache, cluster headache, drug-dependent headache, etc. According to the causes of headache, the International Classification of Headache Disorders 2nd Edition (ICHD-II) developed by the International Headache Society in 2004 divided headache into three major categories: (1) headache disorders, (2) headache disorders, and (3) headache disorders. ) in 2004, divided headache into three main categories.
①The primary headaches: including migraine, tension-type headache, cluster headache, etc.
②The secondary headaches: headaches caused by head and neck trauma, craniocervical vascular factors, intracranial non-vascular diseases, infections, drug withdrawal, psychiatric factors and other causes.
(3) Cranial neuralgia, central and primary facial pain, and other headaches caused by other facial structural lesions and other types of headaches.
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 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.
Infections Febrile illnesses caused by cranial infections or acute infections of 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.
Vascular lesions Subarachnoid space hemorrhage, cerebral hemorrhage, cerebral thrombosis, cerebral embolism, hypertensive encephalopathy, cerebral blood supply deficiency, cerebrovascular malformation, etc.
Occupational lesions Headache caused by increased intracranial pressure due to cranial tumor, intracranial metastatic cancer, inflammatory demyelinating pseudotumor, etc.
Cephalofacial and cervical neuropathy Cephalofacial innervation neuralgia: such as 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 diseases cause head and neck pain.
Systemic diseases of the whole body
Headache caused by hypertension, anemia, pulmonary encephalopathy, heat stroke, etc.
Cranio-cerebral trauma
Such as concussion, cerebral contusion, subdural hematoma, intracranial hematoma, and sequelae of traumatic brain injury.
Poison and drug poisoning
Poisoning by alcohol, carbon monoxide, organophosphorus, drugs (such as belladonna and salicylic acid), etc.
Internal environmental disorders and mental factors
Menstrual and menopausal headaches. Neurotic somatization disorder and hysterical headache.
Others
Such as migraine, cluster headache (histamine headache), headache type epilepsy.
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 diseases often accompanied by fever, vascular lesions often accompanied by hemiplegia, aphasia and other 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, attack time, 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 analgesia can be given to terminate or alleviate the headache symptoms, and appropriate symptomatic treatment can also be given for the accompanying symptoms of headache such as vertigo and vomiting. For secondary headache with a clear cause, the cause 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.