Headache is one of the common clinical symptoms, most of which are functional, but sometimes it is an early symptom of some serious organic diseases. The etiology of headache is complex and not always caused by central nervous system diseases, for example, acute febrile diseases are often accompanied by headache, which can heal on its own as the disease gets better. Headache can also be the main manifestation of certain diseases, such as migraine, trigeminal neuralgia, hypertension and cerebrovascular lesions. Understanding the general knowledge of these diseases is very helpful for proper understanding of headache, timely diagnosis and self-protection.
Headache can occur in the top of the head, frontal, posterior occipital, one or both sides of the head, or even diffuse total headache. The duration of the attack can be as short as minutes or seconds or last for several days, or even for years and months. The headache can be pounding pain, sharp electric shock-like pain, dull pain, stabbing pain and swelling pain.
Some headache attacks are so severe that once they occur, they knock their heads and roll around on the ground; some are just vague pains, sometimes light and sometimes heavy; some are just perceptible and very mild, or even the so-called “painless headache” is just a discomfort in the head and a strange sensation in the mind. All these different manifestations of headache show that headache is intricate and complex. How to recognize headache correctly, we will understand it in the following aspects.
1.Part of headache
The headache site is closely related to the disease. For headache caused by extracranial lesions, the headache site is often near the lesion, so it can often suggest the site of the lesion. For example, if the headache is caused by trigeminal neuralgia, the site is often consistent with the distribution area of trigeminal nerve; if the headache is caused by eye, paranasal sinus or dental lesion, it is often around the orbit and nasal root. However, for headaches caused by intracranial lesions or deep cranial lesions, the site of the headache does not necessarily match the site of the lesion.
For example, the headache caused by supratentorial lesions is located in the frontotemporal region and often hurts on both sides, while the headache caused by subcranial lesions is in the posterior occipital region. In case of meningitis caused by infection or bleeding, the whole head hurts, and it is impossible to tell the exact location, and the pain is also intense. Therefore, it is important to tell the correct location of the headache for the diagnosis of the disease.
(1) Pain located in the upper part of the orbit or around the eye is commonly associated with glaucoma.
(2) Pain located in the forehead and on both sides of the nose and cheeks, mostly seen in sinusitis.
(3) Headache located on one side, common in migraine and trigeminal neuralgia.
(4) Full headache, common in various kinds of encephalitis or meningitis.
(5) Hard neck and severe headache with fever and vomiting are common in rhinencephalitis.
The site of headache as above has only a reference value for the judgment of the disease, and generally the headache of extracranial lesions is consistent with the source of the disease. For example, ophthalmogenic, rhinogenic and odontogenic pain. Headaches caused by glaucoma are mostly located around or in the upper part of the eye. In the case of deep cranial lesions or intracranial lesions, the headache site does not necessarily correspond to the lesion site. Headache caused by acute infectious diseases is full headache, diffuse, and rarely radioactive.
2.The speed of headache occurrence
Acute headache: If the headache is not accompanied by fever but there is vomiting and impaired consciousness, there is often a possibility of intracranial hemorrhage. Especially in young adults with sudden onset of severe headache with nausea and vomiting, with or without impaired consciousness and hemiparesis without fever, it is prudent to consider intracranial aneurysm or subarachnoid hemorrhage due to cerebrovascular malformation; in middle-aged and elderly people, it can be cerebral hemorrhage or subarachnoid hemorrhage. Acute headache with fever is mostly caused by various infectious diseases.
Chronic headache: Chronic headache with constant aggravation is commonly caused by hypertension, cerebral blood supply deficiency, intracranial hypertension due to intracranial occupying lesions such as brain tumors, vascular neuropathic headache, chronic rhinitis and sinusitis, etc. Chronic persistent headache is mostly tension headache or neurofunctional headache. Recurrent headaches are mostly vascular headaches.
3.Nature and degree of headache
Sometimes the nature of headache can determine the cause of headache. For example, primary trigeminal neuralgia is characterized by episodic, transient electric shock-like pain in the face. Hypertension, vascular headache, acute febrile disease and brain tumor are pulsating and throbbing headache. However, the nature of a certain type of headache can be clinically diverse.
The degree of headache is determined by the location of the lesion, the degree of invasion of pain-causing tissues in the head and individual reactivity. Generally, there are three types of headache: mild headache, which is tolerable and does not affect daily work and study; moderate headache, which is severe and affects daily life and work; and severe headache, which is severe and unbearable and prevents patients from carrying out normal life and work. Generally speaking, severe headache is common in trigeminal neuralgia, migraine and meningitis; moderate or mild headache is common in lesions of eyes, nose, teeth and brain tumor.
However, this classification sometimes does not mean much in terms of understanding the condition. This is because people have different levels of pain tolerance, and there are strong-willed people who talk about the pain very lightly; while patients with neurotic and depressive disorders try to complain about it more seriously in order to draw attention to it. This is such as Guan Gong with a knife to scrape the bones when you can talk and laugh, for weak-willed people have long been scared faint.
Of course, although some patients do not have any major physical changes, but people do suffer, it is not intentional, but they can not control their own head, so they should also be care and comfort. However, the more people there are and the more they are comforted, the worse the headache becomes.
In addition, the headache is related to the patient’s ability and habits of speech and emotion, the doctor’s understanding, and the atmosphere created at the time of the visit. A patient with mild occipital pain may have a cerebellar hemorrhage, while a patient who is screaming may be a hysterical patient.
4.Time of occurrence and duration of headache
Time of occurrence of headache: regular morning boring headache is seen in sinusitis; headache with slow onset and frequent morning intensification is mostly intracranial occupying lesion such as brain tumor; more occurrence during daytime and severe pain lasting only tens of seconds is mostly seen in trigeminal neuralgia; cluster headache mostly occurs at night during sleep.
Duration of headache: head neuralgia lasts for a few seconds or tens of seconds for short duration such as trigeminal neuralgia. Duration of 2-3 hours or 1-2 days is characteristic of vascular headache. Neurogenic headache can be continuous for adults and months, varying with emotions or internal or external factors. Recurrent headaches lasting for several hours or 1-2 days are mostly seen in migraine.
5.The triggering, aggravating and relieving factors of headache
Cluster headache is relieved by upright position. Headaches such as brain tumor and meningitis are aggravated by head turning, head bending and coughing. And some headaches caused by excessive tension of cervical muscles related to occupation are relieved by left facial activities.
6.Concomitant symptoms of headache
Paying attention to the symptoms accompanying headache can sometimes be of great help to the cause of the disease. For example, those with severe nausea and vomiting are most likely to be caused by brain tumor or meningitis. Those with obvious vertigo are usually seen in posterior cranial lesions such as cerebellar tumors, vertebral-basilar artery ischemia, cerebellar abscesses and so on. In contrast, headaches that worsen with changes in position are most often associated with tumors near the third ventricle.
Vomiting occurs when the headache reaches its peak, and the headache is significantly relieved after vomiting is common in vascular neuropathic headache. Chronic headache with mental dullness, indifferent expression, indifference to surrounding things, or on the contrary, euphoria, is common in brain tumors and sporadic encephalitis. Headache with visual impairment such as transient vision loss is commonly associated with glaucoma and brain tumor.
7. Age and gender of headache
Migraine in children is often not serious, and sometimes dizziness and other symptoms are the main symptoms, so it is easy to miss and misdiagnose. In some adolescents, daily attacks of frontal pain may be related to anxiety and tension; and the long duration of headache in some adolescents may be endogenous depression. The occurrence of headache in adolescents is sometimes related to factors such as excessive eye use and refractive error, and the possibility of intracranial occupying lesions should be considered in those who have their first headache after the age of 50. In women, there is a special kind of migraine related to menstrual cycle.
8.Factors inducing headache
(1) Headaches caused by changes in the horizontal position of the head are common in cervical spondylosis.
(2) Headache aggravated by head turning, head bending or coughing is commonly caused by brain tumor and meningitis.
9.Other factors
The occurrence of headache is related to various systemic diseases. It is also closely related to personal life such as smoking, alcohol consumption, medication, trauma, surgery, women’s menstruation, marriage and childbirth. For example, alcoholics have a kind of headache called “hangover headache”, which is actually mild alcoholism, and after drinking too much alcohol, headache, heavy head, nausea and other phenomena occur.