I. What is headache?
Headache is a subjective sensation produced by the action of injurious stimulus causative factors on the body, and its painful site is located in the head. Headache can also be caused by lesions of nociceptive fibers or nociceptive centers at all levels or analgesic structures that regulate nociception. Headache can also be associated with a facial or neck lesion.
Headache is one of the most common clinical symptoms. There is no one who has not experienced a headache. Headache is only a clinical symptom, not a separate disease, and many, many diseases can cause headaches, such as encephalitis, colds, migraines, etc. Headache is often accompanied by a certain emotional response, the degree of which varies widely among individuals. In other words, for a certain degree of illness, some people can tolerate it, while others have a significant reaction.
II. What are the causative factors of headache?
1. Physical factors: Headache is caused by inflammation, injury or compression of swelling in pain-sensitive tissues inside and outside the skull.
(1) Traction, extension or displacement of blood vessels: headache occurs when the intracranial blood vessels are traction or displaced, which is called traction headache.
(1) Intracranial occupying lesions: brain tumor, hematoma, abscess, etc.
(ii) Increased intracranial pressure: cerebral edema, venous sinus thrombosis, hydrocephalus, cerebral tumor or cerebral cystic worm compression blockage affecting cerebral crest fluid circulation, etc.
(3) Decreased intracranial pressure: Sometimes after lumbar puncture or lumbar anesthesia, due to more loss of cerebral crest fluid, the intracranial pressure decreases, causing headache due to expansion or traction of intracranial venous sinuses and veins.
(2) Vascular dilation: Various causes of intracranial and extracranial arterial dilation can produce headache. For example, in acute intracranial and extracranial infections, pathogenic toxins can cause arterial dilation; metabolic diseases such as hypoglycemia, hypercapnia and hypoxia; toxic diseases such as carbon monoxide poisoning and alcoholism can cause headache due to intracranial and extracranial vasodilation.
(3) Stimulation of meninges: Headache occurs due to stimulation of meninges or brain edema traction of meninges due to inflammatory exudates in the skull such as meningitis or blood stimulation of meninges in hemorrhagic diseases, such as subarachnoid hemorrhage.
(4) Contraction of head and neck muscles: Headache caused by continuous contraction of head and neck muscles is called tension headache. It can be divided into two categories: one is primary, the cause of which is unknown, and the headache is caused by continuous contraction of head and neck muscles, called tension headache; the other is symptomatic, due to reflex cervical muscle tension contraction caused by neck diseases, such as cervical spondylolisthesis, neck trauma or cervical disc lesion, etc.
(5) Nerve irritation or lesion: cranial nerve and cervical nerve compression lesion or inflammation, such as trigeminal neuritis, occipital neuritis, tumor compression. Cranial nerve irritation lesions such as trigeminal neuralgia, etc.
(6) Involvement headache: lesions in the eyes, ears, nose, paranasal sinuses, teeth, and neck can spread or reflect to the head and face, producing involvement headache.
(2) Biochemical factors: Biochemical factors are currently receiving high attention. In recent years, through the study of migraine, it was found that norepinephrine, 5-antelope tryptamine, bradykinin, prostaglandin and so on have obvious changes in the blood of patients with recurrent migraine. For example, the release of norepinephrine can cause vasoconstriction; 5-antelope tryptophan, if free in the plasma, can cause large blood vessels to constrict and small blood vessels to dilate. When migraine attacks occur, the reduction of 5-antelope tryptamine facilitates the action of bradykinin on cerebral blood vessels, producing a sterile inflammatory response and thus causing headache. In addition, histamine can also cause headache by dilation of intracranial blood vessels.
3.Endocrine factors: From many clinical cases, we can see that the relief and attack of headache are closely related to endocrine. For example, migraine is mostly seen in women, the first attack is often in adolescence, and there is a tendency that the headache is good during menstruation, relieved during pregnancy and stopped during menopause. Tension headache is often aggravated during menstruation and menopause.
4.Neuropsychiatric factors: It is mainly due to various stimuli of external environment, which causes patients to have anxiety and anxiety.
3. What is the relationship between the location, nature, duration and duration of headache and the disease suffered?
From the perspective of anatomy, the distribution of nerves and blood vessels in the head has certain regularity. When the distribution of the nerve or blood vessel is lesioned or injured, the pain in the corresponding area usually appears. Usually, headaches caused by extracranial lesions are usually consistent with or located near the lesion. The common ophthalmogenic, rhinogenic, and odontogenic headaches have pain sites that are mostly connected to these organs. For example, in headache caused by glaucoma, the pain site is mostly located around the orbit or in the orbitofrontal region. In the case of lesions of the greater occipital nerve on one side, the pain is mostly located in the occipital region on that side. However, for intracranial lesions, the site of headache does not necessarily match the site of origin. However, for lesions above the cerebellar curtain, the headache is mostly located at the lesion, mainly in the frontal region, and radiates to the temporal region, while for lesions below the cerebellar curtain, the headache is mostly located in the posterior occipital region. For headaches caused by pituitary tumors or tumors near the pterygoid saddle, the pain site is mostly located bilaterally. Headaches caused by intracranial and extracranial infections and hemorrhagic diseases such as subarachnoid hemorrhage are mostly full headaches.
IV. Is headache related to gender, age structure, seasonal changes, heredity and emotion?
The epidemiological findings of headache show that headache is related to gender. As repeatedly emphasized above, headache is only a clinical symptom, and the diseases causing headache are very complicated. The headache caused by the following diseases is more closely related to gender.
1.Migraine. The incidence rate of women is high, and the ratio of men to women is 1:4.
2.Myotonic headache and neurosis headache are also common in women.
The headaches caused by other diseases are not related to gender. Therefore, it is not possible to generalize that headache is related to gender or not. Mainly, migraine is more closely related to gender.
The epidemiological findings of headache show that headache is not related to age structure. In fact, various diseases that cause headache have different age structures, and thus the headache caused by various diseases also has different age structures.
1.Migraine is mostly seen in young women, with a high prevalence in the age of 20-34.
2.Myotonic headache is mostly seen in young adults, with the highest prevalence in the age group of 20-40 years.
3.The headaches caused by other diseases do not differ much in different age groups.
In conclusion, the age of headache can provide some clues to determine the diseases that cause headache.
In clinical work, we sometimes encounter some patients who say that their headaches are obviously related to the seasons, such as “headaches start every spring or summer”. Then there is a certain relationship between headache and seasonal changes.
1.Migraine. The results of epidemiological survey show that the incidence of migraine is highest in summer in the north and in spring in the south, indicating that hot and humid conditions are closely related to migraine attacks. Another survey data shows that climate tops the list of six expected triggers of migraine, with more frequent occurrence in spring and summer than in winter, showing that changes in humidity, or its when humidity rises, are more likely to trigger migraine.
2. Neurotic headache. Neurotic headache is related to mood changes and lack of sleep, and lack of sleep tends to be more common in summer, thus, neurotic headache is also indirectly related to the season.
In clinical work, we often encounter patients who will ask, “Are headaches hereditary?” The answer to this question cannot be generalized as yes or no. The causes of headache are complex, so we can only say exactly which of the headache causing diseases are hereditary.
The following diseases have a certain tendency to be inherited.
1. Migraine. The epidemiological findings show that the genetic prevalence of migraine accounts for 20%-80%. Most of the genetic rules are in line with autosomal dominant inheritance, while a few cases are autosomal recessive and polygenic inheritance, among which the genetic tendency of typical migraine is the most obvious.
2.Neurotic headache. Its onset is related to emotion, psychological quality and environment. The genetic tendency is not as obvious as migraine, but the psychological quality of human has a certain relationship with heredity, so this kind of headache has a certain relationship with heredity. Neurotic headache is usually found in those who are introverted and sentimental in gender.
3.Cerebrovascular headache. It is known that the occurrence of cerebrovascular disease has a certain genetic factor, so the occurrence of cerebrovascular headache has a certain relationship with genetics.
The headache caused by other diseases has nothing to do with heredity.
In short, migraine is the most closely related to heredity, but it only has a certain genetic tendency, not heredity.
V. What is migraine, is migraine hereditary, and what are its clinical manifestations?
Migraine is a kind of vascular headache. Vascular headache is a headache caused by the change of cranial vasoconstriction, and there are two types of vascular headache: primary vascular headache and secondary vascular headache. Migraine is an ancient disorder, which was described as early as 3000 years ago and named migraine by Hippocraets 2500 years ago, and has been used since then.
The ancestral medicine has long knowledge about migraine and believes that its mechanism is mostly the lesion of the three Yang meridians.
The mode of inheritance of migraine cannot be conclusively confirmed at this time. The distribution of family members is different from recessive inheritance, which is autosomal dominant with incomplete epistasis, but some scholars believe it is recessive with incomplete epistasis. In conclusion, the heritability of migraine is certain, but the mode of inheritance is inconclusive.
In migraine patients, headache attacks often occur during the day, but can still occur at night. The headache attacks are usually confined to one side of the head, and some patients may have a change in the location of the headache with each attack, sometimes with pain in the occipital area and the top of the head, or with pain in the face and neck. However, the diagnosis of migraine cannot be made only from the location of the headache. When a patient has a headache attack, the pain gradually increases, and the headache peaks in a few minutes to 1-2 hours, and can last for several hours or even days, and then the headache gradually decreases or disappears. In a small number of patients, there is a sudden onset of severe headache with no obvious trigger, which peaks within a few seconds and can last for several hours or even days. The pain is often pulsating, some patients present with a non-pulsating dull pain, and a few patients present with a stabbing pain in the head or a percussive sensation. Compressing the artery at the headache site or the carotid artery on the diseased side or the eye can reduce the headache, and bed rest can reduce the pain, and short-term sleep can make the pain disappear completely.
What is typical migraine and what are its aura symptoms?
Typical migraine, also known as migraine with aura, accounts for 10% of migraine patients, mostly develops in adolescence, and there is more family history. The most distinctive feature of typical migraine is that the headache is preceded by aura symptoms.
1. Visual aura symptoms: Patients may have flashing hallucinations in the bilateral visual field, and the shape of the flashing light is variable, such as star-shaped or ring-shaped. Some patients may have black haze in front of their eyes, commonly monocular black haze, which is mostly transient, or they may see distortion of visual objects, larger or smaller visual objects, or change in shape.
2. Sensory abnormalities: The most common ones are tingling and numbness in the hands and forearms, numbness in both hands, limbs, half of the face and around the mouth and lips, and loss of hemianesthesia, which lasts for a few seconds to 20 minutes, occasionally for several hours, and rarely for several days to weeks.
3. Other aura symptoms: In addition to the above aura symptoms, migraine patients may also have motor aura, which may manifest as monoplegia or hemiplegia, or transient aphasia or mental symptoms.
VII. What is common type migraine? What are its symptoms?
Generalized migraine, also known as migraine without aura, is the most common type of migraine, and its aura period is not obvious. It may cause non-specific prodromal symptoms including mental disturbance, gastrointestinal symptoms and fluid balance changes several hours or days before the headache attack. The headache can be unilateral or bilateral frontal and temporal episodic, throbbing pain of longer duration than typical, with completely normal intervals.
VIII. How do headache patients describe their condition to doctors?
Medical history is more important for headache diagnosis. Especially for headache patients, there is no abnormality in physical examination and laboratory and imaging examinations are normal, so the qualitative and etiological diagnosis of headache is made entirely by medical history. Headache patients should describe their symptoms to the physician from the following aspects.
1. Characteristics of the headache itself: What causes the headache? How long has the headache been there? Is the headache persistent or paroxysmal? If the headache is paroxysmal, how long does each headache last and when does the headache occur? What is the nature of the headache – cutting? Burning pain? Stabbing pain? Drilling pain? throbbing pain? Swelling pain irregularly is pounding pain? Aggravating or relieving factors for headache – what medication can be taken to reduce it? Is it worse during menstruation? Is it worse after childbirth and exertion? Is it related to climate change? Is it related to change of head position? Is it worse after drinking alcohol? Is it heavier in the morning or afternoon?
2. Symptoms accompanying headache.
(1) Central nervous system symptoms – disorders of consciousness, sensory disorders, aphasia, slurred speech, unstable walking, limb paralysis, incontinence, stiff neck, uncontrollable movement of arms and legs, convulsions, etc.
(2) Visual system symptoms – diminished vision, double vision, golden light, photophobia, seeing only half of one thing partially blind,, eye strabismus, etc.
(3) Vegetative symptoms – cold sweat, pale and flushed face, cold hands and feet, fluctuating blood pressure, palpitations, vomiting, nausea, diarrhea, etc. Systemic symptoms – fever, cough, weakness, wasting, general discomfort, etc. Mental disorders – insomnia, anxiety, memory loss, irritability, depression, etc.
4.Also introduce the diagnosis of headache, medication treatment and its efficacy by the physician in the past visits.
5.If the patient is bored with answering because of severe headache, or cannot give the history of headache because of intracranial lesion, or because of consciousness disorder, the companion can add and verify the history of the patient.
What is vascular migraine, how does a typical migraine occur, and what are its causes?
Vascular migraine is a kind of headache with long-term attacks, characterized by one-sided or bilateral headache caused by intracranial and extracranial vasodilatory dysfunction, and clinically it is mainly unilateral headache, but a few patients may have bilateral or total headache. The headache usually starts from the frontal and temporal areas, and then worsens paroxysmatically and extends to half of the head or the whole head. The pain is mostly drilling or throbbing pain, accompanied by nausea, vomiting, pallor, sweating, photophobia and other symptoms of plant fiber dysfunction, which can last for several hours to more than ten hours, and returns to normal the next day after going to sleep.
It is generally believed that intracranial and extracranial vasodilatory dysfunction is the basis for typical migraine headaches. Migraine attacks begin with a constriction of intracranial function, vasospasm and ischemic symptoms in its blood supply area, followed by extracranial arterial and especially scalp dynamics that produce severe headaches. This change in contraction is mainly related to the concentration of vasoactive substances in the blood plasma. Studies have shown that during migraine attacks the level of some active substances, such as 5-antelope tryptamine in the blood, decreases significantly, and the excretion of 5-antelope tryptamine and its metabolite 5-antelope indoleacetic acid in the urine increases. Since 5-antelope tryptamine has the function of maintaining the ability of the extracranial arteries to contract, a decrease in its level will cause the extracranial vessels to dilate and headache will occur. The increase of other vasoactive substances such as bradykinin and prostaglandins can cause strong diastolic changes in the extracranial vessels and lead to migraine attacks.
The purpose of the etiology of migraine is not clear, but it may be related to the following factors.
1, genetic factors, about 60% of patients can ask out family history, and some patients can have epileptic patients in their families, so it is thought that the disease is related to genetics, but there is no consistent form of genetics yet.
2, endocrine factors, vascular migraine is mostly seen in adolescent females. It gradually decreases or disappears after menopause, and seizures are frequent during menstruation, stopping during pregnancy and recurring after delivery, indicating that endocrine factors are one of the causes of this disease.
3.Dietary factors, many patients often have attacks related to diet, such as frequent consumption of cheese, chocolate, stimulating food, tobacco and alcohol can produce vascular migraine.
4.Other factors, emotional tension, worry, anxiety, hunger, insomnia, poor external environment and climate change can all trigger migraine attacks.
X. What are the symptoms of migraine attack?
Most migraine attacks are preceded by aura symptoms, among which visual aura is the most common, such as sudden blurred vision, flashing dark light, different colors and even black haze, visual field defects. The aura symptoms usually last for about half an hour. Some aura symptoms may occasionally show abnormal sensation in the pharynx, tongue, lips or hemiplegic limbs, hemiplegia, hemiparesis and speech dysfunction, which appear after the visual symptoms, or appear alone but are relatively rare.
In addition to the aura symptoms mentioned above, some patients may have prodromal symptoms several hours to one day before the aura attack, which may be mild head discomfort, drowsiness, irritability, depression, hunger or decreased urination, followed by aura symptoms, followed by a typical migraine attack with frontal and temporal pain on one side, weakness, change in color, nausea, vomiting, or in severe cases, inability to eat and headache, lasting for several hours The symptoms disappear after sleeping, with intervals varying and can be repeated.
Most typical migraine attacks have aura symptoms, often visual aura symptoms, but it does not mean that visual symptoms are unique to migraine, other diseases can also produce visual symptoms. Other diseases can also produce visual symptoms, such as localized eye lesions, hysteria, occipital lobe epilepsy, intracranial occupancy, cerebral infarction, and digitalis toxicity, all of which cause visual symptoms due to disorders of visual transmission channels. However, these diseases have other symptoms and signs in addition to visual disturbances, and EEG, cranial CT, brainstem auditory and visual evoked potentials and ECG examinations are useful for differentiation. Therefore, the correct understanding of visual symptoms can reduce unnecessary panic and help to prevent and treat migraine properly.
XI. Are migraine attacks related to smoking and alcohol consumption?
Migraine attacks have a great relationship with smoking and drinking. In our daily work, we find that the incidence of migraine is significantly higher in patients who smoke and drink alcohol than in the normal population, especially in young people, so how do these two cause migraine attacks? Long-term smoking can cause tissue hypoxia, compensatory erythropoietic increase, increasing the red blood cell pressure; in addition, see the nicotine contained in cigarettes, so that the nerve endings, adrenal glands release adrenaline and norepinephrine, adrenaline and norepinephrine can make vasoconstriction, vasospasm, increased resistance and vascular embolism. Long-term smoking can also increase blood viscosity, slow blood flow, platelet aggregation, the release of various inflammatory neurotransmitters, so that the intracranial and extracranial vasodilatory function is reduced, and the blood cortisol, renin, aldosterone and pressor hormone elevated, so that the adrenaline nerve activity increased and lead to intracranial and extracranial vasodilatory dysfunction. Therefore, in daily life, we should pay attention to good living habits, not smoking and not drinking alcohol are helpful to reduce migraine attacks.
12.Is tension headache the same as migraine and neurasthenia headache, and which headache should be distinguished from it?
Tension headache is different from migraine. The former is a kind of non-pulsating deep pain, mostly found in occipital, temporal and frontal areas, and may spread to the neck and back of shoulder, and its nature is tightness, numbness, heavy pressure, dull pain, especially the back of shoulder muscles are obvious. In some cases, the skin of the scalp or the back of the shoulder is dull; in some cases, the skin is allergic to sensation and the scalp is very painful when stroking or pulling the hair, which lasts for months or longer. In contrast, migraine is painful on one or both sides for several months or longer. In contrast, migraine headache is painful on one or both sides, with throbbing pain in the frontotemporal region accompanied by nausea and vomiting, pallor and other symptoms of vegetative nerve function, and is effectively treated with ergotamine.
In some patients, headache is often accompanied by insomnia, irritability, agitation, depression, memory loss, etc. Sometimes, it is not easy to distinguish from neurasthenia headache, and detailed physical examination should be conducted at this time. Neuroleptic headache usually does not reveal organic changes. In contrast, tension headache, physical examination often reveals muscle tension in the neck, shoulder and back, with obvious soreness and pain when the part is pressed. If secondary tension headache is caused by cervical spine lesions, trauma and stimulation of tissues and organs near the head and neck such as the eyes, ears, nose, throat, teeth and scalp or cranial lesions, localized symptoms of the head and face may appear.
In addition to migraine, it should be distinguished from posterior headache caused by organic lesions in the occipital region, cervical spine and paravertebral area, neurasthenia, hysteria and various visceral diseases that cause prolonged headache. It can be distinguished by understanding the nature, location, duration of headache, accompanying symptoms and factors that contribute to the intensification and reduction of headache, and should also be differentiated from cluster headache and various headaches caused by various brain diseases for treatment.