I. Overview of headache
1. Headache is the most common clinical symptom, and only 1% of people are spared for life.
2. Headache is the most diagnosed medical condition, with more than 300 different types and causes.
3.Headache needs to be differentiated first: primary? Secondary?
II. Primary headache
More than 95% of headaches are primary and not caused by serious diseases. Primary headaches are headaches without a clear cause, including migraine, tension headache, cluster headache and other primary headaches (such as chronic daily headache, benign cough headache, benign exertional headache, sex-related headache, sleep-related headache, etc.).
(i) Migraine
It is mostly located on one side of the head, and is a severe throbbing pain with nausea, vomiting, photophobia, and phonophobia, and the patient needs to lie down in a dark and quiet environment.
Migraine attacks occur 1-4 times a month.
Twenty percent of migraineurs have a visual aura before the attack.
More than 60% have a family history.
The male to female ratio is about 1:3-1:4.
In women, it is mostly associated with the menstrual cycle.
The first attack is mostly in adolescence.
(II) Tension headache
Tension headache is relatively common
Mild to moderate pain, not affecting the patient’s function
Headache on both sides, mostly temporal, posterior occipital and parietal or total headache
Smooth, not accompanied by nausea or photophobia or phonophobia
Frequency of attacks varies from once a month to three times a week
(iii) Cluster headache
Very rare (0.1%)
Male to female ratio 4:1
Pain located around or in the eye with conjunctival congestion, tearing, runny nose and nasal congestion on the same side of the pain.
The pain usually lasts 45-180 minutes. Multiple episodes per day and at regular times, patients often wake up with pain at night.
The pain is very intense
One attack cycle lasts 4-8 weeks, then symptoms disappear at intervals of about 1 year.
(iv) Chronic daily headache
On average, the attacks last more than 15 days per month
Pain lasting more than 4 hours when untreated
Duration more than 3 months
(V) Drug overdose headache (painkiller rebound headache)
Headache attacks at least 15 days per month
Regular overdose of at least one or more medications (at least 10 days per month) for acute headache control
Duration more than 3 months
Headache worsens as a result
III. Secondary headache
If a headache is caused by an infection, tumor or other disease, it is medically known as a “secondary headache”. When the following danger signs occur, it is a “red alert” from your body and you need to see a doctor as soon as possible.
Sudden onset of a severe headache when headaches are rare.
There is a significant change in the typical headache.
The headache worsens suddenly or gradually over several days.
The first headache of your life occurs after you are over 40 years old.
Headache occurs with exercise, coughing, sneezing, straining to pass stool or similar straining activities, sexual intercourse, or bending over.
Headache with fever, nausea, vomiting, neck stiffness, and pain when the chin touches the forehead.
Headache with the following symptoms: poor coordination, double vision, numbness in any limb or one limb, weakness, drowsiness, inability to stay awake, confusion, language dysfunction, and personality changes.
Have an underlying, serious medical condition, including cancer, lupus-like autoimmune diseases, and chronic infections such as HIV.
(i) Causes of secondary headaches
There are a wide variety of secondary headaches, classified mainly according to their etiology.
Head or neck trauma
cranial or cervical vascular disorders (ischemic stroke or transient ischemic attack, intracranial non-traumatic hemorrhage, unruptured vascular malformation, arteritis, carotid pain, cerebral venous thrombosis)
non-vascular intracranial disorders (high or low cranial pressure, non-infectious inflammation, intracranial tumors, intrathecal injections
epilepsy
seizures, headaches with neurological impairment and cerebrospinal fluid lymphocytosis)
Certain substances or withdrawal from certain substances (headache caused by short-term application or exposure to a substance, headache caused by overdose, headache caused by chronic application or exposure to a substance, withdrawal headache)
Infection (intracranial infection, other systemic infections, AIDS, chronic post-infection headache)
Internal environmental imbalance (hypoxia, hypercapnia, dialysis
hypertension, hypothyroidism, fasting, cardiogenic headache)
Disorders of the head, neck, eyes, ears, nose, sinuses, teeth, mouth, or other facial and cranial structures
Mental abnormalities (somatization disorders, psychiatric disorders)
Cerebral neuralgia and central facial pain (neuralgia: trigeminal neuralgia, glossopharyngeal neuralgia, median neuralgia, supraglottic neuralgia, nasociliary neuralgia, supraglottic neuralgia, other terminal neuralgia, occipital neuralgia; cervical-lingual syndrome; headaches triggered by external compression and cold irritation; compression, irritation or distortion of cranial nerves or nerve roots of the upper cervical segment by structural lesions; optic neuritis; ocular
diabetic
(neuropathy; herpes zoster; Tolosa-Hunt syndrome; oculomotor paralysis “migraine”; central facial pain).
(ii) Factors associated with headache diagnosis
Some acute headaches are caused by organic lesions, and the primary cause can be identified by imaging such as CT and MRI and other laboratory tests. However, for some periodic attacks or chronic recurrent headache, there is often a lack of exact laboratory and specific examination indexes as objective basis, and the diagnosis mainly relies on the patient’s statement, and the doctor needs to make the diagnosis by detailed medical history, such as the onset, duration, development, nature, location, frequency of attacks, influencing factors, triggers, concomitant symptoms, family history, etc., and combined with his own clinical experience The diagnosis is made. However, the patient’s recollection is often vague, and it is not easy for the doctor to obtain this information accurately, which may affect the diagnosis of the condition. Therefore, it would be helpful if chronic headache patients could observe and record their headaches every day and present them to the physician at the time of consultation.
(III) Common causes of headache in the elderly
Intracranial tumor: Headache often occurs at 4 or 5 o’clock in the morning, often waking up in the middle of a deep sleep with pain. In addition, it is often accompanied by nausea, vomiting, seizures and focal neurological dysfunction.
Cerebrovascular accident: When elderly people have cerebrovascular accidents due to brain atrophy and decreased reactivity of the body, they do not always show symptoms such as hemiplegia, hemiplegia or severe headache and vomiting, etc. Many elderly patients tend to have mild headache first, with fixed or diffuse parts, and the headache is persistent and sometimes may be progressive at home. The best time for treatment should be avoided.
Chronic subdural hematoma: Regardless of the severity of the trauma, the elderly should be examined and followed up promptly to prevent the formation of chronic subdural hematoma even if they do not have any symptoms at that time.
Hypertensive emergencies: If an elderly patient with hypertension develops significant headache with vertigo, tinnitus, malignancy, vomiting, palpitations, blurred eyes or even weakness of limbs, numbness and mental abnormalities, it may be a precursor of stroke. Untreated hypertensive encephalopathy can be life-threatening.
Temporal arteritis: Elderly people with intractable, uncontrollable headaches need to be aware of the possibility of temporal arteritis. Headache is the most important and possibly the only symptom. Headache is often located in the temporal and periorbital regions and can be full headache, or pulsating or persistent distension, and patients often wake up in pain during sleep. Headache while chewing is its characteristic manifestation. It is accompanied by varying degrees of vision changes, mainly because of the affected retinal artery.
Cerebral aneurysms and neck diseases are also more common causes of headaches. For this reason, we remind our elderly friends that headaches should not be taken lightly and should be brought to the attention of the doctor in time to avoid delaying the condition.