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 condition in medicine, with more than 300 different types and causes.
3.Headache needs to be distinguished first: primary; secondary.
More than 95% of headaches are primary and not caused by serious diseases. Primary headache means headache without a clear cause, including migraine, tension headache, cluster headache and other primary headache (such as chronic daily headache, benign cough headache, benign exertional headache, sex-related headache, sleep-related headache, etc.) .
(i) Migraine
It is a severe throbbing pain on one side of the head, accompanied by nausea, vomiting, photophobia and phonophobia, and the patient has to lie down in a dark and quiet environment. Migraine attacks occur 1-4 times a month. 20% of migraineurs have a visual aura before the attack, and more than 60% have a family history. The ratio of men to women is about 1:3-1:4, and in women it is mostly related to the menstrual cycle. The first attack is mostly in adolescence.
(II) Tension headache
Tension headache is relatively common. The pain is mild to moderate and does not affect the patient’s function. The headache is bilateral, mostly temporal, posterior-occipital and parietal or full headache. It is smooth and not associated with nausea or photophobia or phonophobia. The frequency of attacks varies from once a month to three times a week.
(iii) Cluster headache
Very rare (0.1%). The pain is located around or in the eye and is accompanied by conjunctival congestion, tearing, runny nose and nasal congestion on the same side as the pain. The pain usually lasts 45-180 minutes. Episodes occur multiple times a day and are fixed in time, and patients often wake up with pain at night. The pain is very intense. A cycle of attacks lasts 4-8 weeks and then the symptoms disappear at intervals of about 1 year.
(iv) Chronic daily headache
The attacks last more than 15 days per month on average.
Pain lasts more than 4 hours when untreated.
Duration more than 3 months.
(V) Drug overdose headache (painkiller rebound headache)
Headaches occur at least 15 days per month.
Regular overdose of at least one or more medications (at least 10 days per month) for the control of acute headache attacks.
Duration more than 3 months.
Headache worsens as a result.
II. Secondary headache
If the 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 in 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 is a wide variety of secondary headaches, classified mainly according to their etiology.
Trauma to the head or neck.
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, seizures, headache with neurological impairment and cerebrospinal fluid lymphocytosis) Certain substances or withdrawal from certain substances (headache from short-term application or exposure to a substance, headache from overdose, headache from chronic application or exposure to a substance, withdrawal headache) Infection (intracranial infection, other systemic infection, AIDS, chronic post-infection headache) internal environmental imbalance (hypoxia, hypercapnia, dialysis, hypertension, hypothyroidism, fasting, cardiogenic headache) head, neck, eye, ear, nose, sinus, dental, oral or other facial and cranial structural disorders, psychiatric 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 caused by external compression and cold stimulation; compression, irritation or distortion of cranial nerves or upper cervical nerve roots by structural lesions; optic neuritis; ocular diabetes mellitus, sexual neuropathy; herpes zoster; Tolosa-Hunt (i) Headache diagnostic factors
(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. 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 combine 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 tumors.
Headaches often occur 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 accidents.
When cerebrovascular accidents occur in the elderly due to brain atrophy and decreased body reactivity, they do not always show symptoms such as hemiparesis of the limbs, hemiplegia or severe headache and vomiting, etc. Many elderly patients often first have a mild headache with a fixed or diffuse location, and the headache presents persistent and sometimes may be progressive at home, requiring timely consultation for CT examination to avoid delaying the best time for treatment.
Chronic subdural hematoma.
Regardless of the severity, elderly people with trauma, even if they do not have any symptoms at that time, should be examined and followed up promptly to prevent the formation of chronic subdural hematoma.
Hypertensive emergencies.
If an elderly patient with hypertension develops significant headache with vertigo, tinnitus, malignancy, vomiting, palpitations, blurred eyes or even weakness, numbness and mental abnormality of the limbs, it may be a precursor of stroke. Untreated hypertensive encephalopathy can be life-threatening.
Temporal arteritis.
Older adults 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.