Headache symptom, migraine
he causes of headaches (cephalalgia) are extremely diverse. The main of them – diseases of the brain and the membranes (hydrocephalus, encephalopathy), outside of the cranial cavity organs – soft tissue of neck, paranasal sinuses, eyes, or other conditions - angioneurosis, internal diseases, chronic and acute intoxication, etc.
The lesion of the meninges (meningitis, arachnoiditis, subarachnoid hemorrhage, brain injury) entails a headache due to mechanical irritation of the meningeal branches of the trigeminal nerve receptors, and in some cases and impairments of the circulation of cerebrospinal fluid from increased intracranial pressure. Impaired circulation of cerebrospinal fluid with a change in intracranial pressure in the direction of its increase is a major factor headache occurring during the process of restricting the space (brain tumors, abscesses).
With hypertension, migraine, hypotension based headaches are disorders of blood circulation in the basins of internal and external carotid arteries. As a result of lowering the tone of cerebral arteries pulse wave causes excessive stretching of its walls and in the investigation of this man formed a sense of headaches. Also has a value of stagnation that occurs in the capillaries.
Involvement in the pathological process of the nerves innervating the soft tissue of the head, lining of the brain, brain vessels (trigeminal, vagal, C1–C3 spinal nerve roots, cervical sympathetic ganglia), is another pathogenetic factor of headache.
It is important to determine the nature, location, duration of headache, the time of its occurrence.
Distinguish pressing, drawing, piercing, pulsating, stabbing and shooting headaches. The localization of the headache associated with the location and nature of the pathological process. Irritation of the meninges, trigeminal nerve usually causes a local headache.
More diffuse vegetative pain, but I find their preferential localization in a certain area of the vessel. Thus, when the damage of the internal carotid or ophthalmic artery pain occur more frequently in the forehead, eye sockets, eyeballs, the root of the nose. Pain associated with vertebral artery, are projected in the neck and neck.
In addition to local, can be a pain, exciting the whole head or half. For the duration distinguish permanent and paroxysmal headaches. Time of occurrence of headache is not the same: morning, afternoon, evening, night.
Long-term, persistent, intense pain arising in lesions of the meninges. When meningitis and subarachnoid hemorrhage are more diffuse than in arachnoiditis.
An important tool for diagnosis is the combination of headache with meningeal syndrome. Their expression is determined by the proximity of the process to the shells (in these cases can be observed, and local pain) and degree of intracranial hypertension. Only in early disease Golovan pain can be paroxysmal, then it becomes a constant, very intense, sometimes growing at night.
Focal neurological symptoms, hypertensive effects in the fundus and radiographs of the skull bones, electroencephalogram, changes in the cerebrospinal fluid can clarify the origin of headaches.
Often headaches are observed in hydrocephalus. For all the headaches that arise as a result of hypertensive syndrome, characterized by their increased when turning the eyes, sudden head movements, coughing, straining.
Hypertensive disease characterized by dull, pressing, throbbing headache, worse physical and mental stress. It may be noted in some cases, some of communication between the severity of headaches and blood pressure, but the pain arises and when a sharp decrease in pressure. The level of blood pressure changes from the side of the heart and angiospastic picture fundus help correct diagnosis.
Hypertension headaches are less intense and are usually accompanied by general weakness, feeling of weakness, decreased performance. Rather typical unilateral paroxysmal pain of migraine, paroxysmal attacks of pain in rezchayshih trigeminal neuralgia, rarely pterygopalatine node occipital nerves.
Headaches may develop and in eye diseases. First of all, you need to remember about glaucoma and suspected it to investigate the intraocular pressure. Pains in iritah and the impairment of refraction. In the latter case, selection of appropriate glazing eliminates the pain. For the whole of this group is characterized by localized headache in the forehead.
Cause of headaches may also be inflammatory diseases of paranasal sinuses (sinusitis, ethmoiditis, sinusitis, purulent otitis media). Diagnosis of this type of pain is usually facilitated by their localization, radiological data and the study otolaryngologist. Local headaches may be due to impairments of the bowel (constipation), liver, kidneys (uremia).
Headaches – a common symptom of acute febrile diseases. In many diseases there is a constant visceral, diffuse, moderately severe headache. In children, the cause of headache may be a worm infestation.
Headache and migraine classification
The secondary headaches
Cranial neuralgias central and primary facial pain and other headaches
Headache and migraine diagnosis
If there are complaints about the long-term or chronic, as well as acute. headache may be necessary to apply to a neurologist for a consultation first. According to the results of neurological examination may be already placed an accurate diagnosis. If the diagnosis is advanced, the patient will be given additional diagnostic purposes.
- cerebrovascular Doppler ultrasonography, REG, EhoEG
- skull and cervical spines x-ray examination
- brain MRI
- brain CT
- cerebrovascular MR-angiography
- cervical spine MRI
- lumbar puncture (LP) for cerebrospinal fluid (CSF) analysis
There are a number of diagnostic tests and procedures, application of which is widespread in clinical practice, but they are not always required for the diagnosis of headache and migraine.
- Patients with stable headache, that meets migraine criteria, does not require neuroimaging studies. The probability of detecting any organic pathology in these patients is extremely low. Neuroimaging studies are expensive and have unnecessary radiation exposure on the body. In addition, diagnosis of possible random findings (congenital cerebrovascular and vertebral anomalies), will cause (or effort) anxiety in a patient, while these findings are not clinically significant.
- Computed tomography (CT) in patients with headache dose not indicated, if magnetic resonance imaging (MRI) is available, except emergencies (third cerebral ventricle colloid cyst with acute occlusion hydrocephalus). If the headache is sudden and increases, the best option is magnetic resonance imaging (MRI), because of it is not associated with patient radiation exposure and identifies more brain’s pathological conditions.
- Without pre-clinical studies is not recommended use surgical treatment on the trigger points in migraine (deactivation procedure), because this type of treatment are still in the experimental stages. In this situation is preferred drug therapy rather than surgery.
- In the case of recurring headache as first aid for their relieving symptoms should not use opioids or barbiturates substitute drugs. Their frequent use gives sedation and somnolence, and causes addiction. Therefore, these drugs are best to have as reserve preparations for situations when other medicines (triptans, NSAIDs) does not relieve the pain or contraindicated in patients.
- For headache symptoms relieve dose not recommended independent prolonged or frequent use of OTC drugs. In such a situation, it is important that the patient communicate with doctor for best treatment options.
Headache and migraine treatment
Once an accurate diagnosis will be installed, depending on the severity of manifestations of the disease the patient will be asked to conservative or surgical treatment depending on the detection of the disease.
Depending on the severity of symptoms and causes of the symptom of headache in a patient, the following therapeutic action: