Headache is an unpleasant or painful sensation of varying intensity, covering the entire head or part of it. It can be prolonged, paroxysmal, dull, acute, pulsating, bursting. It is observed with migraine, provoked by vascular disorders, injuries, increased intracranial pressure, infections, intoxications and other causes. The etiology of cephalgia is established on the basis of survey data, neurological examination, hardware and laboratory techniques. Treatment is carried out using medicines and physiotherapy methods. Sometimes surgery is required.
general characteristics
Headache (cephalgia) is common. During the year, at least once occurs in 90% of people. In 95-98% of cases, it develops in the absence of organic pathology. Symptomatic (secondary) cephalgia can disturb people of any age and gender, more often appear in representatives of older age groups, which is associated with the high prevalence of vascular pathologies, the presence of previously transferred provoking diseases. The incidence of various primary cephalalgias correlates with the sex of patients.
There are no pain receptors directly in the brain tissues, therefore, the irritation of neighboring structures becomes the factor causing the occurrence of pain: meninges, cranial and spinal nerves, nocireceptors in the walls of extracranial vessels, muscles of the head and neck against the background of compression, muscle tension, changes in tone arteries and veins, etc. The causes of primary headaches are still not fully understood. Most experts suggest that such cephalalgia develop as a result of complex changes in the nerves and blood vessels.
Classification
Rare or single cephalalgia, which occur against the background of external influences and do not entail a threat to health, are considered as physiological. The remaining variants are considered pathological. Taking into account the presence or absence of provoking diseases, all headaches are divided into primary and secondary. There are the following causes of secondary cephalalgia:
- trauma;
- vascular pathology;
- non-vascular lesions of intracerebral structures;
- intoxication or withdrawal syndrome;
- infectious diseases;
- homeostasis disorders;
- diseases of neighboring structures: eyes, ENT organs, etc.;
- neuralgia;
- mental disorders.
Depending on the location, pain is isolated in the entire head, its right or left half, the back of the head, the crown of the head, and the temples. In some cases, the pain syndrome migrates or occurs in one zone, and then spreads to neighboring ones.
Why does my head hurt
Physiological causes
Episodic single or rare cephalalgias can be observed in the following circumstances:
- stressful situations. They are one of the most common triggers. Headache is combined with vivid emotional experiences. Possible insomnia.
- Meteorological dependence. The symptom appears during weather changes or shortly before they begin. Dull squeezing painful sensations of weak or moderate intensity are complemented by dizziness, weakness, irritability, fatigue.
- sexual activity. Pain syndrome is observed mainly in men, it can develop during arousal, during orgasm or immediately before it. As a rule, it has a pulsating character. Caused by increased blood pressure and increased heart rate.
Other possible causes are mental or physical overwork, hunger, strict diets, drinking a lot of strong tea and coffee, or, conversely, a sharp rejection of caffeinated drinks when used to drinking them.
Primary cephalgia
Despite the absence of an organic basis, they appear regularly, often have a high intensity, worsen the quality of life, and negatively affect the ability to work:
- Migraine. The most common cause of headache in women of reproductive age. Belongs to the category of hemicrania, the right half of the head hurts more often than the left, the side sometimes changes. The epicenter of pain is in the area of the temple, eye or forehead. Pain is pressing, pulsating, persists from several hours to 3 days.
- cluster headache. Appears in strong young men. Another hemicrania, but with predominant localization in the left side of the head. Pain syndrome with an epicenter in the orbit, extremely intense, unbearable, stabbing, burning or bursting. Complemented by vegetative disorders. Lasts from 15 minutes to 3 hours.
- Tension headache. It is found in people of both sexes, provoked by chronic stress, overexertion, depressive disorders. Covers the entire head, constricting, squeezing, dull, aching. It is combined with irritability, anxiety, increased fatigue.
- Hypnic headache. Seen in older people. It develops only during sleep, causes the patient to wake up. It spreads to the entire head or half of it. As a rule, moderate, dull.
Headache
Traumatic injuries
Cephalgia accompanies all traumatic brain injuries. The pains are diffuse, can be pressing, bursting, moderate or intense. Increased in the standing position and during movement. Combined with dizziness, nausea, vomiting, neurological disorders. The duration depends on the severity of the injury. With a concussion, pain persists for 2-3 weeks, with a bruise - 1-2 months or more.
Vascular diseases
The most formidable condition that causes a headache of vascular origin is hemorrhagic or ischemic stroke. Cephalgia occurs suddenly, accompanied by a rapid deterioration, weakness, nausea, autonomic symptoms. Then paresis, disorders of consciousness, speech disorders develop. Other pathologies include:
- PNMK. Headaches are the same as before a stroke, but all symptoms disappear within a day.
- Cerebral atherosclerosis. Concerned about soreness in the back of the head or diffuse cephalalgia during emotional and physical stress, memory loss, worsening sleep, asthenia.
- Hypertension. The pains are diffuse, throbbing, bursting with the epicenter in the back of the head or forehead.
- Hypotension. Painful sensations are bursting, dull, complemented by a feeling of heaviness in the head, weakness, dizziness.
- Vegetative-vascular dystonia. Dull compressive, less often - burning arching pains, combined with numerous vegetative symptoms, are typical.
- Vertebrobasilar insufficiency. There is a sharp unilateral pain in the back of the head after awkward movements of the neck with irradiation to the temple, forehead and eye. Falls, vegetative disturbances are possible.
- Horton's disease. The pain syndrome is caused by a lesion of the temporal artery, localized in the temple area, at first it has a aching, then a burning character, it increases when talking and chewing.
Nonvascular intracranial lesions
The most common cause of this group of cephalalgias is intracranial hypertension. The pain is symmetrical, diffuse, more pronounced in the region of the crown and forehead. With a rapid increase in CSF pressure - intense, progressive, with chronic disorders - moderate, dull, undulating or constant. Possible provoking conditions are:
- Volumetric formations: primary neoplasia, brain metastases, abscesses, hematomas, cysts.
- Cerebral edema: aseptic and carcinomatous meningitis, aseptic arachnoiditis.
- Liquorodynamic disorders: hydrocephalus of various origins.
In addition, this group includes headaches with a decrease in cerebral pressure (with cerebrospinal fluid fistulas, after spinal puncture), epileptic seizures, direct compression of the meninges by neoplasia.
infectious diseases
Headache is caused by the following infectious lesions of the cerebral structures:
- Meningitis. More pronounced in the back of the head, spreading over the entire head. It increases rapidly, accompanied by chills, fever, nausea, vomiting, severe weakness, meningeal symptoms.
- Encephalitis. It occurs acutely, progresses rapidly, covers the entire head, is combined with severe intoxication. Convulsions, disturbances of consciousness, mental disorders are possible.
- brain abscesses. Along with a diffuse headache, intoxication is observed. There are focal symptoms of varying severity, epileptiform seizures.
- Empyema. Manifests cephalgia and severe hyperthermia. Nausea, vomiting, meningeal symptoms are observed. Later neurological deficit joins.
A slight or moderate aching, pressing, prolonged headache may be associated with an infectious toxic syndrome with influenza, SARS, and other common infections. The causes can also be diseases of the respiratory tract (pneumonia, tracheitis, bronchitis) or urinary system (pyelonephritis, glomerulonephritis). Cephalgia are observed in some local purulent processes: abscesses and phlegmon of soft tissues, hydradenitis, carbuncle. Accompany erysipelas of the scalp.
neuralgia
Occipital neuralgia provokes pain in the back of the head. It proceeds in the form of excruciating painful paroxysms, more often disturbs on the one hand, gives to the neck and ears. With trigeminal neuralgia, attacks of intense burning or shooting pains in the temple, spreading to half of the face, are possible. The duration of the paroxysm in both cases ranges from a few seconds to 2 minutes, episodes can be repeated many times during the day.
Intoxication and withdrawal of drugs
Cephalgia most often develop against the background of the following intoxications:
- Alcohol intake. As a rule, the cause is a hangover. The pains are insignificant, dull or strong, sharp, pulsating. Sometimes the symptom occurs immediately after drinking alcohol.
- Food poisoning. The headache is not intense, aching in nature, combined with abdominal pain, nausea, diarrhea.
- Carbon monoxide poisoning. Moderate diffuse aching pain is noted, sometimes in combination with foolishness, uncriticality to one's behavior.
Substances that can trigger the symptom include nicotine, hashish, cocaine, and opiates. Abusive headache develops with prolonged use of painkillers. Other drugs that can cause cephalalgia are ergotamine, histamine-containing drugs, some hormones, and phosphodiesterase inhibitors. Pain syndrome can be observed with the abolition of estrogens, opiates, and other drugs.
homeostasis disorders
A heterogeneous group of pathologies associated with a violation of the constancy of the internal state of the body: oxygen starvation, overheating, etc. Includes:
- hypoxia, hypercapnia;
- decompression sickness;
- heat and sunstroke;
- respiratory disorders in sleep apnea;
- preeclampsia and eclampsia;
- hypothyroidism, pheochromocytoma;
- ischemic heart disease.
Pathologies of adjacent structures
Cephalgia may accompany the following diseases of nearby organs and tissues:
- Otolaryngological: frontal sinusitis, pansinusitis, acute otitis media, mastoiditis, Thornwald's cyst, purulent labyrinthitis.
- Ophthalmic: myopia, hyperopia, strabismus, acute glaucoma.
- Dental: TMJ dysfunction against the background of malocclusion, trauma, dentition defects, brusqueism, masticatory muscle overload.
- Vertebrological: osteochondrosis, intervertebral hernia, spondylosis, spondylarthrosis.
Mental disorders
Patients with hypochondria, anxiety and depressive disorders may complain of dull, arching pains in the head. Patients with neurasthenia describe their sensations as "squeezing the head with a helmet." With hysteria, the pain syndrome is often unusual in nature, does not fit into the picture of a certain pathology. In patients with severe mental disorders, pain sensations are often unusual, artsy, and strange.
Electroencephalography
Diagnostics
Neurologists are engaged in determining the nature of the pathology. According to the indications, consultations of the therapist, infectious disease specialist and other specialists are prescribed. As part of the survey, they find out complaints and a life history, establish the circumstances of the onset and characteristics of a headache, and the dynamics of the development of the disease. During an external examination, signs of head injury and intoxication syndrome are detected, hypotension or hypertension is detected by measuring blood pressure. To clarify the diagnosis, the following procedures are carried out:
- Neurological examination. The goal is to detect focal neurological symptoms, meningeal symptoms, and other manifestations suggestive of CNS involvement. The doctor examines reflexes, sensitivity and muscle strength, conducts special tests.
- Radiography. X-ray examination of the skull is prescribed to detect fractures of the base and arch. If digital impressions and osteoporosis of the back of the Turkish saddle are found, it indicates chronic intracranial hypertension. If a pathology of the hard structures of the neck is suspected, an x-ray of the cervical spine is required.
- EEG. Produced to assess the functional activity of the brain. Confirms foci of epiactivity in epilepsy, makes it possible to suspect volumetric formations (abscesses, tumors, hematomas). If necessary, it is performed with functional tests.
- Ultrasonography. Echoencephalography in TBI detects the presence of displacement of the median structures, hydrocephalus, cerebral edema. Duplex examination and dopplerography are indicated for suspected vascular nature of cephalgia, reveal circulatory disorders.
- Tomography. CT and MRI of the brain are performed at the final stage of the examination, helping to clarify the data obtained during other diagnostic procedures. They allow assessing the structure of tissues, detailing information about the location and features of focal changes. They can be native and contrasting. The second option is recommended for tumors and vascular pathologies.
- Lumbar puncture. It is performed with hydrocephalus, infectious and inflammatory lesions of the brain, TBI. Confirms an increase or decrease in intracranial pressure, the presence of inflammation and bleeding. According to microscopy and PCR of cerebrospinal fluid, the composition of the punctate can be studied, and pathogens can be detected.
- Laboratory tests. They are carried out to assess the general condition of the body, diagnose infectious and inflammatory pathologies, atherosclerosis, metabolic disorders, intoxications.
Treatment
Conservative therapy
Therapeutic tactics is determined taking into account the etiology of headache:
- Primary cephalgia. Combined painkillers, triptans, NSAIDs are recommended. With intense pain, narcotic analgesics are indicated. In some cases, therapeutic blockades are effective.
- Vascular pathologies. Treatment of atherosclerosis and arterial hypertension is carried out using lipid-lowering and antihypertensive drugs, diuretics, beta-blockers, antiplatelet agents. With VVD and hypotension, adaptogens, antidepressants, tranquilizers, antioxidants, vitamin complexes are prescribed. Apply acupuncture, massage, hydrotherapy, aromatherapy.
- Infectious diseases. Antibiotics are administered parenterally. The plan of symptomatic therapy is made taking into account the existing violations. Infusions of solutions are carried out, resuscitation measures are performed according to indications, vital functions are maintained using mechanical ventilation and medicines, and monitoring is carried out.
- Intoxications and general infections. In the first case, antidotes are used, in the second, etiopathogenetic therapy is prescribed. Patients of both groups need detoxification measures: drinking plenty of water, infusion of crystalloid and colloid solutions, enterosorbents, stimulation of diuresis. The list of measures is determined by the patient's condition.
- Neuralgia. The main drugs are anticonvulsants. The therapy plan is supplemented with antihistamines, microcirculation correctors, antispasmodics. Carry out therapeutic blockade.
Patients with diseases of neighboring structures require treatment with the participation of an otolaryngologist, ophthalmologist or dentist. The program may include analgesics, antibiotics, vasodilators, etc. Patients with tumors are treated with radiation therapy or chemotherapy.
Surgery
Depending on the existing pathology, the following operations are performed:
- Vascular diseases: carotid endarterectomy, creation of extra-intracranial anastomoses, prosthetics of the brachiocephalic trunk, removal of hematomas, ventricular drainage.
- Hydrocephalus: removal of neoplasms and abscesses, decompressive craniotomy, external ventricular drainage, various bypass options.
- TBI: removal of depressed fractures, decompressive trepanation, minimally invasive and open removal of hematomas.
- Neuralgia: stereotaxic operations, microsurgical decompression, radiofrequency destruction.
- ENT diseases: sanitizing intervention on the middle ear, bypass of the tympanic cavity, mastoidectomy, open and endoscopic variants of polysinusotomy and frontotomy.