Pain in the right half of the head may accompany migraine, paroxysmal hemicrania, and some other types of primary cephalalgia. It is observed in the syndrome of the vertebral artery, a number of diseases of the brain, ENT organs and the cervical spine. The character is pulsating, breaking, pressing, bursting, dull, sharp, weak, moderate, intense. Diagnosis is based on the results of the conversation, objective and instrumental studies. Symptomatic and etiopathogenetic treatment is carried out using NSAIDs, analgesics, triptans, other drugs, non-drug methods. Operations are sometimes shown.
general characteristics
Hemicrania (pain in half of the head) is a typical manifestation of primary headaches. Sometimes it occurs in other diseases, may be due to unilateral damage to blood vessels, nerves, other structures of the neck, face and head. In patients with primary cephalalgia, it is paroxysmal, in other cases it is prolonged or relatively short-term, less often it has a paroxysmal character. Pain can occur both in the right and in the left half of the head.
Why does the right side of my head hurt?
Physiological causes
Episodic hemicrania are detected in many healthy people, disappear after taking painkillers, sleep, rest. There is a connection with external circumstances, the absence of a tendency to relapse. Provoking factors are acute and prolonged stress, mental and physical overload. The right half of the head can also hurt against the background of alcohol intoxication, frequent smoking, and abuse of caffeinated drinks.
Migraine
A distinctive feature of migraine is paroxysmal unilateral pain with a periodic change of half of the head. For unknown reasons, the disease is more often manifested by pain in the right half of the head. Painful sensations are localized in the area of the eye, forehead, temple, less often - in the occipital region. Often start in one place, and then cover the entire half of the head.
Most types of migraine are characterized by the persistence of symptoms over a period of several hours to 3 days. Some symptoms depend on the type of disease:
- Simple migraine. The most common. Accompanied by classic seizures without aura, sometimes preceded by a prodrome in the form of impaired performance, deterioration of the emotional state. Nausea, vomiting, light and sound phobia are noted.
- Migraine with aura. Paroxysms are the same as in the previous case. They are preceded by an aura, which is most often represented by visual disorders. Unusual sounds and smells, sensory disturbances, speech difficulties are possible.
- vestibular migraine. A typical feature is vertigo that occurs during the prodromal stage and may persist or disappear with the onset of headache. Sometimes different variants of the aura are observed.
- Eye migraine. Along with visual disturbances (flickering, the appearance of cattle, loss of parts of the visual field), which precede cephalalgia and persist for 10-2 minutes, this type of migraine differs from the others by an atypical duration - less than 3 hours.
- Ophthalmoplegic migraine. Another variant of the disease with ophthalmic disorders and unusual duration. Symptoms persist for more than a week. Disturbances from the oculomotor, less often - trochlear or abducens nerve occur on the 1-4th day. Possible diplopia, mydriasis, strabismus, omission of the eyelid.
If the duration of a migraine attack (with the exception of types with eye symptoms) is more than 3 days, or paroxysms continuously occur one after another during this time, status migraine is diagnosed. This condition is characterized by high intensity of pain, undulating decrease and increase in symptoms, progressive dehydration due to repeated vomiting.
Paroxysmal hemicrania
It proceeds with episodes of extremely intense pain in the right or left side of the head with an epicenter in the orbit, temporal zone, crown, occiput, forehead. It can be provoked by sharp turns of the head, alcohol intake, strong emotions. Pain sensations are stabbing, boring, burning, throbbing, aching. The duration of the episode is 5-45 minutes, during the day in severe cases there are up to 4 attacks. Paroxysmal hemicrania is accompanied by autonomic disorders: lacrimation, local hyperhidrosis, sensation of heat, nasal congestion.
Pain in the right side of the head
Hypnic headache
This primary cephalalgia is characterized by the occurrence only in a dream. Separately, the right or left half of the head is affected in 40% of patients, in other cases the pain is bilateral. At the beginning of the attack, the patient wakes up, after the end of the paroxysm, he falls asleep again. Hypnic headache is dull, moderate, rarely severe. It is diagnosed in people of the older age group, once it appears, it continues to disturb throughout life.
cluster headache
Unlike migraine, the left side of the head suffers more often than the right, but right-sided cephalalgias are also possible. Among the patients, young men predominate. Attacks of cluster headache develop suddenly, increase within 1-3 minutes, stop after 15-12 minutes. Painful sensations are extremely intense. They are localized mainly in the region of the orbit, stabbing, burning, tearing, pressing. They decrease with moderate physical activity, therefore, during a paroxysm, patients are constantly moving.
Vertebrobasilar insufficiency
Pain in half of the head is typical for the spondylogenic form of the disease. The left and right half suffer equally often, localization is determined by the side on which blood flow disturbances occur in the vertebral artery. The pain is provoked by movements of the neck, its severity clearly depends on the position of the head. Painful sensations in vertebrobasilar insufficiency appear in the back of the head, cover the temple, forehead, orbit, radiate to the upper limb. Accompanied by autonomic and cerebellar disorders, visual and hearing disorders.
Other cerebral pathologies
Pain in the right half of the head is noted with brain tumors, limited arachnoiditis of the corresponding localization. With neoplasms, it appears in the early stages of the disease, severe or moderate, bursting, deep, often observed in the form of seizures. With arachnoiditis, it proceeds chronically, gradually progresses, worries mainly in the morning, is supplemented by neurosis-like symptoms.
Other reasons
Right-sided cephalalgia can be detected in the following diseases:
- Sinusitis. The pain syndrome is bursting, pulsating, provoked by sinusitis or frontal sinusitis of the right paranasal sinuses. It is more pronounced in the forehead area, radiates to the temple. Discharge from the nose, common signs of an inflammatory process are characteristic.
- Mastoiditis. Manifests simultaneously with acute purulent otitis media or a few days after its onset. There are intense pains behind the ear, spreading to neighboring parts of the head, fever, outflow of pus from the ear.
- Temporal arteritis. Rheumatic pathology is caused by damage to the temporal artery, accompanied by throbbing dull pain in the temple. Soreness increases at night, gradually progresses. It is combined with general intoxication manifestations.
- Diseases of the spine. Pain in the right half of the head is caused by right-sided compression of the nerves and blood vessels. It is detected in patients with osteochondrosis, intervertebral hernia. Typical pain in the neck, aggravated by movement. Possible muscle weakness, numbness of the right hand.
Diagnostics
Determination of the pathology that causes pain in the right half of the head is the responsibility of a neurologist. If necessary, the patient is referred for a consultation with an otolaryngologist, rheumatologist, oncologist. To identify focal symptoms, a neurological examination is performed. Diagnosis of primary cephalalgia is based on the compliance of the clinical picture of the disease with certain criteria. Additional techniques are used in the course of differential diagnosis. For other pathologies, the list of procedures is determined taking into account the nature of the disease. May be assigned:
- Ultrasonography. Duplex and dopplerography are informative in assessing the condition of the vessels. With vertebrobasilar insufficiency, they are made to study the cervical and intracranial vessels, determine the localization and extent of stenosis. In other cases, they are prescribed to exclude vascular diseases.
- Tomography. Patients with arachnoiditis and tumors are referred for brain MRI. If the vertebral artery is affected, MR angiography is performed. Diseases of the spine are diagnosed using CT or MRI of the cervical spine.
- Otolaryngological examination. Necessary for sinusitis, mastoiditis. Along with an external examination, anterior rhinoscopy, otoscopy, and diagnostic puncture of the accessory sinus can be performed.
- Radiography. Pictures of the cervical region are recommended for disc herniation, osteochondrosis, and suspicion of compression of the vertebral artery by surrounding solid structures. X-rays of the temporal bone are shown with mastoiditis, paranasal sinuses - with sinusitis.
Electroencephalography
Treatment
Conservative therapy
The plan of therapeutic measures is drawn up taking into account the nature of the disease. The following drugs and non-drug methods are used:
- Migraine. To eliminate paroxysms, non-narcotic analgesics are prescribed. With persistent attacks, blockades are performed. With intense excruciating pain, migraine status, triptans are used, in tablets, rectal suppositories, solutions for parenteral administration. The last two options allow you to solve the problem of taking the drug with persistent vomiting.
- Paroxysmal hemicrania. NSAIDs, glucocorticosteroids, calcium channel blockers are effective. Depending on the severity of the pathology, medications are taken in short courses or constantly.
- cluster headache. Pain attacks are eliminated with the help of triptans, applications of local anesthetics on the nasal mucosa. The effectiveness of inhalations of 100% oxygen is noted. Preventive measures in the interictal period are carried out using calcium channel blockers, hormonal, antiepileptic drugs.
- Hypnic headache. The basis of treatment is hypnotics, lithium preparations, atypical benzodiazepines. Some researchers report the effectiveness of steroids and NSAIDs. Before going to bed, patients are advised to take caffeine-containing and melatonin-containing products.
- Vertebrobasilar insufficiency. Recommended antiplatelet agents, anticoagulants, neuroprotectors, antihypertensive, vascular drugs, exercise therapy, massage, manual therapy, hyperbaric oxygen therapy, magnetotherapy, laser therapy.
- Tumors. To reduce the severity of symptoms, non-narcotic and narcotic analgesics, antiemetics, glucocorticoids, and psychotropic drugs are used. Radiation and chemotherapy are carried out as part of palliative therapy or are part of complex treatment in the pre- and postoperative period.
- Pathology of the spine. Pain is eliminated with the help of oral and parenteral forms of NSAIDs, muscle relaxants, local administration of glucocorticosteroids. They use B vitamins, neurometabolites, phonophoresis, UHF, electrophoresis, magnetotherapy.
- ENT diseases. Treatment regimens include antibacterial, vasoconstrictor, antihistamines, physiotherapy, paracentesis of the tympanic membrane, punctures of the paranasal sinuses.
Surgery
Treatment of primary cephalgia is only conservative. For other pathologies, the following may be shown:
- Vertebrobasilar insufficiency : reconstructive surgeries to restore blood flow.
- Cerebral neoplasias : removal of cerebral tumors using traditional and minimally invasive surgical techniques.
- Diseases of the spine : low-traumatic (endoscopic microdiscectomy, puncture laser vaporization) and traditional (discectomy) interventions for hernias, sometimes in combination with fixing operations.
- Pathologies of ENT organs : sanitizing operation, mastoidectomy, frontotomy, maxillary sinusectomy, micromaxillary sinusectomy.