What Causes Headaches?

Headache is a common clinical symptom, which is usually limited to the upper half of the skull, including pain above the eyebrow arch, the upper edge of the ear wheel and the line outside the occipital bulge. Headaches are caused by a variety of causes, such as neuralgia, intracranial infection, intracranial space occupying lesions, cerebrovascular disease, extracranial head and face disease, and systemic diseases such as acute infection and poisoning. The age of onset is common in young, middle-aged and elderly.

Wei Cuibai

(Deputy Chief Physician)

Department of Neurology, Xuanwu Hospital, Capital Medical University

Western Medicine Name: headache
English name: headache

Affiliated Department: Internal Medicine-Neurology
Contagious: Non-contagious

Classification of headache diseases

According to the clinical onset of headache, it can be divided into: headaches with acute onset: common such as subarachnoid hemorrhage and other cerebrovascular diseases, meningitis or encephalitis; headaches with subacute onset: such as temporal arteritis , Intracranial tumors, etc .; chronic onset headaches: such as migraine, tension headache, cluster headache, drug-dependent headache and so on.

According to the etiology of headaches, the second edition of the International Classification of Headache Disorders 2nd Edition (ICHD-II) developed by the International Headache Association in 2004 classifies headaches into three major categories: Primary headache (The primary headaches): including migraine, tension headache, cluster headache, etc .; the secondary headaches: including head and neck trauma, cranial neck vascular factors, intracranial non-vascular diseases, Headaches caused by infection, drug withdrawal, mental factors and other reasons; cranial neuralgia, central and primary facial pain, and other types of facial and facial structural disorders and other types of headache. ^[1]

Causes of headache

There are many causes of headache, which can be roughly divided into two categories: primary and secondary. The former can not be attributed to a specific cause, and can also be called idiopathic headache, and common ones include migraine and tension headache; the latter can involve various intracranial diseases such as cerebrovascular disease, intracranial infection, and craniocerebral Trauma, systemic diseases such as fever, internal environment disorders, and abuse of psychoactive drugs. details as follows:

Headache infection

Fever due to craniocerebral infection or acute infection of other system of the body. Craniocerebral infections that often cause headaches such as meningitis, meningoencephalitis, encephalitis, brain abscesses, and intracranial parasitic infections (such as cysticercosis and hydatid). Acute infections such as influenza and pneumonia.

Headache vascular disease

Subarachnoid hemorrhage, cerebral hemorrhage, cerebral thrombosis, cerebral embolism, hypertensive encephalopathy, insufficient cerebral blood supply, cerebral vascular malformations, etc.

Headache space occupying lesion

Brain tumors, intracranial metastatic cancer, and inflammatory demyelinating pseudotumors cause headaches caused by increased intracranial pressure.

Head and neck neuropathy

Head and facial innervation neuralgia: such as trigeminal nerve, glossopharyngeal nerve, and occipital neuralgia. Head and face facial disorders such as headaches caused by eye, ear, nose and tooth diseases. Cervical spondylosis and other neck disorders cause head and neck pain.

Headache systemic disease

Hypertension, anemia, pulmonary encephalopathy, heat stroke, etc. cause headaches.

Headache traumatic brain injury

Such as concussion, brain contusion, subdural hematoma, intracranial hematoma, sequelae of traumatic brain injury.

Headache poison and drug poisoning

Such as alcohol, carbon monoxide, organic phosphorus, drugs (such as belladonna, salicylic acid) and other poisoning.

Environmental disorders and mental factors in headaches

Menstrual and menopausal headaches. Somatization disorder of neurosis and snoring headache.

Headache other

Such as migraine, cluster headache (histamine headache), headache-type epilepsy.

Headache pathogenesis

The pathogenesis of headache is complicated, which is mainly caused by the stimulation of pain receptors in the intracranial and external pain sensitive structures, and the conduction to the cerebral cortex through the pain sensory pathway. Intracranial pain-sensitive structures include venous sinuses (such as sagittal sinus), anterior and middle meningeal arteries, skull base dura mater, trigeminal nerve (), glossopharyngeal nerve () and vagus nerve (X), and proximal carotid artery And adjacent branches of the Willis ring, gray matter around the brain stem midbrain aqueduct, and thalamic sensory relay nuclei; extracranial pain-sensitive structures include periosteal bone, head skin, subcutaneous tissue, cap fascia, head and neck muscles, and extracranial Arteries, 2nd and 3rd cervical nerves, eyes, ears, teeth, sinuses, oropharynx and nasal mucosa. Mechanical, chemical, biological stimulation, and biochemical changes in the body can cause headaches in intracranial and external pain-sensitive structures. If the intracranial and external arteries are dilated or stretched, the intracranial veins and sinuses are displaced or pulled, the cranial and cervical nerves are oppressed, stretched, or stimulated by inflammation, cranial or neck muscle spasm, inflammation or trauma , Meningeal stimulation caused by various reasons, abnormal intracranial pressure, dysfunction of intracranial serotoninergic neuron projection system and so on. ^[2]

Headache pathophysiology

Head and face blood vessels, nerves, meninges, venous sinuses, head and face skin, subcutaneous tissue, mucous membranes, etc. constitute head pain sensitive structures, which cause head pain when they are mechanically stretched, chemically, biologically stimulated, or the internal and internal environment changes.

Clinical manifestations of headache

Headaches range from mild to severe, and the duration of pain is short or long. There are many types of pain, such as bloating, stuffy, tear-like pain, electric shock-like pain, acupuncture-like pain, some with pulsating vasculature and head tightness, and nausea, vomiting, dizziness and other symptoms. Secondary headaches can also be accompanied by other systemic symptoms or signs, such as infectious diseases often accompanied by fever, vascular lesions often accompanied by symptoms of neurological deficits such as hemiplegia and aphasia. Headaches have different hazards depending on the degree, and serious conditions can make patients lose their ability to live and work. ^[3]

Headache diagnosis

The diagnosis of headache is based on the patient's head pain. In the diagnosis of headache, a distinction should be made between primary and secondary. Primary headaches are mostly benign, while secondary headaches are caused by organic lesions. The diagnosis of any primary headache should be based on the exclusion of secondary headaches. The etiology of headache is complicated. In the collection of the history of headache patients, it is important to inquire about the onset mode, frequency, duration, duration, location, nature, degree of pain, headache, and predisposing factors of headache. , Headache exacerbation and reduction factors. At the same time, in order to better identify the cause and nature of headache, it is also necessary to fully understand the general effects of the patient's age and gender, sleep and occupational status, previous medical history and concomitant diseases, trauma history, medication history, poisoning history and family history on the incidence of headache . A comprehensive physical examination, especially the examination of the nervous system, skull, and facial features, helps to find the pathological changes of the headache. The timely and appropriate selection of auxiliary imaging such as neuroimaging or lumbar puncture cerebrospinal fluid can provide a basis for the diagnosis and differential diagnosis of intracranial organic lesions. ^[4-5]

Headache treatment

Headache treatment includes two parts: drug treatment and non-drug physical therapy. Treatment principles include symptomatic treatment and primary disease treatment. Acute attacks of primary headaches and secondary headaches whose causes cannot be corrected immediately can be given symptomatic treatment such as analgesia to stop or alleviate headache symptoms. At the same time, appropriate symptomatic treatment can be given to headache-related symptoms such as dizziness and vomiting. For secondary headaches with a clear etiology, the cause should be removed as soon as possible. For example, intracranial infections should be treated with anti-infection, those with intracranial hypertension should be dehydrated to reduce the cranial pressure, and intracranial tumors need to be surgically removed.

Headache medication

Analgesics include non-steroidal anti-inflammatory analgesics, central analgesics, and narcotic analgesics. Non-steroidal anti-inflammatory analgesics are effective and have no addictive advantages. They are the most commonly used analgesics for headaches. Such drugs include aspirin, ibuprofen, indomethacin, paracetamol, paclitaxel, rofecoxib, Celecoxib and others. Tramadol is a central analgesic drug. It belongs to the second class of psychotropic drugs. It is a non-narcotic analgesic. It has a stronger analgesic effect than ordinary antipyretic analgesics. It is mainly used for moderate and severe headaches and various postoperative and cancer Sexual lesions and so on. Opioids, such as morphine and dulentin, are representative of narcotic analgesics, which have the strongest analgesic effect, but long-term use can be addictive. These drugs are only used in patients with advanced cancer. In addition, there are some traditional Chinese medicine compound headache and painkillers, which can help relieve and prevent headaches. ^[6]

Headache non-drug physical therapy

Non-drug physical therapy of headache includes: physical magnetic therapy, local cold (hot) compress, oxygen inhalation, etc. For chronic headaches, the author should give appropriate treatment to control frequent headaches.

Headache disease prevention

The prevention and treatment of headache should reduce all causes that may cause headache, including avoiding soft tissue damage to the head and neck, infection, avoiding contact and intake of irritating food, avoiding mood swings, etc. At the same time, the cause of secondary headache should be diagnosed and treated in time. Disease. Sedatives, antiepileptics, and tricyclic antidepressants are effective in preventing primary headaches such as migraine and tension headache.

Headache disease care

Patients with headache should reduce foods that cause pain, such as chocolate, cheese, wine, coffee, and tea. At the same time, the diet should be light, and spicy and cold foods should not be tabooed. During the headache period, foods such as ham, dry cheese and long-preserved game should be fasted.