What Is a Vascular Headache?

Vascular headache refers to clinical syndromes caused by vasomotor dysfunction of the head and dysfunction of the cerebral cortex, or temporary changes in certain body fluids. It is the most common type of headache in the clinic. It is characterized by one or two paroxysmal pulsatile throbbing pains, swelling pains or drilling pains, and may be accompanied by symptoms of vascular autonomic dysfunction such as visual hallucinations, photophobia, blindness, nausea and vomiting. Vascular headache is divided into two categories: primary and secondary. Headaches due to vasomotor dysfunction of the head are called primary vascular headaches, including migraine, cluster headache, etc .; headaches with clear cerebrovascular disease are called secondary headaches, including high headache Headaches due to blood pressure, subarachnoid hemorrhage, stroke, intracranial hematoma, cerebrovascular inflammation, etc.

Basic Information

Visiting department

Neurology

Common locations

head

Common causes

Primary is vasomotor dysfunction of the head; secondary is caused by cerebrovascular disease: acute ischemic cerebrovascular disease, subarachnoid hemorrhage, arteriovenous malformation

Common symptoms

Mild to moderate total headache, soreness, or pain in the occipital, forehead, and bitemporal areas; obvious vasocardial pain and nausea and vomiting during attacks

Causes of vascular headache

Primary vascular headache

Also called migraine, is a functional headache caused mainly by vasomotor dysfunction of the head. According to the different manifestations of headache, it can be divided into five main types: typical migraine, common migraine, cluster migraine, hemiplegia migraine and ophthalmoplegia migraine.

2. Secondary vascular headache

Refers to headaches caused by cerebrovascular diseases, including acute ischemic cerebrovascular disease, subarachnoid hemorrhage, arteriovenous malformations, hypertension, intracranial hematoma, intracranial venous thrombosis, internal carotid and vertebral artery disease Headache.

(1) Acute ischemic cerebrovascular disease: transient ischemic attack; thromboembolic cerebrovascular disease.

(2) Intracranial hematoma: subdural hematoma; epidural hematoma.

(3) Subarachnoid hemorrhage.

(4) Unruptured vascular malformations: arteriovenous malformations; intracranial aneurysms.

(5) Arteritis: giant cell arteritis; other systemic vasculitis; primary intracranial arteritis.

(6) Carotid or vertebral arterial pain: Carotid or vertebral artery block; (primary) carotid pain; headache after endarterectomy.

(7) Venous thrombosis.

(8) Arterial hypertension: acute response to foreign substances; pheochromocytoma; malignant hypertension; preeclampsia and eclampsia.

(9) Vascular disorders: headaches related to other vascular disorders.

Clinical manifestations of vascular headache

Headaches are usually mild to moderate total headaches, soreness, and can also manifest as occipital, forehead, and bitemporal pains. Headaches are exacerbated when using the brain, exerting force, moving the head, and changing posture, and are often accompanied by similar symptoms of nervous breakdown . Seizures also often show obvious vasodilation, nausea and vomiting, and typical patients have blurred vision and dazzling performance before the attack. Headaches often occur after sleep disturbances, emotional agitation, excessive fatigue, excessive drinking, etc. Female patients have aggravated headaches before and after menstruation.

Vascular headache examination

Cerebrospinal fluid examination

Increased intracranial pressure, mostly bloody. Cerebral hemorrhage that has not broken into the subarachnoid space. Although there is no blood in the cerebrospinal fluid, the white blood cells can be slightly higher and the protein is slightly higher. Routine examination of cerebrospinal fluid in patients with migraine is usually normal, and lymphocytes may increase in some cerebrospinal fluid.

2.CT scan

CT has high diagnostic value for acute cerebral hemorrhage, and provides a reliable basis for clinical qualitative, localization and quantitative.

3.MRI scan

MRI scans are particularly sensitive to the diagnosis of posterior cranial fossa hemorrhage. Due to bone artifacts, lesions in the posterior cranial fossa are often unclear on CT. Therefore, MRI showed that brain stem hemorrhage and cerebellar hemorrhage were significantly better than CT.

4. EEG examination

In general, patients with migraine have a higher incidence of abnormal EEG than in the normal control group, whether in the onset or intermittent period. However, the EEG changes in patients with migraine are not specific because it can have normal waveforms. Various waveforms such as ordinary slow wave, spike discharge, focal spike, quasi-wave and abnormal response to hyperventilation and flash stimulation. The abnormal rate of EEG in children with migraine is high, ranging from 9% to 70%. Spikes, paroxysmal slow waves, fast wave activities, and diffuse slow waves can occur.

5. Cerebral blood flow examination

The main changes in the patients' cerebral blood flow patterns during the onset and intermittent periods are asymmetrical amplitudes on both sides, high on one side, or low on the other.

6. Cerebral angiography

In principle, patients with migraine do not need to undergo cerebral angiography. Only in patients with severe headaches who are highly suspected of subarachnoid hemorrhage, cerebral angiography should be performed in order to exclude diseases such as intracranial aneurysms and arteriovenous malformations. No doubt, the vast majority of patients with migraine have normal cerebral angiography.

7. Platelet function test

Platelet aggregation can be increased in patients with migraine.

8. Immunological examination

In general, patients with migraine have higher levels of immunoglobulin IgG, IgA, C3, and E rosettes than normal people.

Vascular headache treatment

(A) headache caused by cerebral ischemia

1. Actively treat primary diseases

Such as adjusting blood pressure, treating diabetes and cerebral arteriosclerosis, and stabilizing heart function.

2. Blood volume expansion

Salvia injection is commonly given intravenously, once a day, for 10 to 14 days as a course of treatment. Low-molecular dextran, intravenous infusion once a day. Wei Nao Lu Tong is administered intravenously once daily.

3. Platelet aggregation inhibitor

Enteric-coated aspirin is commonly used once a day. Pansentin is taken orally 3 to 4 times a day. Sulfopyrazolone is taken orally 3 times a day.

(B) Hypertensive headache

Treatment Reasonably arrange work and rest according to the condition, maintain adequate sleep, pay attention to diet adjustment, low salt, low animal fat is appropriate, for people with mental stress, headache and insomnia can take a small amount of sedatives or tranquilizers. Use of antihypertensive drugs: For long-term administration, oral antihypertensive drugs with mild, long-lasting antihypertensive effect, few side effects, and easy to use should be selected, such as dihydrocortisol, reserpine, etc. as basic antihypertensive drugs; combined medication , Commonly used diuretics and other antihypertensive drugs; start with a small dose, gradually increase the dose to achieve the purpose of antihypertensive, can be changed to maintain the amount to consolidate the efficacy; aggressive hypertension and hypertension crisis need to apply reduction Drugs with strong blood pressure effects, such as post-node sympathetic nerve inhibitors, calcium antagonists, arteriolar dilators, etc .; For patients who have significantly increased blood pressure for many years, it is not appropriate to make the blood pressure drop too much or too fast, because patients often cannot adapt to counter-intuition. Discomfort, and cerebrovascular accidents can be caused by low blood pressure.

(Three) headache caused by hemorrhagic stroke

1. Actively resist cerebral edema and reduce intracranial pressure

The rapid use of dehydrating agents to prevent cerebral edema and reduce intracranial pressure is an important measure for the treatment of hemorrhagic stroke. Commonly used 20% mannitol intravenously, once every 6 to 8 hours, or with glycerol fructose, two times a day, can also be used fast dehydration. If necessary, surgical treatment, such as hematoma elimination or hematoma aspiration, is used to remove hematoma and reduce intracranial pressure. For severe headaches caused by subarachnoid hemorrhage, replacement of cerebrospinal fluid therapy is feasible (that is, after successful lumbar puncture, 3 to 5 ml of cerebrospinal fluid is slowly released each time, and then the same amount of physiological saline is slowly injected), and the headache can be significantly reduced.

2. Etiology treatment

Treatment of common causes of hemorrhagic stroke, such as hypertension, arteriosclerosis, cerebrovascular malformations, intracranial aneurysms and hematological diseases caused by various reasons.

3. Hemostasis

Tranexamic acid, 6-aminocaproic acid, hemostatic aromatic acid, etc. can be used to prevent rebleeding and reduce blood irritation to sensitive structures of intracranial headache.

4. Symptomatic treatment

Appropriate use of analgesics, tranquilizers and sedatives.

(D) headache caused by temporal arteritis

Steroid hormone therapy has a good effect on headaches in patients with temporal arteritis. Sometimes the temperature drops to normal after steroid treatment. The headache symptoms disappear within 1 to 2 weeks. When the patient no longer complains of headache within one week, the hormone can be gradually reduced. . Generally, the erythrocyte sedimentation rate returns to normal within four weeks, and treatment is gradually stopped after several months.

(E) Physical therapy

1. Do neck extension exercises often

The full set of neck extension exercises is: turn your head to the right, as if looking back from the right side and looking back, put your right index finger on your left cheek, your thumb on your chin, and gently push your head to the right; Extend the top of your head, touch your middle finger to the top of your right ear, and then gently pull your head down toward your chest (if you hurt your muscles or feel dizzy, stop pulling again). After ten seconds, move in the opposite direction, turning your head to the left. It's also ten seconds. Repeat this process three times each. Make a set every two hours every day.

Neck extension exercises stretch and relax the tight muscles and fibrous tissue of the neck. It is mainly used to relieve headaches caused by tension.

2. "laugh therapy"

More than 90% of headaches are a "tension headache". Excessive brain use, insomnia, etc. can also cause headaches. In addition to medication for chronic headache, "laugh therapy" is an important treatment method, and it has a good effect. Laughing can regulate the nerves of the brain, eliminate tension, promote appetite and sleep, increase the secretion of digestive juice and the function of the digestive tract, and can regulate the function of the autonomic nervous system. Laughing can also cause facial muscles, chest and abdominal muscles to move, and even the muscles of the extremities are moving. Muscle movement speeds up blood circulation and lymphatic circulation, deepens breathing, and increases vital capacity, thereby improving the body's metabolism and disease resistance. Laughing can not only cure chronic headaches, but also treat systemic pain.

3. Reduce salt intake

Salt can cause hormone reactions in the body, which can cause periodic migraines, or cause vascular headaches (sudden contraction or excessive expansion of blood vessels). Therefore, in the case of headaches, such as eating a low-salt diet, can increase blood camps resistance to several causes of periodic migraine. Conversely, if you eat a high-salt diet, it will worsen the condition, and even the pain is unbearable.

4. Distract attention

Choose the patient's favorite music or opera, let the patient listen, and tap with your hands, nod, etc. while listening to the rhythm. When listening, focus your eyes on one place or close your eyes. The hand can be placed on the volume switch of the recorder. When the pain is aggravated, the volume is turned on, and when the pain is relieved, the volume is turned off, which keeps the attention away from the pain. Can achieve analgesic effect.

5. Abdominal breathing

Have the patient close their eyes or fixate on a fixed object, slowly inhale through the nose, exhale through the mouth, the abdomen bulges during inhalation, and the abdomen is depressed during exhalation, and breathing should be as slow and deep as possible. Gently stroke the sore area with your hands. This abdominal breathing analgesia method can keep patients relaxed and often relieve persistent pain. Sometimes it can also help patients fall asleep.

6. Wipe off the cooling oil

Rub the cooling oil on your forehead or temple. Can play an analgesic effect.

Vascular headache care

1. Reasonably arrange work and rest time, pay attention to the combination of work and rest, but do not work long hours. Patients with headache should maintain a good mentality, avoid ups and downs, and eliminate tension, anxiety, and depression.

2. When the vascular headache occurs, it is necessary to observe the rule of the headache by yourself. It is best to record the time, degree and nature of each headache, and pay attention to whether there are symptoms such as vomiting, nausea, decreased vision, limb convulsions, etc. Go to the hospital for examination if necessary.

3. If vascular headache is caused by prolonged depression, it cannot be ignored. When headaches are accompanied by dizziness, a CT scan is best.

4. In daily life, do not smoke, do not drink too much, diet should also be moderate, mainly light.

5. Pay attention to personal hygiene. Some infections can also cause headaches.

Vascular headache prevention

1. Don't be nervous when things go wrong

Even healthy people are nervous and can cause headaches over time. Patients with headache should be more open-minded, and take care of whatever happens, so that the headache will gradually heal.

2. Ensure good sleep

Poor sleep often causes headaches. Therefore, patients with chronic headache must first ensure adequate sleep. Measures such as washing hot feet before bedtime often help with headache relief.

3. Avoid excessive use of the brain

Once people have a cold, they already have headaches, soreness and other symptoms. At this time, if they overuse the brain (such as writing materials, making statistical reports, etc.), the headache will inevitably worsen. Therefore, in addition to actively treating colds, the brain should be rested.