Headache, this is a difficult topic, extensive and profound; It is also a headache symptom, seemingly simple, but the mechanism behind it is very complicated. No way, because it is so common that it is encountered almost every day in emergency department.
Without understanding, sometimes the headache that had nothing to do was very nervous, but the patients and their families were very nervous. They were rushed to the emergency department by 120 and were scared.
Or sometimes it is originally a life-threatening disease, but patients and their families think it is a common symptom. It’s not a big deal. They miss the best time to see a doctor and cause irreparable consequences.
Therefore, the introduction of headache here will at least let everyone know which needs urgent treatment, which needs to be sent to the hospital immediately, which can be taken calmly, and know a little knowledge of prevention and treatment, so as to better choose treatment and prevention programs, thus achieving the goal.
First, clearly define:
Headache here refers to headache in the upper part of the head (above the line connecting the eyebrow arch, the upper part of the auricle and the external occipital eminence). The mechanism of headache is caused by stimulation of the pain sensitive structures of the head. Interestingly, most brain tissues do not have pain receptors themselves.
There are many structures that cause headache, including skin, subcutaneous tissue, subscalp muscles, extracranial arteries and intracranial periosteum. Eye, ear, nose, paranasal sinus and other structures. Intracranial venous sinus and its large branches nearby, dura mater at the bottom of the brain, large artery, middle meningeal artery, superficial temporal artery, trigeminal nerve and other cranial nerves.
Headache is a super common symptom. About 90% of people have headache symptoms at least once a year. 3% of emergency patients complain of headache.
From the perspective of etiology, it can be divided into primary headache and secondary headache. The former refers to headache without other diseases, while the latter often has clear etiology leading to headache such as subarachnoid hemorrhage, meningitis, temporal arteritis, etc. Generally speaking, headache is divided into two types, safe headache and dangerous headache.
Of course, the former is primary, More than 90% are relatively safe headaches, at least not causing life danger, at most is to bring temporary discomfort, affecting work and life. Although the latter is rare, but the mind should have such vigilance, sometimes, miss a day, will miss the precious opportunity to turn the tide, causing permanent serious dysfunction and even death of patients.
The most common primary headaches are migraine and tension headache, both of which are recurrent but only cause temporary discomfort and generally do not have serious consequences of what.
What kind of headache will have serious consequences?
Often some types of secondary headache: It is mainly subarachnoid hemorrhage, acute meningitis, acute encephalitis, and other intracranial hemorrhage such as cerebral hemorrhage, subdural hematoma, epidural hematoma, cerebral venous sinus thrombosis, cerebral arterial dissection, temporal arteritis, etc. These require a series of assessments including head CT and other imaging examinations to determine the cause of headache and select appropriate treatment.
I once met a patient with fever accompanied by severe headache as the main symptom. I thought I had a cold. After taking antibiotics orally for 3 days, the symptoms eased somewhat. I thought I was fine and stopped taking antibiotics. I didn’t expect the symptoms of fever and headache to worsen obviously. I came to the emergency department for lumbar puncture. Fortunately, targeted antibiotics were given in time and the typical bacterial meningitis was cured quickly.
Bacterial meningitis, if not treated in time, may leave limb paralysis, mental retardation, epilepsy, hydrocephalus and other sequelae, and even have the risk of death. It is still very terrible. Obviously, some headaches and carelessness are not allowed.
Since tension headache and migraine are the two most common types of primary headache, the following is a brief introduction to these two diseases.
Tension headache
The headache with the highest prevalence rate, The global prevalence rate is 38%, accounting for 70-80% of headache patients. The pathogenesis is still unclear. The pain is usually bilateral, mostly in occipital, temporal or forehead, and often in the whole head. Most of the pain is mild to moderate headache, which does not affect daily activities. The pain sensation is mostly compression, tightness, distending pain, blunt pain, soreness, or even explosive sensation.
Some patients described it as if a band was tightly tied to their heads, while others felt like they were wearing a magic spell. The treatment methods are mainly non-drug therapy, drug therapy during acute attacks and preventive medication. Non-drug therapy includes relaxation training, cognitive behavioral therapy, acupuncture, etc.
Acute attacks often use some over-the-counter analgesic drugs such as Fenbid, Sanlitong, Aspirin, Tylenol, etc. The most commonly used drug for prevention and treatment is amitriptyline. If amitriptyline has obvious side effects, mirtazapine or venlafaxine can be taken.
The prevalence rate of migraine is second only to tension headache, but it is often moderate to severe headache, which is more severe than tension headache, so it is the most common headache encountered in outpatient and emergency departments.
Often recurrent attacks, mostly pulsatile, consistent with the pulse beat frequency, often distributed unilaterally, accompanied by nausea, vomiting, photophobia and fear of sound, physical activity aggravated headache. A few patients have visual, sensory and motor precursors before headache attacks, with visual precursors being the most common, which can be dark spots, flashes and blackness.
Symptoms last for 4-72 hours, and women can be related to menstrual cycle.
85% of the patients complained of inducements. Common inducements include: weather changes, stress, depression, anxiety, sleep disorders, overwork, light stimulation, noise, drinking, chocolate cheese, coffee, tea, etc.
Therefore, paying attention to avoiding inducements can reduce headache attacks. Treatment is divided into two aspects: treatment and preventive medication during the attack period. Some analgesic drugs such as Tylenol, Sanlitong, Fenbid, etc. can be applied during the attack period, and triptan drugs can be used for severe headache.
If the patient has frequent headaches, Symptoms are severe and seriously interfere with work and life. Preventive drugs can be used to reduce the frequency of attacks and relieve symptoms during attacks. Common preventive drugs are receptor blockers (such as metoprolol and proneolol), calcium channel antagonists (flunarizine), antiepileptic drugs (sodium valproate and topiramate) and antidepressants (amitriptyline and venlafaxine).
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