As evidenced by constant headaches, what are their causes and what to do

Headache (cephalalgia, GB) is a socially significant problem: a huge number of sick leaves issued by therapists and neurologists about this, millions of people lose the ability to lead a full life.

About 52% of the adult population of the Russian Federation (according to the survey, 2008) notes have frequent headaches, but only half of them get qualified and receive adequate treatment.

The Rest do not consider this issue worthy of going to the doctor, doing self-treatment. Many are simply not aware of the possibility of effective treatment, don't trust the doctors either can't determine to what doctor to address, but also fear that they will have identified a serious disease.

The Term "headache" includes pain of different origin, which are localized above the top edge of the eye sockets, behind the ears, above the neck in the occipital region. It may be caused by irritation of the nerve endings of vessels or receptors of the meninges, excessive toning up the muscles of the head and neck, lesions of cranial nerves or of organic changes in the brain substance.

The Cephalalgia is a huge group of disparate for the reason and the mechanism of occurrence of pathological States: a number of them can be treated as independent diseases, others relate to specific or non-specific symptoms of other diseases.

Views on the international classification of

According to the International classification (MCHB, table 1) of cephalgia are divided into primary and secondary, and the neuralgia and pain in the head and face identified as a separate group. If the pain has no organic substrate, and therefore, is not a consequence of the disruption of brain structures or pathways, it is called primary. The cause of it, may be different: the violation of vascular tone or abnormal muscle tension.

Tsefalgii, which is the result of injury, brain lesions or other structures of the neck or face is called secondary or symptomatic. In this case, to clarify the diagnosis, assign additional study that can detect organic changes.

	Type of headache according to MKGB-2	The prevalence among the population
Part I: the Primary headaches
1	Migraine	5 - 20%
2	tension Headache	24 - 86%
3	Beam headache and other trigeminal autonomic cephalgia	0,1 - 0,4%
4	other primary headaches (cough, associated with physical exertion or sexual activity)	3,5%
Part II: the Secondary headaches
5	Headaches associated with head trauma and/or neck
6	Headaches associated with vascular lesions of the skull and cervical spine	About 1%
7	Headaches associated with intracranial extravascular lesions
8	Headaches associated with various substances or their abolition	1 - 6,5%
9	Headaches associated with infections
10	Headaches associated with the disturbance of homeostasis	About 1%
11	Headaches and facial pain associated with the violation of structures of the skull, neck, eyes, ears, nasal cavity, sinuses, teeth, mouth or other structures of the skull and face	2,82%
12	Headaches associated with mental illness	0,24%
Part III: Cranial neuralgias, Central and primary facial pain and other headaches
13	Painful cranial neuropathies and other facial pains	2,67%
14	head pain	5,76%

the danger Signals when tsefalgii

The Vast majority of primary cephalalgias is, in this case the patient's life is not in danger. "Alarms" is a common term referring to the presence of associated symptoms or characteristics of pain, which allow to suspect the presence of severe pathology, which can cause impairedGeneral condition, permanent disability, breach of the General condition and even death. So, what are the symptoms deserve attention and what to do when they identify?

Symptoms of impaired cerebral circulation

If there is at least one of the following symptoms, the patient needs emergency medical care.

1. "Thundering" headache

If the strong GB appears suddenly and independently from external influences, it can be a manifestation of a hemorrhagic stroke, or bleeding in the intermembranous space. This condition is often preceded by excessive physical strain, nervous tension, or other factors that cause increase in blood pressure. The increase in the pressure force on the vessel wall can cause its rupture, brain structure compressed is accumulated in the cranial cavity with blood, which causes pain. This condition requires emergency care physician, which means that the patient must provide full rest, to eliminate any stress and to call an ambulance.

2. impaired speech, vision, or unexplained muscle weakness

In some cases, the pain attack is preceded by neurological disorders, it is especially characteristic of migraine. This condition is called aura, most often it is the flickering fire balls or spots in vision, limitation of field of vision in one eye, an attack of dizziness or weakness in the extremities, less often – a speech disorder.

If the aura lasts more than one hour without the occurrence of atypical seizure or is leaking, it should be regarded as a possible symptom of ischemic stroke. This condition also requires immediate medical intervention.

3. Aura when taking oral contraceptives

Taking estrogen-containing oral contraceptives, along with migraine and Smoking is a major risk factor for circulatory disorders of the brain. If the symptoms characteristic of the aura, appeared for the first time after you start taking hormonal contraception, you'll need to seek medical help, and subsequently to look for an alternative method of contraception.

Intracranial neoplasm

These symptoms do not threaten human life directly, but their appearance should consult a doctor in the near future:

1. First identified cephalalgia in adolescents or patients older than 50 years.
2. If in the course of a week or more constantly a headache, and the intensity of pain increases.
3. If you have a headache stronger with increasing physical activity, changing posture, sneezing and coughing, straining.

Infectious brain damage

Persistent cephalalgia, accompanied by nausea and vomiting, increased tone of the muscles of the neck, and fever up to 39 °C and above, can be a symptom of an infectious inflammation of the membranes or the brain (meningitis or encephalitis). Treatment must be carried out only in a hospital, and medical help should be urgent.

Symptoms of common types of headaches

According to the world health organization to socially significant and the most common include migraine, tension headache (TTH) and abussou headache. These violations are often the cause of noticeable deterioration in the quality of life, loss of ability to perform professional duties and even disability. Migraine and tension-type headache are primary, so the diagnosis is made solely on the basis of clinical manifestations.

Ubusuna cephalalgia refers to a group of secondary chronic diseases. Most often it is the result of the uncontrolled use of analgesics or other drugs. If a person has frequent headaches, but did not seek medical attention and not receiving adequate treatment, and instead, pain control medications at higher doses than recommended, the pain becomes constant, and the relief from drugs is temporary. This constant excruciating pain and called aboutuse.

Sometimes hypersensitivity to light, pain in neck

Clinical sign	Migraine	TTH	MIGB (AGB)
location of pain	Unilateral bounded area of the eye, temple or forehead	Bilateral, diffuse in the temples, crown, nape	Single or double, no specific localization.
Duration	Paroxysmal, the duration of the paroxysm to 72 hours	Paroxysmal, takes place during the day	Constant increases with exposure to precipitating factors
Character	Pulsating	Compressing	Most pressing or aching, but can be throbbing
pain Intensity	the Pain is severe, almost unbearable, during the attack the person is disabled	the Pain is mild or moderate, does not interfere with daily activities	Weak or moderate, more intense in the morning.
Associated symptoms	Nausea, vomiting, increased sensitivity to light and sounds	Pain in the neck, muscle stiffness
the Relationship with physical activity	Increases during exercise	Not connected	there is No direct connection, with regular physical activities condition is improving
triggers	Emotional stress, menstruation, hunger, sleep disturbance, alcohol intake	Emotional stress, forced uncomfortable posture	Long drugs about the primary GB
Heredity	60% positive family history	Not indicated	Not indicated

triggers of primary headaches

The Primary cephalgia, both chronic and episodic paroxysmal character are. As a rule, the onset of pain is preceded by a precipitating factor or trigger. The exception trigger is a form of effective pain control. To identify them, the patient is instructed to keep so-called diary of pain. It can be used to determine what preceded its appearance. It can be physical stress, the consumption of a particular product or to emotional stress.

development Reasons (triggers) migraine attack:

• emotional stress or relaxation after stress;
• menstruation
• hunger
• sleep disturbance
• alcohol
• nitrite-containing foods (sausage, smoked, canned).

Causes of pain during episode of cephalgia voltage:

• emotional;
• for long periods in an uncomfortable posture.

keeping a diary of pain allows us to understand why often a headache and as far as possible to avoid precipitating factors.

Secondary pains in head

1. post-Traumatic headache

About 80% of patients who have suffered a head injury in the posttraumatic period noted frequent headaches. Headache, which appears immediately or within two weeks after the injury, called acute post-traumatic provided that it lasts no more than 8 weeks. If the pain does not cease after this period, speak about chronic PTGB. Causes of acute PTGB – damage to the skin, muscles and aponeurotic membranes of the skull, wounds to the neck, as well as functional or structural disorders in the brain.

• When the concussion pain caused by the violation of vascular tone and function pathways of the brain. This gives rise to nausea, may be vomiting. Compliance with bed rest even without medical treatment leads to the weakening and cessation of cephalgia in a few days. Violation of the regime, the rejection of rational medical treatment, emotional stress can lead to chronic pain.
• brain Injury leads to the development of local tissue edema and increase pressure inside the skull, this is the cause of the pain. When subarachnoid hemorrhage and intracranial hematoma it is the result of compression of the brain tissue volumetric liquid education. This is a serious injury requiring hospitalization and inpatient treatment.

In the pathogenesis of chronic PTGB leading role of psychogenic factors as a direct link between severity of injury and intensity PTGB not revealed. Organic changes in brain tissue resulting from traumatic injuries may also contribute to the formation of persistent pain.

2. Headache as a result of violations of cerebral circulation

• Pain during transient ischemic attacks or stroke of the same nature is the result of spasm of blood vessels of the brain. The narrowing of the vessel lumen leads to disruption of metabolism through the wall. Wherein the oxygen in the tissue is not supplied, and the products of tissue metabolism are not removed. The accumulation in tissues of harmful metabolites causes the release of inflammatory mediators, which are responsible for pain response.
• Hemorrhagic stroke and subarachnoid hemorrhage – a rupture of the wall of large blood vessel. The brain tissue is squeezed by increasing hematoma and the pressure inside the skull increases. Thus there is irritation of receptors of the meninges and the patient feels pain.
• Cervicogenic headache. Important role in ensuring blood supply to the brain play a vertebral artery in the bone canal, consisting of the transverse processes of the cervical vertebrae. Temporary squeezing them with head tilt in normal does not affect the blood supply to the brain. However, in marked spasm of the neck muscles or the cervical degenerative disc disease that was exacerbated, the brain lacks oxygen, so there is the cephalalgia. Head at the same time, usually hurts in the same place, the pain is localized, resembles migraine, but not so strong.

3. Headache in brain tumors and intracranial structures

Intracranial tumors located away from important brain centres and pathways in the initial stages, may exist without causing any symptoms. The growth of the tumor pushes brain tissue, so the pressureinside the skull increases. Irritation of receptors of the meninges leads to the fact that the patient is constantly a headache, and the pain intensity increases.

4. Headache caused by a malfunction of the temporomandibular joint

The temporomandibular joint joins the moving bone of the lower jaw with the temporal bone of the skull. In the immediate vicinity are large sensory fibers. The malocclusion and the loss of posterior teeth result in a change of the mutual arrangement of the articular surfaces and stretching of the joint capsule. If the jaw began to move unevenly, as in the joint but there is a crunching or clicking noise, most likely, this is dysfunction.

The Head of the mandible is displaced and presses on nearby nerves, causing a range of symptoms, one of them is frequent headaches, sometimes quite strong. Such patients often become patients of neurological departments and psychotherapists, but if you provide them with a rational dentures, you don't have to.

Diagnosis of cephalgia

The basis For the diagnosis is taken of the international classification of III revision (mgcb III). According to this document, all headaches are classified depending on their causes. They are divided into primary without organic substrate, and secondary, resulting from damage to intracranial structures.

Statistics show that primary headaches prevail over secondary, the latter are identified less than 10% of cases. So there is no need to immediately do a CT scan or assign other expensive surveys. Diagnostic search start survey General examination of the patient and keeping a diary. Additional instrumental and laboratory tests, if will be identified symptoms, is not characteristic of primary cephalgia.

method Name	When assigned	Preparation and holding	What you get out of
cerebrospinal fluid Analysis (lumbar puncture)	If the headache immediately after the injury accompanied by focal neurological symptoms. Headache combined with neck stiffness and fever.	requires No special training. Is the neurosurgeon in the treatment room. The resulting puncture, the fluid is sent to the laboratory for microscopic examination.	microscopic examination can be detected in the erythrocytes, indicating the presence of subarachnoid hemorrhage, or elevated levels of leukocytes in the CNS.
Radiography	Injury, suspected dysfunction of the temporomandibular joint, the presence of changes in paranasal sinuses, cervical headache.	Performed radiography of the skull in frontal and lateral projections for examining the joint according to the Star. paranasal sinuses – in semi-axial projection; of the cervical spine.	the Presence of bone defects, foreign bodies in the soft tissues, the cranial cavity, or paranasal sinuses; the change in the shape and relations of the articular surfaces; deformation of the vertebrae.
Computed tomography	skull fractures, a suspected tumor or focal lesion of the brain tissue.	Special training is not required.	the Availability and nature of bone injury; the presence, localization and size of tumors, subarachnoid hemorrhage.
MRI	Suspicion on the tumor process or focal brain damage	Required clothing without metal inclusions.	the Presence, localization and size of tumors, subarachnoid hemorrhage or other lesion of tissue of brain.

To Make a computer or magnetic resonance tomography, if not for this good reason, no need. Often in the course of the study revealed slight structural deviations that are accepted and for the cause of GB, but you are not. At the same time assigned inadequate treatment, the effect of which, naturally, is missing. The patient loses confidence in the expert and attempts to self-medicate, which often leads to the formation of aboutuse headache.

Summarize

Cephalalgia can be an independent disease or a symptom of trauma and organic brain damage. Most often, despite the severe discomfort, it does not directly threaten human life, but significantly impairs quality and can cause disability.

The Presence of specific pain characteristics or accompanying symptoms extra is a danger signal. In this case medical attention should be immediate. In other cases, the medical treatment is also needed.

To get Rid of primary cephalgia completely is not always possible, but almost always itscan be controlled by changing lifestyle and taking medicines is correctly matched. Chronic headache significantly impairs quality of life, reduces efficiency and social activity.

A Timely appeal to the specialist will help to avoid the transition of episodic to chronic pain and find an effective way to control pain.

Sources:

1. Headaches in General practice. S. S. Pavlenko. Interregional Siberian anti-pain Fund, Novosibirsk.
2. European principles of management of patients with the most common forms of headaches. T. J. Steiner et al. A practical guide for physicians; translation from English Yu. e. Azimova, V. V. Osipova; research edited by V. V. Osipova, T. G. Voznesenskaya, G. R. Tabeeva. – Moscow, 2010.
3. Primary headaches (practical guide). V. V. Osipova, G. R. Tabeeva Department of neurology and clinical neurophysiology, Department of neurology, medical faculty of MMA. I. M. Sechenov, 2009
4. tension Headache (practical guide for physicians). V. V. Osipova Department of neurology and clinical neurophysiology MMA. I. M. Sechenov. 2009