Why is there headache in the vertex area of the head
Headache, or cephalalgia, is the most common form of manifestations of pain among the population. Up to 30% of men and 50% women are turning to doctors complaining of headaches of different origin and localization.
In the primary treatment in 70% of cases it causes headache it is impossible to establish, so requires a comprehensive, more in-depth examination. Migraine as one of the causes of pain in the head, included in the who list of diseases, the most violating social adaptation.
Why still encounter difficulties in the management of such patients? Tsefalgii are multifactorial neurobiological problem searching in the mainstream of medical and psychological treatment.
Types of cephalgia
Headaches (GB) are divided into primary and secondary.
- tension headache
- cluster (beam) and other autonomic cephalgia.
Secondary – symptomatic pain syndrome accompanying other diseases.
Cephalalgia could be:
- periodic (episodic);
The Most common causes of cephalgia secondary are:
- Inflammatory processes involving the meninges (encephalitis, meningitis, arachnoiditis).
- Neoplastic processes, leading to violation of the outflow of cerebrospinal fluid.
- Severe infection, in which the cephalalgia is a manifestation of intoxication, or signal the beginning of brain edema.
- hypertension (hypertension) or stroke as a complication of it.
- Reflex pain in inflammatory diseases and injuries of the eye, ear, paranasal sinuses, temporomandibular joint, cervical spine or neck muscles.
- Endocrine disorders, including menstrual cycle in women.
- Pathology pericranial muscles.
- Vascular disease (temporal arteritis).
- post-Traumatic pain syndrome in the head.
- Cephalalgia, associated with the acquisition or abolition of drugs (including alcohol, drugs, hormones, caffeine, biological additives).
- Mental and psychological disorders, resulting in a loss of vascular tone.
the Most common causes of pain in the parietal region
so, why does it hurt the top of the head? In Table 1 the following is the pathology that most frequently become a cause of GB in the parietal region.
|Types of headaches||Complaints||Symptoms||Causes|
|tension Headache||Dull, oppressive headache in the parietal region is the type of "wrap" or "helmets" that occur after prolonged physical or emotional stress.||• low-level pain; |
• without focal neurological symptoms;
• hypertonicity of the muscles of the neck and head.
|Overwork, stress, prolonged muscle tension of the head and neck.|
|Migraine||Often unilateral, intense, throbbing headache in the temporal, parietal and rarely the occipital region.||• presence of auras (precursors);|
• nausea, vomiting;
• light and somebean;
• numbness or tingling of the hands;
• the facial skin is hyperemic;
• in speech;
• twinkle in the eyes, double vision;
• increased symptoms during exercise.
Visual, sensory and speech impairment is completely reversible.
|There is a genetic predisposition.
Provoked by fatigue, strong emotions, sudden odors and sounds, changes in weather conditions, excessive consumption of coffee, cheese and red wine.
|Temporal arteritis||Headache and soreness of the scalp when touched, pain when chewing.||• local swelling and tenderness in the temporal region;|
• drooping of the upper eyelid;
• transient diplopia and blurred vision.
|inflammation of the blood vessels supplying certain areas of the head, with subsequent thrombosis. Usually develops in old age (after 50 years).|
|occipital nerve Neuralgia||Acute paroxysmal throbbing pain in the occipital and the parietal cortex accompanying movement of the head and neck.||• tinnitus;|
• soreness of the scalp.
|System and inflammatory diseases affecting the occipital nerves.|
|Coin cephalalgia||Moderate intensity pain syndrome that occurs locally at the site of 2-6 cm chronic or occurs with periods of attacks andthe periods of remission.||• increased sensitivity in the area of pain, tenderness of the skin in the same area;|
• you may experience sensations of pins and needles.
|Presumably neuralgia of the terminal branches of the trigeminal nerve, more precisely undetermined.|
Symptoms – warning signs
Among the variety of symptoms it is necessary to allocate more significant, the appearance of which requires immediate treatment to the doctor in General practice with subsequent examination by a neurologist, ophthalmologist, endocrinologist, vascular surgeon, psychiatrist, etc. so, you need urgent medical help if the headache is combined:
- nausea and vomiting has a sudden onset;
- with disorders of vision, hearing or the appearance of hallucinations, pain usually increases in dynamics;
- with post-traumatic cephalalgia, especially after injuries of the head and neck;
- with the changing nature of the pain syndrome with lesions of the neck, eyes, ears, nasal cavity
- with loss of consciousness or disorders of vision;
- improving blood pressure;
- with any infectious process or an isolated rise in body temperature;
- with a change in the nature and intensity of usual pain syndrome;
- with the amplification of the pain syndrome on the background of medication.
Normally apply the following additional methods of examination for diagnosis and exclusion of complications:
- electroencephalography (EEG) to identify episodes of pathological impulses and diagnosis of epilepsy;
- angiography of cerebral vessels;
- extra - and intracranial vascular Doppler;
- lumbar puncture
- neuroimaging methods.
The Last type of diagnosis is performed by radiation method. Depending on the need apply
- Computed tomography (CT).
- Magnetic resonance imaging (MRI).
- Positron-emission tomography, which gives an indication of the metabolism of cells of different parts of the brain in pain.
- SPECT is the tomographic image of radionuclide distribution.
Differential diagnosis of various types of headache (table 2)
|pointer||types of pain||The duration and cycles||Autonomic||diagnostic Criteria|
|tension Headache||Bilateral, diffuse, dull, oppressive character, more often in the parietal and occipital region, the average intensity||Episodic or chronic nature, aggravated by physical exertion. Duration from 30 minutes to 7 days.||Nausea, sleep disorder, disturbance of breathing rhythm, physical and mental exhaustion, anxiety.||the Frequency and duration of attacks, no aura, dependence on continuous overvoltage of muscles in the head.|
|Migraine||Paroxysmal, recurrent, throbbing, often one-sided. Characterized by the presence of an aura.||Acute attacks lasting from 4 to 72 hours.||Nausea, vomiting, tinnitus, painful skin half of the face and head, photophobia, speech disorder, numbness of the fingers.||the Frequency and duration of seizures, presence of aura, combined with vomiting, nausea, light and somebean.|
|Cluster headache||Sharp, painful, burning, drill, one-sided. Sudden, without warning||the Changing nature of pain during a cluster period. The duration from 15 minutes to 1.5 hours, cycles 6 to 12 weeks.||Psychomotor agitation, lacrimation and redness of the eyes, rhinorrhea, sweating of the face, ptosis, miosis.||Cyclicity and seasonality, the nature of pain.|
|Organic brain damage (tumor, infection, trauma)||Intense, bursting, continually growing in dynamics.||Continuous (including at night).||Vomiting, fever, local neurological symptoms.||the Presence of a bulk process or damage during imaging, local neurological symptoms.|
|Hypertension||Crushing or bursting in the crown area or the nape of the neck, aggravated by straining, coughing, bending over.||Intense, throbbing pain on the background of the rapid and significant rise in blood pressure.||Dizziness, nausea, flushed skin, flies before the eyes.||Persistent increase in blood pressure with daily monitoring, left ventricular hypertrophy according to ECG and ECHO-KG.|
|Epilepsy||Dull, aching or weak medium intense, diffuse character, aggravated by reading, physical and mental stress.||From a few minutes to hours, occurs 1-2 times a month.||Confusion, loss of consciousness, convulsions.||Structural abnormalities in neuroimaging and abnormal wave activity in the EEG.|
|Daily, dull, diffuse, varying in intensity throughout the day, associated with the analgesics.||Chronic in nature, occurs after taking the medication for at least 3 months.||Depression, anxiety, psychological dependence.||the Permanent character of the pain and identify in history a significant factor dependence.|
- Preventive therapy. Relief pain attack should start with changes in lifestyle: prevent stress, emotional and physical stress, exclusion from the diet trigger foods, avoiding alcohol and Smoking.
- relief of occasional bouts with ingestion of acetaminophen (paracetamol, Panadol, tsefekon, efferalgan 500 mg up to 4 times a day), acetylsalicylic acid, combined drugs (Pentalgin), the mechanism of action which is aimed at the suppression of prostaglandins – modulators of pain;
- of β-blockers (obzidan, inderal, nebilet) to prevent vasoconstriction with concomitant hypertension, angina
- serotonin antagonists – dihydroergotamine, imigran, zomig, acute neurogenic inflammation;
- antidepressants – amitriptyline, lerivon used in related neurasthenia and depression;
- NSAIDs – indomethacin, ibuprofen, voltaren;
- anticonvulsants – Finlepsin, carbamazepine;
- muscle relaxants mydocalm for removing pericranial tone of the muscles;
- massage the neck area.
Why unsafe self-treatment of symptoms
Headache can be as independent disease, and the manifestation of various pathologies that must be diagnosed by a doctor. Unskilled approach leads to an aggravation of problems, the chronic pain and serious complications.
- international classification of headaches 2nd edition. The English doctor. honey. Sciences V. V. Osipova, with the participation of doctor. honey. Sciences Professor T. G. Voznesenskaya
- Stock V. N. Headache. – M.:Medicine, 1987.
- Neurology and neurosurgery, Gusev E. I., Konovalov A. N., Skvortsova V. I., GEOTAR-Media, 2015
- Neurology: NAT. hands. Ed. by E. I. Gusev, A. N. Konovalov, V. I. Skvortsova, A. B. Hecht, the all-Russian society of neurologists, 2009