Headaches (headaches), forms, symptoms, diagnosis, and treatment. (Comprehensive article)

Headaches (headaches), forms, symptoms, diagnosis, and treatment. (Comprehensive article)
Headache is a common problem occur for many reasons and many making the identification and classification difficult. Chronic headaches
Common occurrence in cases of:
• sister
• effort and tension (anxiety)
• Stress

But it could also be linked to:
• intracranial lesions
• head injuries
• ankylosing spondylitis
• dental disease or in-kind
• work disorder TMJ lower
• sinusitis
• High blood pressure
• a wide range of disorders that affect the membership and cause medical problems.

- Although most patients who suffer from headaches do not have lesions structural, saying only that, although it must keep in mind the possibility of a background of structural and behind the headaches complained of by the patient; For example, a third of patients with cancers of the brain demonstrating Initially filed a complaint of headaches.

- The unit and the nature and location of pain in addition to other things, the most important bout for headaches and the presence of accompanying neurological symptoms, all of this gives us the key to solve the mystery of the underlying cause of headache, which affects the patient.
Headache that occurs because of migraine or tension often described as throbbing or flapped, and the sense described by the patient as feeling Btadhaq vessel head or feeling the pulse of the head vessels are also associated with headaches caused by tension.
Headache associated with pain pike acute suggests a reason relates to inflammation of the nerves; Kalasb kind or nerve around the orbits, where there is pain - described as the pain hit ax ice - a companion of migraine or cluster headache, while the headache associated with pain dim light or constant constant suggests mainly the presence of the scourge of intracranial in mass.
Pain on the kind or kind suggests the existence of pest-related eye; when the pain is "bar", it is commonly associated with tension headache, while the pain is often accompanied by collateral deposited with migraine or cluster headache.
In patients with inflammation of the sinuses, in addition to the presence of headache, there is tenderness in the skin and bone deposited over the area of ​​the infected pocket.
If the headaches caused by lesions in mass within the skull - the trajectory a nerve - we can Nsnfe to a position and a generalized, for example if a patient has pain of the trigeminal nerve or glossopharyngeal neuralgia, this pain will be the subject of a branch of the trigeminal or in the pharynx and external auditory meatus (respectively).

When questioning the patient should be asked for headaches:
 genetic factors
 inflammation of the pockets of recent
 injury hay fever
 dental surgery
 injury to the head
 symptoms of systemic viral infection may be indicative of a possible underlying reason behind the presence of headache


For migraine headaches aggravated in cases of:
 emotional stress
 fatigue and fatigue
 eating materials containing nitrite or tyramine
 menstrual cycle [menstrual]

** The alcohol may be due Balubal the owner and has developed a type of severe headache is the "cluster headaches".

- The work of the disorder of TMJ pain and cause the lower Aghia type of headache or be predisposed chewing trigeminal neuralgia or glossopharyngeal nerve may also cause pain as well be predisposed to chewing chewing or ten so called stopped chewing] that sometimes occurs in conjunction with inflammation artery giant cell (temporal arteritis).

- Cough-induced headache is happening in the case of structural lesions of the hole background, but in many cases can not find a clear reason for this type of cough.

In a patient with headaches, learn the timing of symptoms and headache episode is important because headache is bad when the alarm awakens the patient is already inflamed sinuses or intracranial mass.
Cluster headaches usually occur in the same time every day or typically occurs at night, but for tension headache and fatigue effort it is getting worse and worse at the end of the day.

- The incidence of Sudden headache severe suggests an association with lesions and disorders of intracranial Kalnsv subarachnoid or meningitis, especially if this happens when a healthy person without a history of satisfactory, but to be a chronic headache was the proposal against the backdrop of turmoil within the skull when a healthy person before this probability is relatively rare.

For additional surveys, we we request depending on the principled clinical evaluation of the patient, for example, in cases of:
• severe headache, progressive
• New onset of headache in the middle or late life
• headache that haunts the sleeping
• headache tension and stress
• headache associated with neurological symptoms in general or the subject of a nervous disorder

All of these cases require a magnetic resonance MRI of the cranium or photography class a pivotal head CT in order to deny the existence of intracranial lesion with mass.
But when there are signs of meningeal irritation or deterioration in consciousness, it also requires a CT scan, MRI and examination of cerebrospinal fluid so as to exclude subarachnoid hemorrhage or infection of the meninges.

The diagnosis and treatment of neurological disorders associated with primary headache is not uniform and varied and all have a special type of a particular neurological disorder.

The types of headaches are studying:

1 - Stress and tension headaches:
Patients often complain of poor concentration with vague non-specific symptoms of the other, in addition to the continuous daily headache as Alhadh Court on the head like a vice, this iron is exacerbated headache severity or emotional fatigue or excessive fuss or staring with something dazzling to the eye.
Headache is usually generalized, but be as strong as possible within the scope of Agafoh neck and head, and not associated with neurological symptoms placement.

Treatment:
- Start simple palliatives of pain, if did not work then we resort to drugs of anti-sister and that would be the effect worthwhile.
- Are technologies that provide comfort is also helpful in alleviating the pain of headaches, these techniques include:
 massages
 hot baths
 Self-feedback technology (a technology through which the controlled person and involuntary body functions Kalnd, pressure and other functions that are normally controlled voluntarily, using specific devices).
- Survey of the main reasons for the chronic state of anxiety is usually a useful and appropriate for the development of appropriate treatment.
- Injection of the toxin type A Albotulini sometimes helpful, with possession of a few systemic side effects, but given protocol must be irregular.

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2 - headache depression:
In this type of headache is repeated every day is a pain episode is the worst of its kind and which are in the early morning, in addition to this headache may be associated with other symptoms of depression.
It is said that depression is causing the headaches, but on the other extreme is said that the headache occurs first and is the focus is causing depression or activated the device Aldilala (placebo), physical, and therefore may be both the cause of headaches or depression of another.
In this case the benefit is usually antidepressants, also serve as medical and psychological counseling.

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3 - sister:
Basics of diagnosis:
Headache is often throbbing, associated symptoms include nausea and vomiting as well as phobias and optical audio.
May precede the attack of some neurological symptoms (especially visual) may also occur without the presence of people (and a certain sense of aura felt by the patient before an attack).

General ideas:
Studies have shown that the neurotransmitter "serotonin" may play an important role in the pathogenesis of migraine.
That in the case of migraine headaches may be due to release peptides act as vectors in the nerve branches of the trigeminal nerve, leading to an inflammatory process and there is another theory says that the headache could be due to induction of dorsal nucleus Alrvaúah.

Clinical findings:
Classical migraine headache is unilateral nature vibrant frequently occurs periodically after the first episode that may occur in adolescence or early adult and with that not every headache is diagnosed with a vibrant nature of the sister that in addition to many types of headaches do not match the form mentioned above, although the characteristics and response to drugs because of its sister show the same pathogenicity.

And consequently, migraine headaches may be unilateral or bilateral (generalized) with the nature of a vibrant or dullness is often accompanied by anorexia, nausea and vomiting and light and sound phobia disorder, and (confusion) optical.
Symptoms begin gradually and last for several hours or more have been observed in facilities for these symptoms and the presence of over-expansion and an increase in the external carotid artery pulse.
May be preceded or accompanied by headache, focal disturbances in the work of the central nervous system and due to the presence of narrowing in the carotid artery branches.

Visual disturbances are common and include visual field disturbances or visual hallucinations and bright, which may take different forms are in the form of stars or sparks, or specific geometric shapes or ripples and may not take a particular form and can include visual disturbances both visual field disturbance and hallucinations.
May occur as focal disorders such as aphasia, numbness, tingling, weakness in specific muscles in the body, movements are inaccurate (lout).

There is often a family history of migraine injury
Factor is induced mental stress or physical deficiency or increased sleep, missed meals, specific foods (chocolate), alcoholic beverages, the menstrual cycle, take oral contraceptives.

Of cases (variations) is common:
Sister of basilar artery, which is characterized by the loss or disturbance of vision in both fields visual accompanied or followed by dysarthria (difficulty word), upset the balance, tinnitus, numbness around the mouth and in remote areas, disturbance (loss of cross-awareness) or a state of confusion my mind, followed by headache, pulsatile especially in the occipital region, accompanied by nausea and vomiting.

In migraine associated with paralysis kind there is pain telescopic building maintenance around the eye with nausea and vomiting, and diplopia (double vision) due to a partial paralysis in the muscles of the external eye as a result of paralysis of third nerve, which may be accompanied sometimes paralysis of the sixth nerve and can continue to be paralyzed for several days after the occurrence of pain, and could include ophthalmic branch of the trigeminal nerve.
The migraine associated with paralysis of the eye is rare.
Of the most common causes of painful ophthalmoplegia maternal blood in the carotid artery disease and diabetes.
In some rare cases may be physical or neurological disorders demonstrate only diagnosed the attack.
Migraine may lead in very rare cases the injury of nerve permanently.

Treatment:
The management of migraine includes avoiding provocative factors in addition to the preventive treatment of the symptoms of drug or existing, and when necessary.

1 - Symptomatic treatment:
Many of the patients during the acute attack and found the benefit of rest and relaxation in a quiet room is dark until the symptoms disappear, and pain relievers simple (such as aspirin, aspirin - paracetamol acetaminophen - ibuprofen ibuprofen - naproxen, naproxen), when given directly Oharthm comfortable, as well as the HANDLE of blood outside the brain and other medicines are sometimes necessary.

 Kavirgot: Cafergot is a combination of tartrate ergotamine ergotamine tartrate (1 mg) with caffeine caffeine (100 mg), a product with a clear benefit, especially when dealing with a disk or two disks at the start of headache or when symptoms warning of the occurrence onslaught of pain followed by a disk every half hour, and if needed we can increase the number of disks to 6 tablets during the acute attack and 10 during the week.

May fail oral treatment sometimes be useful because of the absorption of the weak and Alakieouat occurring during the acute attack and in such cases, the Kavirgot can be given via the rectum Kthamil anal (suppository every half hour containing 2mg of ergotamine) or we can give Dai Hydro ergotamine Messelat dihydroergotamine mesylate (0.5 - 1 mg intravenous) or (1 - 2 mg subcutaneously or intramuscularly) in addition to that given prochlorperazine prochlorperazine through the rectum (25 mg) or intravenous (10 mg), and we must not forget that ergotamine affects the pregnant uterus and therefore should be avoided. give during pregnancy.


 Sumaatrepettan Sumatriptan: have a familiar high serotonin receptors -1, a factor effectively and promptly to stop the acute attack when given by subcutaneous self-injection device, and can be given as nasal absorption, but limited, and the eating is orally available.


 Zulma triptans: Zolmitriptan stimulant selective for serotonin receptors -1 and has the availability of a dynamic high after taking orally is effective in the treatment of acute attack of migraine, the initial dose ideal of it is (5 mg) and relaxes the patient, usually after hours, and there is a product I deny my own and developed the start of its effect quickly, We can also use some other drugs from a group including triptans Triptans (Rizzatreptan rizatriptan - Naratreptan naratriptan - Olmutreptan almotriptan - Afrovathriptan frovatriptan), which has a longer half-life which is worthwhile for the treatment of patients with long attacks (more than 7.5 mg in 24 hours). We should avoid triptans during pregnancy, and that this group is one of Contraindications in people who have the disease in the coronary or peripheral vessels, and may also cause nausea and vomiting.


 droperidol: droperidol antipsychotic and is also useful to stop the acute attack.


Pain relievers, which has affected a drug may be necessary in some special cases such as Mberden meperidine (100 mg intramuscularly) and tartrate Baotovanol butorphanol tartrate by nasal spray (1 mg / spray in each nostril, and repeated after 3-4 hours if necessary), and propofol propofol for intravenously in doses given under anesthesia could be beneficial in cases resistant to treatment.


2 - preventive treatment:
The preventive treatment is necessary if the headaches caused by migraine get frequent 2-3 times a month and that the most common drugs used for this purpose are summarized below, and the way it works is not clear it affects all of education outside the brain in addition to their effects brain; such as installing transport of the nervous system serotonin.
Drugs:
 Aspirin
 propranolol (and other β-receptor blockers are also useful)
 Amitriptyline
 Amapramen
 sertraline
 ergonovine maleate
 cyproheptadine
 Clonidine
 verapamil (and other calcium channel blockers are also useful)

Many of the drugs should be tried sequentially until the headache and control a counter attack as soon as we find the panacea we must continue to take him for a few months and if the patient felt that he get rid of the headaches we can reduce the dose gradually we eventually withdraw the drug.

Albotulini toxin A effective in the prevention of migraine in some patients in the event of localized injections of the scalp, but it has some side effects and only needs to give him at intervals during several months.


The use of antimicrobial agents is also useful anticonvulsant drugs used:
 valproic acid (500 - 1500 mg) with a note not to use it during pregnancy.
 Gababintin (900 - 2400 mg)
 Topeeramat (50 - 1100 mg)

Drugs blocking the calcium channels can reduce the recurrence of attacks after several weeks, but the severity and duration of attacks will not be affected, and we should not we use with beta blockers.

The receptor blockers, angiotensin-converting enzyme (Candy Sartian candesartan) and that have been evaluated, may be useful and effective.

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4 - cluster headache (neuralgia Alhqiqi Migrainous Neuralgia):
This type of headache generally affects men in middle age. Its causes are not yet known but it may be associated with headache caused by vascular disorders or disorder mechanisms of action of serotonin.
- Seen in this type of headache to activate the cells of the hypothalamus in the same side as there is a pain.
- Often happens this type of headache without family history of headache or migraine.
Occur bouts of severe unilateral pain localized around the pilgrims on a daily basis for several weeks and is often associated with one or more of the following:
• nasal congestion that occurs in the same side where the pain
• runny nose
• runny lacrimal
• red eyes
• Horner's syndrome
Seizures often occur at night Moukzh the patient from his sleep and continue per attack less than two hours and then place spontaneous remissions lasting weeks or months where the patient is in good health before they have converged from heart attack later.
During the attack a number of alcohol patients accuse of inciting a heart pain, and others accuse the intensity, or very bright light, or eating certain foods is working on the induction of heart pain.
In some patients, repeated episodes of pain and accompanying symptoms without the period of remission, and this disparity in the protocol of a pain due to the presence of chronic cluster headache.


Drugs which are useful for the prevention of migraine important in the treatment have been mentioned at the top .....

Examination shows the absence of any appearance is abnormal only in Horner's syndrome, which occurs either on a temporary basis during the attack, or that already exists Kaadz permanent and continuous rest between the attacks.
Treatment of single attack of oral pain medications are often not completely satisfied with the result of the use of medicines, injections under the skin it is often useful drugs used are:
 Somaterbtin (6 mg)
 de Hydro ergotamine (1 - 2 mg)
It may also benefit from the inhalation of 100% oxygen to give 7L \ min for 15 min.

Ttrut Albotorvnol - a synthetic opiate anti-cough - may also be useful when used Kboukhakh my nose and dose (1 mg) one puff in each nostril, and repeated every 60 - 90 min if needed.
Ttrut ergotamine effective in the prevention of attacks if given in anal suppositories dose (0.5 - 1 mg) at night or twice a day, but if given orally Valjrah (2 mg) per day, and if I give the injections under the skin Valjrah (0.25 mg) three times daily for 5 days each week.

Preventive medicines that have been found effective in patients are:
 Alvalbrooat
 cyproheptadine
 lithium carbonate (must be used when the monitor lithium concentration in plasma)
 prednisone (20 - 40 mg) daily or a reciprocal system of sequential doses for two weeks followed by a gradual withdrawal of the drug
 verapamil (240 - 480 mg) per day

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5 - headaches following trauma:
A wide range of symptoms Allanoaah can track the closed head injury, regardless of whether he had lost consciousness or not. Headaches often have a clear profile.
- Some authorities believe that psychological factors could be important because there is no link between the severity of the infection and neurological signs.
Headache disappears within days after self-injury, may get worse in the ensuing weeks and then gradually disappears. It is often constant pain deaf and overlay, and pulsed with pain or be subject, or generalized side is sometimes accompanied by nausea or vomiting, scotomata, or blinking.

Imbalance may occur associated with the composite rotary (dizziness compound) is also often increases with position changes or movements of the head.
Memory ailing (sick), poor communication, emotional instability and high irritability (irritability), all previous complaints might be common, and sometimes the views only of the disease syndrome.

Duration of symptoms associated with tongs as to the severity of the original injury and even minor injuries can be followed by symptoms may last for months.

Surveys are usually not assist, EEG power EEG can show small changes of unknown cause, while the proposed planning nystagmus electricity in some cases, either in morbidity vestibular ocular peripheral or central, CT and MRI magnetic head appears free of the assets is not natural.

- Treatment is difficult, but optimism and encouragement and the gradual rehabilitation based on the occupations appropriate to the conditions recommended.
Headaches often respond to simple analgesics, but severe headaches requiring treatment by using:
 Amitriptyline
 Propranolol
 derivatives clavus scalenus

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6 - Saala headaches:
May cause coughing, severe pain in the head as this may result in pain, fatigue and also for the effort, sneezing, laughing, but fortunately only lasts for several minutes or a few less than that even.

Mechanism of physiological disease of the complaint is not accurately known yet often does not have a structural lesion considerable potential beyond the pain, but the lesions are intracranial usually in the posterior fossa in particular (malformation Arnold - Kiara [prolonged and flat bulb and cerebellum) are present in approximately 10% of cases, and brain tumors or lesions of the worker into the manifest also in the same way.