Do you think you have a headache?

Headache is a very common clinical symptom.
According to statistics, less than 1% of people who have never experienced a headache during their lifetime have the incidence rate second only to the common cold
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Such common symptoms can appear in various diseases, and it also makes it difficult for clinicians to accurately diagnose diseases
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In clinical practice, clinicians tend to take the diagnosis process and results lightly because the patient's symptoms are common, and it is easy to make judgments based on their own experience, which can easily lead to incorrect or inaccurate diagnosis
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Based on clinical cases, this article summarizes the main points and procedures of consultation for headache diseases
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Author: Hu Tian Ye physician (Jiaxing First Hospital) This article is the author's permission NMT Medical publish, please do not reprint without authorization
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Case review: The patient, a young female, complained of pain and discomfort in the left neck, which lasted for 1 week in the left shoulder
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Once oral meloxicam was ineffective, the first doctor prescribed eperisone and referred to me
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When I saw the patient, although the onset had been on for 1 week, the patient still complained that the pain had not been relieved, and it seemed to be getting worse
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So, I first checked the patient’s shoulder, neck and back neck muscles, and found that the patient’s left neck did not have obvious muscle stiffness and tenderness was not obvious
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I thought in my heart: Is it another headache patient treated for cervical spondylosis? The reason for this suspicion is that this situation is so common in clinics that some patients tell the doctor when they come to see the doctor: "Doctor, my neck is uncomfortable, I have cervical spondylosis
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"Of course, the neck discomfort is not just cervical spondylosis, it is likely to be a manifestation of other diseases
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This patient could hardly sit when she saw a doctor, so I asked her to lie down and asked her medical history carefully
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"Except for the neck this time .
" Discomfort, are there other discomforts? "
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"It's the'string' on the left side of the neck that continues to hurt until the back of the head
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When the patient replied, his thoughts were very clear and his speech was strong
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"Have you had a headache before?" "
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"Yes, about 2-3 months ago
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"The patient replied
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"Is this headache the same as the last one?" "I began to think that the diagnosis should be at least "headache"
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"It's not the same.
Last time, it was painful before menstruation, but it was fine after a sleep.
This time it has been painful for a week
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"Since the two times are different, I want to ask about the situation last time first
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"Where did the headache hurt last time?" What kind of pain is it? "The whole head hurts, especially here in the temple.
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" "Is it throbbing pain?" "I was afraid that she didn't know how to express "pulsation", so she cut in
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"Do you want to stay in a darker place, it's best if no one is talking around?" Do you have nausea and vomiting? Do you need to rest? "I began to subjectively think that this should be another "migraine"
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"Yes, yes, I feel vomiting, but not vomiting.
I am afraid of light and noise, but I continued to work a few times before.
Just sleep at night
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I also felt nauseous and vomiting this time, afraid of the light and noisy, but I can’t go to work anymore, now I’m standing for a long time.

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"I asked about the family history again and found no abnormalities
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Based on the current information, this headache is not like a migraine, and the number and duration of attacks are not consistent
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The
patient was prescribed medicine for 5 days.
Ask the patient to come back to the clinic again, wanting to be treated for migraine first, to see if it will get better
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A few days later, I followed up on WeChat and found that the patient’s headache did not get better.
The only improvement was that his sleep improved
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The patient had a head CT before coming to my clinic again, and it showed no abnormalities
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After a few days, the patient said that he did not continue the treatment, but it was better
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The
patient's cervical MRI showed that the cervical 3/4 and 5/6 discs were slightly herniated , The dural sac is compressed (see Figure 1 and Figure 2)
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At this time, the patient has no headaches, and it has been 3 weeks since my first consultation
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Figure 1 Figure 2 Headache consultation key points and process Headache consultation and The consultation of neurological diseases such as dizziness is similar.
It is also necessary to grasp the time, degree, nature, location, predisposing factors, mitigating factors, family history and other key points to ask
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Therefore, I created a headache consultation song, hope It can help the smooth progress of the consultation: the time factor is the first factor, the frequency and maintenance of the first recovery; the third nature of the second question site, the precursor and the accompanying; the daily activities are suitable? The relief method should not be forgotten; the family history of the predisposing factors, the underlying disease Please be aware
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Here are some explanations around this song
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Time is the most important point.
The pain time, including whether it is the first attack or recurring attack, how often the attack, and how long each attack lasts
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Among them, if it is recurring, it is necessary to ask whether the pain of each episode is the same, because the same patient may have both a tension-type headache and a migraine at the same time, or it may have been a migraine before but is now a tension-type headache
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"Every patient has the authority to obtain all kinds of headaches"
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"Frequency and maintenance of the first recovery" refers to whether the first attack or repeated attack, the frequency and how long each pain lasts
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The location and nature of the pain are generally not missed.
The pain is in the forehead, posterior occiput, temporal, top of the head or periorbital; whether the pain is distending pain, tingling, throbbing pain or tight band-like pain
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"Aura and prodromes" mainly ask patients about other symptoms other than headaches before and during the onset of headache.
Among them, "aura and prodromes" is for migraine.
There are many headaches with accompanying symptoms, such as whether there is nausea and vomiting, fear phonophobia light, sensitivity to odors, fatigue flu
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"Daily activities are suitable?" The impact of headache on daily activities and whether daily physical activity will aggravate the degree of headache can be used to determine the degree of headache, and it can also be used as one of the basis for diagnosis.
Possibly, if daily activities can be continued or the headache can be relieved after the activity, then the possibility of tension-type headaches needs to be considered
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"Relief mode" can be used together with the impact of headache on daily activities to assist in determining the degree and type of headache and disease changes
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"Causing factors and family history" have reference significance for judging the type of headache, and are also a routine content in clinical inquiry, but they are very easy to miss and need to be paid attention to
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"Underlying disease" refers to whether patients with other diseases cause headaches occur, such as high blood pressure, insomnia, infections, cerebral vascular malformations, such as a patent foramen ovale
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At this time, relevant examinations need to be improved to avoid some hidden causes.
Patients may not necessarily know
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Like the patient in the first case, she knew that she was not having a headache for the first time.
This attack has lasted for 1 week; this time the headache is not exactly the same as the previous ones (time/first recovery), this time the pain is later Neck, the entire head for the first few times, throbbing pain (location/nature), without aura and prodromal symptoms, but accompanied by nausea (concomitant)
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In addition, the patient’s activities were significantly affected this time, while the first few times were basically unaffected (daily activities).
Both headaches were relieved by sleeping.
Although sleep was affected this time, it was significantly relieved after taking the medicine (relief method)
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The predisposing factors for this patient’s headache were related to menstruation in the first few times.
There were no obvious predisposing factors this time.
The family history was not abnormal (predisposing factors/family history).
The underlying disease is a point that is particularly easy to forget, because I am a young female patient.
I simply asked about the next menstrual period without asking other details.
This is an area that needs improvement, especially when facing middle-aged and elderly patients (underlying diseases)
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Through such inquiry, the basic condition of the patient’s disease was obtained
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Therefore, if you can master this song tactics, common headaches can be solved with this "template"
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Inquiry still needs to ask more and practice more in the clinic to form one's own habit, so as to obtain as much detailed information as possible during each consultation.
Medical history is king, and consultation is the most important thing
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 Summary Common primary headaches are mainly tension-type headaches, migraines and cluster headaches.
The first two are more common in young and middle-aged women.
Migraines are more common in women of childbearing age, and some are related to menstruation
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Therefore, when encountering patients who meet the relevant conditions in the clinic, clinicians are likely to give a diagnosis of migraine subjectively, which leads to a flood of migraine diagnosis
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For tension-type headaches, the degree of headache is a very important diagnostic point.
Generally, it does not affect work and study.
Some patients have headaches that can be relieved after activities
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Cervical headache is a secondary headache, which requires clinical, laboratory, and imaging evidence to support, and the occurrence or relief of headache is causally related to the neck disease in time.
Stimulating actions can lead to restricted neck movement or The symptoms are aggravated, and there are some symptoms similar to tension-type headaches and migraines, but they are not specific
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As for the patient in the case, she later learned that she didn't usually have a headache when she went to work, but she had a slight headache when she returned home.
This may be related to the pressure of life and the environment
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Perhaps it is more likely to consider tension-type headaches, and there is no clear diagnosis of what the headaches are at the time of treatment
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Perhaps, it is "the time has not come"-the time for a clear diagnosis has not come, and the level of disease diagnosis has not yet come
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