The common causes of headaches, the Great God summed up 16 kinds, too complete!

*For medical professionals to read and refer to headache diagnosis and treatment, the first step in identifying the cause
.

Almost everyone has had the experience of headache, which is second only to the common cold and is also a common disease in clinical neurology
.

Although occasional headaches may not necessarily be diagnosed as a disease, in terms of clinical prevalence alone, headache rates also reach around 20%
.

Headaches can be divided into two categories, namely primary headaches and secondary headaches
.

Common primary headaches include migraine, tension headache, cluster headache, trigeminal neuralgia, etc.
; common secondary headaches include headaches caused by intracranial lesions, such as subarachnoid hemorrhage, cavernous sinus thrombosis, etc.
Including otitis media, headaches caused by glaucoma, and headaches caused by systemic diseases, such as high blood pressure, colds,
etc.

16 common neurological headaches are summarized, classified as follows
.

Primary Headache▌ Migraine Migraine is one of the most common headaches with a lifetime prevalence of 18%
.

It usually occurs on one side of the head, and is unilateral, pulsatile or beating, and usually lasts for 4-72 hours.
The onset may be accompanied by discomfort such as photophobia, nausea, and vomiting.
Some patients have symptoms such as blurred vision, which can be severe Affecting patients' daily work and life, pain relievers are often needed to relieve pain.
Some female patients have migraine and menstrual periods are significantly related
.

▌ Tension headache Compared with migraine, the incidence of tension headache is higher, the onset is slow, gradually aggravates, and can last for several days or years.
It often appears after emotional tension, excitement, fatigue, or staying up late, similar to wearing a hat on the top of the head, often manifested as dull pain, a sense of oppression, fullness, tightness, girdle, etc.
Heavy shoulders
.

Currently, drug therapy and physical therapy are the mainstays
.

▌ Cluster headache The etiology of cluster headache is not clear, it may be related to heredity and chronic biological disorders mediated by the central nervous system.
Most of them are severe unilateral headaches with acute onset, which can recur repeatedly.
The pain location is mostly unilateral orbital and supraorbital.
, retrobulbar and temple, less common, sharp, explosive, non-pulsatile severe or extremely severe pain
.

At present, it can be treated by high-concentration oxygen inhalation, drugs and nerve electrophysiology
.

▌ Trigeminal neuralgia The peak age of onset of trigeminal neuralgia is between 48 and 59 years old.
It often occurs in the ocular area, which is the ocular branch of the trigeminal nerve.
The most severe pain areas are concentrated in the orbit, retroorbital, temporal area and frontal area.
area, sometimes involving the occipital region, maxilla, neck, ears, and teeth, and occasionally radiating to the ipsilateral shoulder and arm
.

The pain of this kind of headache is extremely severe, and this kind of headache will appear acupuncture, burning, throbbing, sharp pain, electric shock, tearing pain, drilling pain,
etc.

In principle, drug therapy is the first choice
.

Secondary headache 1.
Headache caused by intracranial lesions▌ Subarachnoid hemorrhage Most patients describe the headache caused by subarachnoid hemorrhage as the most serious headache in their life, which is a severe, sudden onset severe headache.
Partly caused by increased intracranial pressure, localized or total headache, may be accompanied by other symptoms and signs of neurological deficits, such as severe nausea and vomiting, disturbance of consciousness, meningeal irritation,
etc.

Early head CT and lumbar puncture can confirm the diagnosis.
The causes of subarachnoid hemorrhage include aneurysm, arteriovenous malformation, vasculitis, and connective tissue disease
.

▌ Intracerebral hemorrhage Most patients with cerebral hemorrhage have a history of hypertension, which usually occurs suddenly during activities or emotional agitation
.

Head imaging examination is required to confirm the diagnosis.
The most common site of hypertensive intracerebral hemorrhage is the basal ganglia.
Common causes of intracerebral hemorrhage include cerebral amyloidosis, arteriovenous malformation, blood disease, moyamoya disease,
etc.

▌ Intracranial venous system thrombosis Headache caused by intracranial venous system thrombosis is often accompanied by symptoms of increased intracranial pressure or focal neurological deficit, oral contraceptives, pregnancy or postpartum, tumors, blood hypercoagulability, coagulation factors Lack of other patients are high-risk groups
.

Corresponding signs of venous sinus occlusion, poor venous imaging, dilated collateral veins, barrier veins, and scalp veins can be found on head MRV
.

▌ Intracranial mass Intracranial mass is an uncommon type of headache, often characterized by sudden severe headache, peaking within a few seconds, and rapid resolution after a few minutes to several hours.
This type may be related to Changes in consciousness or falls
.

Headache is mild to moderate, dull in nature, persistent or intermittent, located in both foreheads, and may be aggravated by changes in body position or actions that increase intracranial pressure, such as coughing, sneezing, and straining to defecate
.

The classic headache of this type is most obvious when waking up in the morning, accompanied by nausea and vomiting, and head imaging can confirm the diagnosis
.

▌ Reversible cerebral vasoconstriction syndrome often has predisposing factors, such as exercise, swimming, bad mood, stress, cough,
etc.

Patients often describe thunderclap-like and lightning-like headaches, which usually resolve within minutes or hours, with repeated attacks, worsening severity, and other symptoms of neurological deficits
.

Beaded vascular changes can be seen on MRA or angiography, and 20% of patients may develop ischemic or hemorrhagic stroke, and the postpartum period is a risk factor
.

2.
Headaches caused by systemic diseases▌ Hypertensive headache Hypertensive headache refers to the symptoms of headache, dizziness, nausea, etc.
when the pressure in the cerebrovascular increases sharply.
The pain areas are mostly concentrated in the occipital and temporal regions, and sometimes The head feels heavy and oppressive
.

Headache symptoms usually go away slowly after blood pressure stabilizes
.

▌ Low intracranial pressure headache Patients with low intracranial pressure headache usually have moderate bilateral symmetrical dull or distending pain, which is characterized by obvious pain in sitting or standing, and can be relieved quickly in lying position.
Pain, dizziness, diplopia, blurred vision, etc.
In severe cases, there may be manifestations such as cerebellar subtonsillar herniation, subdural or epidural hemorrhage
.

Most of the causes are due to leakage after lumbar puncture
.

The first diagnosis is enhanced MRI, which shows extensive dural enhancement, subdural or epidural effusion or hemorrhage, cerebral subsidence, etc.
, and the lumbar puncture cerebrospinal fluid pressure decreases
.

3.
Other related headaches ▌ Sinus headache Sinus headache is more common in sinus infection, and the pain area is around the sinus, including the cheekbones, forehead or bridge of the nose.
It can be accompanied by symptoms such as runny nose, full ears, swollen face, and fever
.

▌ Headache caused by otitis media often occurs on the same side of the affected ear, and the nerve endings in the ear are very rich.
If the inflammation of the middle ear directly stimulates the nerve endings of the ear, it will cause migraine on the same side of the affected ear.
The pain is sometimes strong, and severe otitis media may lead to intracranial complications
.

▌ Headache caused by glaucoma Headache caused by glaucoma often occurs on the forehead.
Acute onset of glaucoma can cause a sharp increase in intraocular pressure and severe headache, mostly located in the forehead, temporal region, and around the orbit, which can be accompanied by reflex nausea, Symptoms such as vomiting
.

▌ Drug overuse headache Drug overuse headache refers to frequent headaches that occur after long-term overuse of painkillers.
Patients often have a history of persistent headaches and long-term use of acute symptomatic drugs for headaches; headaches occur almost every day and are almost continuous Mild to moderate dull, bilateral or diffuse pain throughout the day, sometimes localized to the forehead or occiput
.

▌ Postherpetic neuralgia is characterized by persistent severe stabbing or burning pain and insensitivity, often with a history of herpes zoster
.

Quick clinical summary of headache characteristics "Four-step walk" ■ Step 1: The pain part of the headache part, that is, "where the pain is", first of all, it is necessary to clarify the specific part of the headache, and whether it is always fixed in one area or running around
.

■ Step 2: The nature of headaches caused by different diseases is different
.

For example, the pain of a brain tumor is a dull distending pain that is progressively aggravated; the pain of a ruptured blood vessel is a severe pain; a tension headache is a feeling of pressure and tightness
.

■ Step 3: Headache degree The degree of headache, that is, "how much pain" is used to judge the degree of pain in the patient's head.
Clinicians sometimes ask the patient to give a score.
0 is no pain, 1-3 is mild pain, and 4 is mild pain.
A score of ~5 is considered moderate pain, a score of 6 to 7 is considered moderate to severe pain, a score of 8 to 9 is considered severe pain, and a score of 10 is considered very severe pain
.

■ Step 4: Number and Frequency of Headache Attacks The number and frequency of headache attacks, ie "how long it hurts", is very important for diagnosing headaches
.

In addition to headache, it is also necessary to ask the patient whether there are other symptoms, such as nausea and vomiting, photophobia and phonophobia, conjunctival congestion and lacrimation, etc.
These can help us quickly determine the cause of the patient's headache and provide an important basis for further treatment
.

Reference source: [1] Simple determination of the cause of headache [J], Family Medicine, 2014 (01).
[2] Various headaches [J], Medicine and Health Care, 2013, 21 (11).
Text first: Neurology in the medical field Channel Author: Wang Lulu Review of this article: Li Tuming, Deputy Chief Physician Responsible editor: Mr.
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