"Yangkang" Those rare headaches you should know

As a large number of "warriors" who "first" experienced "blade voice", "cement nose", "electric drill bit" and "bone removal pain" gradually recovered, the "post-epidemic" era also came
.
After experiencing this unforgettable "human catastrophe", in addition to preparing for XBB, we can also learn about those rare but perhaps related to previous experience headache types
.

Written by Tinyel

This article is authorized by the author to be published by Yimaitong, please do not reprint
it without authorization.

Primary cough headache

In the International Classification of Headache (Third Edition) (ICHD-3), primary cough headache is classified as 'Other Primary Headaches
'.
The most striking feature of this type of headache is that the headache is caused by coughing, exertion, and/or other Valsalva movements, and the occurrence of headaches is only associated with
these movements.
At the same time, it should be noted that headaches appear immediately after stimulating actions such as coughing, and headaches can persist between 1 second and 2 hours
.
The headache is mostly bilateral and posterior, and the severity is related to the frequency of cough, and some patients may be accompanied by dizziness, nausea, and sleep abnormalities
.
When diagnostic criteria are not fully met, the diagnosis is likely to be primary cough headache
.
Indomethacin is usually effective
for this type of headache.

Fig.
1 Primary cough headache

Headache due to systemic viral infection

This type of headache belongs to the category of "headache due to infection" under the category of "headache due to infection"
.
Diagnosing this type of headache requires first confirming that the patient is free of meningitis or encephalitis and that the headache is caused
by a systemic viral infection.
The degree of headache is strongly correlated
with systemic viral infections.
When the headache lasts less than 3 months, it can be diagnosed as acute headache; If systemic viral infection persists and headache exceeds 3 months, chronic headache
can be diagnosed.

Fig.
2 Headache due to systemic viral infection

Headache due to nasal or sinus disease

This type of headache falls under
the broad category of "headaches or facial pain due to diseases of the skull, neck, eyes, ears, nose, sinuses, teeth, mouth, or other facial or neck structures.
" This type of headache was once called "sinus headache" because its reference is unclear (both for primary headaches and headaches presumed to be related to nasal or sinus structures), so it has now been replaced
by a more explicit name.
As can be seen from the diagnostic criteria, more than just radiographic evidence is required to diagnose this type of headache, and ICHD-3 considers that the radiographic alterations associated with acute sinusitis lesions and the pain associated with it are not sufficient to diagnose this type of headache
.
It should be noted here that migraine is often accompanied by nasal autonomic symptoms and the location of the headache can be similar to this type of headache, so it is necessary to distinguish clinically with purulent nasal discharge and/or other features of acute sinusitis to help in the differential diagnosis
.

Figure 3 Headache due to nasal or sinus disease

Medication overuse headache

Drug overuse headache belongs to "due to a substance or substance stage headache" in ICHD-3, which has a large number of subcategories, of which drug overuse headache is also a very important subcategory
.
There are many subtypes of this type of headache depending on the type of drug, among which the categories that may be related to this "electric drill" and "bone removal pain" include non-opioid painkiller overuse headache and combined analgesic overuse headache
.

Medication overuse headaches are also known as "drug abuse headaches," and as you can see from the name, this type of headache is associated
with an overdose of painkillers.
However, it should be pointed out that "excess" here does not mean "a single overdose" use
.
It is clear from the diagnostic criteria that regardless of the subtype, it is necessary to meet the criterion
of "regular use".
Therefore, the key to this type of headache is that the patient has a history of primary headache, and because of this primary headache, he regularly overdoses of drugs used to treat headaches every month, which can be drugs for acute exacerbations of headaches or drugs for symptomatic treatment, and the patient has headaches for more than
15 days per month.
When a patient takes multiple medications, even if each drug does not overdose, the diagnostic criteria
for this type of headache may be met because of the overall overdose.
Among patients with primary headache, migraine patients and tension-type headache patients are susceptible to
drug-overuse headache.

Fig.
4 Drug overuse headache

Non-opioid overuse headache is diagnosed when a patient is eligible for a drug-overactive headache
and is taking a non-opioid painkiller.
Because non-opioid painkillers are very common in clinical practice, such as ibuprofen, acetaminophen, or diclofenac, celecoxib, and even aspirin that are used to replace these two when they can't grab them, long-term overdose of these drugs will not only cause headaches, but also cause other damage to patients, so identifying and diagnosing this type of headache has very important clinical significance
.

Fig.
5 Non-opioid analgesic overuse headache

Combination overuse headache is diagnosed when the patient is eligible for medication overuse headache
and is taking combination analgesics.
Compound painkillers are also uncommon in clinical practice, such as aminophenol oxycodone, profendiine tablets, and generally non-opioid painkillers plus opioids, butabital, or/and caffeine
.

Fig.
6 Compound analgesic overuse headache

brief summary

The above types of headaches are not necessarily related to "yang", but it can be found from the clinical practice that many patients will stack their own ingredients and drugs with similar effects after taking a fever-reducing drug/painkiller with poor effect, or take it at the same time as Chinese proprietary medicine, and some proprietary Chinese medicines are compound preparations, which contain Western medicine ingredients and are prone to drug overdose
.
After "Yangkang", many patients are left with low-grade fever or cough, and are also prone to abuse of fever-reducing or cough medicines, which also pose a risk
of drug overdose.
Therefore, before the next wave of "yang", it is necessary to understand some types of headaches related to infections, coughs, nasal diseases, and drug overdoses, although rare, but perhaps also a warning
from this "common human experience".

Past Review

☑ Has the new crown pneumonia affected our hearing and vestibule?

☑ What has COVID done to our cerebrovascular?

☑ Coronavirus and headache: features, prognosis, and importance