Description headaches
Headache is a very common symptom of many often systemic (whole body) disease. His presence not only annoy the patient, but also cause mental status changes (depression, apathy, aggressiveness, etc.).
Headaches can be divided into primary and secondary, and called. Cranial neuralgia. Primary(idiopathic) pain is not a manifestation of some other disease and its cause is often not fully understood. Secondary (symptomatic) pain are symptoms of the disease not only in the head.Cranial neuralgia is pain associated with waveforms cranial nerves.
Primary headaches
Category: diseases of the central nervous system
Migraine
Field: Neurology
Migraine is the most primary headache. Its incidence in Europe is about 18% for women and 5% respectively. Usually it comes in adolescence, but also occurs in children. It repetitive seizure disorder. A seizure is preceded by warning symptoms (prodromal), irritability and hypersensitivity.After prodromes can follow so. Aura. According to its presence distinguishes migraine with aura and migraine without aura. Aura is called a set of accompanying symptoms caused by altered brain activity, which usually disappear within an hour from their inception. During the actual migraine seizures appear vibrant, mostly one-sided pain (hemicrania). Parties in the individual bouts subject to change and at the maximum seizure can spread to the whole head. Duration of seizure is from several hours to several days. If the seizure lasts longer than three days, refers to this as the status migrenosus.
Typical for the disease is the family history (genetic predisposition). The cause of the seizure is probably excessive activity of cells in the brainstem, which cause erroneous core activity of the fifth cranial nerve and local vasodilation (widening of blood vessels). Some migraines may be associated with stress, allergies or with the menstrual cycle.
The preventive medication is usually taken when the seizure frequency of about 3-4 per month.These include drugs of categories antidepressants, antiepileptics, β-blockers, calcium channel blockers, serotonin antagonists and inhibitors of prostaglandin.
From the symptoms of the disease are the most important unilateral chronic (recurring) pain. The pains are very intense and are accompanied by the urge to vomit (nausea) to vomiting, sensitivity to sound (phonophobia) and light (photophobia). Aura with migraine with aura is not the same as an epileptic. Symptoms of migraine auras are sensitive (temporary unilateral numbness-hypoesthesia, unilateral tingling-hemiparestézie), visual (flashes, flashing outages visual field), motor (unilateral paresis-hemiparesis or unilateral complete loss of momentum-hemiplegia), speech disorders , oculomotor disturbances. In basilar migraine (a special type of migraine, where symptoms are similar to those with disabilities and cerebral arteries. Basilar artery) can be dizziness, double vision (diplopia), sometimes loss of consciousness.
Migraine treatment can be divided into acute attack treatment and preventive medication. In the treatment of seizure medication used category of analgesics, antiemetics, NSAIDs. Causal (cause) treatment of migraine headache medications are the category Triptans. Preventive medications for migraine prevention, see.
When dealing with bouts of sleep helps compress the arteries (around the head scarf), a cold compress, stay in the dark and silence and especially sleep.
Complication of migraine is called. Transformed migraine. It is caused by long-term overuse of analgesics. The brain absorbs less pain management. Earlier subliminal (low intensity) stimuli are evaluated as painful.
Symptoms: pain, hemicrania, nausea, vomiting, phonophobia, photophobia
Examination: history, neurological examination
Tension headache (tension headache)
Study: Neurology, Psychiatry
This is the most common headache. A distinction is episodic form (pain lasting one to several days), a form of chronic pain (lasting more weeks). It affects about 20% of the population in developed countries. It occurs most often in puberty, peak incidence is in the working age and old age incidence is decreasing. Rarely can occur even in childhood. Frequent is the family history. It may be associated with migraines and even transient variations between tension headache and migraine.
The most prominent risk factors are stressful situations, most often at work, family, school.Susceptible people are neurotic, people with depression or high physical or mental stress. Queuing factor also can be a voltage neck and head muscles.
The prevention is important lifestyle change. The patient should try to avoid stressful situations, incorporate into a daily exercise program and relaxation techniques.
The main symptom is a dull ache at most moderate, mostly reversible. Not present vomiting. Typical localization of pain in the back and temples.
The most important treatment is psychotherapy. Of the drugs is inappropriate use of analgesics.They are used NSAIDs, antidepressants, anxiolytics.
From self-help therapies are the most important lifestyle change, practicing relaxation techniques and regular exercise.
Complications of tension-type headache is the transition from episodic to chronic form. It is often accompanied by excessive use of analgesics and the emergence of a headache from overuse of analgesics (Drug-induced headache).
Symptoms: headache
Examination: history, neurological, psychiatric,
cluster headache
Field: Neurology
This disease does not have a Czech name. It occurs about 10 times less than a migraine and it affects mostly middle-aged men. It is typical for severe unilateral pain seizure in orbit (of the eye). Bouts last for one to three hours and are clustered in a few days or weeks. These time periods are seizures are called clusters. The time course is also the most valuable diagnostic clue.
Symptoms are stunningly sharp pain with typical time course and orbital localization. Furthermore, the present watery eyes, red conjunctiva (conjunctival injection), runny nose, nasal congestion, perspiration on the forehead and cheeks, swollen eyelid (eyelid edema). Form bouts of alternating periods of calm (episodic form) can go in the chronic form, where seizures alternating with periods lasting pain less intense in orbit.
As pharmacological prevention of seizures may be used Prednisone or Carbamazepine. Resistant forms are treated with lithium. However, it is necessary to monitor the levels of lithium in blood. To treat an acute attack is used short-term inhalation of 100% oxygen. Of the drugs triptans and prednisone.
Symptoms: headache in orbit, conjunctival injection, tearing, runny nose, nasal congestion, sweating, eyelid edema
Examination: history, neurologic
Chronic paroxysmal hemicrania
Field: Neurology
The disease is similar to cluster headache. It is rare and primarily affects women. Typical is a shorter bouts that are repeated several times a day. Diagnostically and therapeutically served Indomethacin.
Symptoms: headache in orbit
Examination: history, neurologic
Headaches from medication overuse
Drug-induced headache, drug rebound headache, chronic daily headache, transformed migraine
Field: Neurology, Psychiatry
Pain occurs as a complication of other primary headaches. It is caused by frequent (daily) use most often analgesics, or ergot medicines. Secure borders using analgesics that would definitely protect before this complication can not be clearly determined. For migraine occurs in about 60%, with tension-type headache in about 30%. The essence of this pain is a change of control of the management of pain in the brain, induced by the use of analgesics. Earlier subliminal (low intensity) stimuli are evaluated as painful. The time required to produce pain depends on the amount and type of used analgesics. It indicates that occurs with conventional analgesics after ten years, with combined may arise after year.
Risk factors are neurotic personality, depression, stress (most often at work, family, school), menopause, use of analgesics.
Prevention is taking analgesics as possible. Relatively safe limit is expressed about 5 tablets per month.
The symptom is chronic pain less intense. After some time passes in daily pain. At this stage already disappears seizures original disease.
When treatment is necessary to complete withdrawal of overused medication. After overcoming withdrawal symptoms after about two days, it is necessary to correctly diagnose the initial painful disease and deploy the right treatment. Up to 50% of patients with reoccurring overuse medications and recurrence.
Symptoms: headache
Examination: history, neurological, psychiatric,
Other primary headaches
Idiopathic stabbing headache, pain in the external compression, cold-induced pain, pain when coughing, sore from exertion, pain associated with sexual activity.
Secondary headache
Pain from this group have a different character, localization, inducing stimuli and duration.
post-traumatic pain
Field: Neurology, Traumatology
Pain after a head injury. Can appear next to acute pain and chronic pain.
Investigations: CT brain
Pain associated with cerebrovascular disease
Field: Neurology, Neurosurgery
These include cerebrovascular disease (ischemia – ischaemia, haemorrhage – bleeding).
Everything belongs to life-threatening conditions.
Examination: brain CT angiography
Pain associated with intracranial disorders
Field: Neurology, Neurosurgery
This is the most severe group of headaches. Most causes of pain in this category are the life-threatening conditions. These include the syndrome of intracranial hypertension (increased intracranial pressure). In this case it is necessary to think and to tumor involvement in the brain.Another cause of pain is inflammation of the meninges (meningitis).
Examination: brain CT, magnetic resonance (MR), lumbar puncture
Headache associated with high blood pressure (hypertension)
Field: Internal Medicine, Cardiology
Treatment is to reduce blood pressure, lifestyle changes, relaxation.
Pain associated with infections outside the head
Field: Interna
Examples include the flu, infectious feverish states.
The pain caused by chemical substances or their omission
Field: Neurology, Psychiatry
Period of pain from overuse of drugs. These behaviors include alcohol.
Pain associated with metabolic disorders
Field: Interna
These include headaches after dialysis, diabetes, lack of oxygen, etc.
Pain associated with disease of the skull, neck, eye, teeth, sinusitis
Field: Internal Medicine, ENT, Ophthalmology, Dentistry, Rehabilitation
Treatment, there is always the elimination of the underlying cause of pain. It also includes known. Cervicocranial syndrome. It is a headache that they cause in the cervical spine. They have a great influence psychological factors, the burden of cervical spine, cervical spine affection.
Symptom is pain in the nape and temples, sometimes dizziness. The uncertain diagnosis is necessary to exclude another cause pain, especially intracranial hemorrhage.
cranial neuralgia
Location and nature of the pain depends on the course of sensory fibers (fiber-sensory stimuli result in pain, pressure, temperature, etc.) cranial nerves.
Trigeminal neuralgia (neuralgia V cranial nerve, trigeminal neuralgia)
Field: Neurology, neurosurgeon
A distinction is a form of primary and secondary. With primary neuralgia is up to 90% of the oppressed tribe trigeminal nerve, blood vessel (often a.cerebelli superior) and a so called. Neurovascular conflict. It occurs in the working age and old age.
The symptom is a few seconds-long bout of intense pain in the area innervated by the second and third branches of the trigeminal nerve (the area of the eye, jaw and cheek). Seizures are repeated up to several times per day. You can find so called. Trigger zone, which is a district of the oral mucosa or the skin in the area innervated, whose irritation is induced seizure. The stimulus may be a touch or even just the wind, talking. Seizure manifests itself as a painful contraction of facial muscles so. Painful tic. Patients have problems with eating, washing and adding thereby to the disease and the social and psychological problems.
Pharmacological therapy is used carbamazepine, gabapentin, hydantoins, neuroleptics, antidepressants. If medications do not help, you can go for neurosurgical treatment, in which the tribe nerve and blood vessel inserted Teflon plate (microvascular decompression). It is also possible surgery using gamma-knife (stereotactic radiosurgery). Previously widely used method using glycerin (glycerol rhizotomy retrogasserská) has been used less.
Secondary trigeminal nerve arises during stimulation by other disease processes. The most common post-herpetic neuralgia (after suffering shingles) neuralgia in sinusitis, neuralgia caused by diseases of the oral cavity (teeth, temporomandibular joint involvement).
In secondary neuralgia does not trigger zone is not painful tic, may be affected by all three branches of the trigeminal nerve. Pain is more durable and less paroxysmal character.
In therapy, the most important finding and eliminating the underlying cause neuritis.
Rarer neuralgia: glossopharyngeal neuralgia, neuralgia ganglia geniculata, occipital neuralgia
All these neuralgia have similar symptoms and therapy as trigeminal neuralgia. They vary according to the localization of pain during the relevant nerves.
Symptoms: headache, hemicrania, nausea, vomiting, phonophobia, photophobia, orbital pain, dizziness
Examination: history, CT, magnetic resonance (MR), lumbar puncture, neurological, internal, mental, dental, eye, ENT examination
Other names: Migraine, headache, headache, tension headache, tension headache, cluster headache, chronic paroxysmal hemicrania, headache from overuse of drugs, Drug-induced headache, Drug rebound headache, chronic daily headaches, transformed migraine, Cervikok
