Primary headache: causes, nature, methods of treatment

Perhaps there is no such person who at least once would not have had a headache.Usually, when it appears, we take a "magic" pill and the pain subsides until the next time.And in fact sometimes it can testify about serious infringement in nervous system to treat which it is necessary and at all usual, far not harmless анальгетиками.

Table of contents: Types of headache Migraine Headache of tension Abuse headache Cluster headache Headaches as the cause of other diseases

Types of headache

Most of the diseases doctors primarily divide according to an important criterion for diagnosis: is it an independent unitOr was the result of another disease.Headache( GB, cephalalgia) is no exception.There are primary and secondary headaches .Each of these groups has its own "representatives":

1. Primary GB:
   1. a) migraine;B) tension headache;
   2. c) cluster headache and other cephalgia associated with the trigeminal nerve.

1. Secondary headaches associated with:
   1. a) head trauma;B) vascular lesions of the head and cervical spine;C) with non-vascular lesions of the head;D) with the reception or cancellation of various substances;E) with infections;
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   2. f) with mental illnesses, etc.

Obviously, depending on the type of cephalalgia, its nature will differ, as will the methods of combating it.

Migraine

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This is perhaps the most famous type of headache.Suffer it from 10 to 25% of women and 4-10% of men.The pain in this case occurs as an attack and is often located only on one side of the head.It is noteworthy that the side of pain may change from an attack to an attack.Moreover, if a person always has a headache only to the right or only to the left, then this is most likely not a migraine, but an intracerebral problem( tumor, cyst, etc.).The pain is most often either pulsating or pressing, begins at one point and quickly seizes the half of the head, most strongly felt in the temple, forehead, around the eye.The duration of the attack varies from 3 hours to 3 days.

Some patients feel precursors a few hours before the pain attack - a drop in mood, weakness, impaired concentration, increased sensitivity to light, sound and odor irritants.This is called a prolong, which some confuse with the aura that also precedes the attack. The aura is usually purely neurological in nature and looks like the appearance of visual phenomena in the form:

• "flies" and light flashes before the eyes;
• loss of fields of vision;
• by the appearance of a glowing zigzag in front of the eyes, etc.

Sometimes the aura appears as a sensation of shivering in the limbs, speech disturbance, sometimes the person distorts the size and shape of familiar objects.Unlike the prodrome, the aura occurs shortly before the attack and completely disappears with the onset of pain.Simultaneously with a migraine headache, the patient experiences nausea, smell, sound and photophobia, and a decrease in appetite.Relatively often there is vomiting, dizziness, fainting.Daily physical activity increases pain, making them intolerable. The main signs of migraine:

• a strong pulsating headache on one side only;
• typical additional symptoms in the form of photophobia, nausea, intolerance to sharp odors and loud sounds;
• strengthening of pain from everyday physical activity;
• presence of provoking factors;
• severe disability;
• presence of aura;
• poor headache response to conventional analgesics;
• the presence of migraine in blood relatives.

Most often, a painful attack does not occur "on level ground," but after exposure to various provoking factors.Usually they become stress, menstruation, hormonal contraceptives, weather changes, hunger, physical overstrain.In addition, there are a number of products that can cause a migraine attack: alcohol, chocolate, citrus, some cheeses, products containing yeast.Finally, external factors also play a role in migraine development: staying in a stuffy room, noise, bright light or flashes of it( strobe effect).

Treatment of migraine. In the treatment of migraines, it is important not only to eliminate the already existing attack, but also to prevent subsequent ones.And if the first task is usually not very difficult to handle, then the second can be a real problem.Causing an existing attack is carried out using non-narcotic analgesics, often in combination with codeine.For very intense pain, prescribe drugs that inhibit the activity of serotonin - imigran, eletriptan, etc. This is the "gold standard" for treating migraine, but taking triptans should be under the strict control of the treating doctor because of a rather serious spectrum of contraindications and side effects. Preventive treatment of migraine includes diet therapy( excluding products that contribute to the onset of an attack) and taking drugs from several pharmaceutical groups:

• beta blockers - metoprolol, propranolol;
• calcium channel blockers - diltiazem, verapamil;
• antidepressants - amitriptyline, fluoxetine;
• vasodilating and antioxidant agents - nootropil, Cavinton.

In cases of migraine caused by the emotional-psychological state of the patient, psychotherapy is most effective.

Tension headache

This form of cephalalgia is the most frequent.In different periods of life, it affects from 30 to 78% of people.Pain very rarely affects only one side of the head, it feels like squeezing or squeezing the skull( patients describe it roughly as follows: "as if someone is trying to crush the head"), the intensity is mild or moderate.Strengthening from physical exertion is not available, nausea with it does not happen, but sometimes there is light and phobia.A painful attack can last from a few minutes to a day or more.

The main cause of tension headaches is psychoemotional stress.Indirect proof of this is the disappearance of the headache or a decrease in its intensity, if the patient begins to experience positive emotions or simply distracted from their feelings. The second reason is the so-called postural stress - long-term stay of the head in one position, for example, when working with a computer( especially with a laptop) or driving in a car as a driver.This situation causes a spasm of several muscles, which by a complex mechanism and cause a headache.The insidiousness of this type of headache is that people, without eliminating its causes, suppress it with analgesics, and with time they use pain medication more often.As a result, tablets not only cease to function, but they themselves start to cause headaches.This phenomenon is called "abusus headache" and is a separate disease, which will be discussed below.

Treatment of tension headaches. Since the primary cause of GB stress is most often psychoemotional stress and the depressive state that provoked it, antidepressants are on the first place in terms of its treatment.The second reason - muscle tension - is treated with muscle relaxants.In addition, under careful medical supervision, conventional non-steroidal analgesics are used, and not always those that are familiar to us.For example, none of the neuropathologists will prescribe a citramone from a headache, and it is they who are "indulged" by almost every second woman.

Among the non-pharmacological methods an important place is occupied by:

• psychological relaxation;
• Behavioral Therapy;
• acupuncture;
• massage of the collar zone and general;
• manual therapy.

Impressive successes can be boasted by psychotherapy, which allows eliminating the main provoking factor of tension headaches - psychoemotional stress.

Abuse headache

Otherwise, this type of GB is called drug or ricochet.It usually occurs in people who have been suffering from GB tension and migraine for a long time and are taking a lot of pain medication on this matter.In such patients, the head starts to ache right from the moment of awakening and hurts all day, changing its intensity, but not disappearing completely.Reception of tablets usually does not eliminate it completely and has a rather short effect.In the diagnosis of abusum GB it is important to know how long and how often the patient took the pill and what exactly the drugs used.In addition, the doctor must know the dosage of analgesics used to get rid of the headache.

Treatment. The simplest method of treating Abusus - the complete rejection of the "guilty" drug - often runs into full rejection of it to the sick.The average patient can not understand how the pills designed to eliminate pain can provoke this very pain.Here, the doctor is required first of all to convey to the patient the mechanism of development of his pains, so that it is easier for him to accept the abolition of the "favorite" medicine.Parallel to this, antidepressant therapy, amitriptyline, is performed, after which improvement is observed in almost 75% of patients.Treatment of a drug abusus is usually performed on an outpatient basis, although in some cases it is necessary to hospitalize a patient for detoxification.

Cluster headache

This type of headache is associated with the inclusion of a complex reflex mechanism that transfers excitation from the trigeminal nerve to the blood vessels of the brain.The cephalgia is extremely intense, localized in the temples or around the eyes, lasts 15-180 minutes and occurs at a different frequency, from once every two days to 8 times a day.Sometimes it can take half a head.During an attack, there are almost always a runny nose, reddening of the eyes, lacrimation, lowering of the eyelids, narrowing of the pupils, sweating of the forehead. One of the symptoms of a cluster headache is its peculiar course.Seizures occur in series, one after another - such a course of headaches is typical for this type of theirs.After a series of painful attacks, there comes a remission - a relatively long period( months), when there are no headaches.Lead to the attack may change the diurnal rhythm, which the patient is accustomed to, when moving to another time zone, night or daily working schedule, etc. During the exacerbation, alcohol, histamine-containing foods and nitroglycerin can also cause another pain attack.During remission, no provoking factors are capable of causing an attack.

Treatment. As the cluster headache develops along a mechanism similar to migraine, the attack is likened similarly, using drugs from the group of triptans.A good effect gives oxygen therapy and the introduction of a nose spray with lidocaine.

Headaches as the cause of other diseases

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Secondary headaches are just a symptom of one of the diseases affecting the nervous system:

• head trauma;
• increased intracranial pressure;
• infections, including intracranial;
• osteochondrosis of the spine in its cervical region;
• arterial hypertension;
• circulatory disorders of the brain structures;
• of brain tumors, etc.

The amazing variety of species, localizations and features of this symptom in dozens of diseases does not allow describing them within the framework of one article, but it should be remembered that any headache is a signal of the body thatSomething is wrong with him.And taking regular tablets "from the head" is the same as sealing the patient's mouth with a patch of the mouth to stop the patient from moaning.The headache must be treated, and no one will do it better than a doctor.

Bozbey Gennadiy, medical reviewer, ambulance doctor.