Headaches: Types. Diagnostics. Treatment.
From time to time, almost every person, both young and old, experiences headaches. According to experts, up to 15% of the population experience headaches quite often. Headache can be chronic, sometimes debilitating, which can significantly reduce the quality of life (affect the ability to work, relationships with loved ones, etc.).
Although, in most cases, it is possible to find out the true cause of the headache, errors often occur when determining the genesis. The fact that it is obvious that the headache is real and existing treatment methods help, if not to control, then at least to reduce it. The key to solving the headache problem is science.
Headaches are the main symptom of the primary disease and have no other etiology. Pain and other symptoms caused by headache are not the result of another disease of the body. The main types of primary headache include:
Headaches occur as a symptom of another pathological condition. There are more than 300 organic causes accompanied by headache (tumors, infections, injuries, hypertension, etc.) Some of the most common types of secondary headache are:
If migraine is much more common in women, men are more prone to cluster headaches. The term "cluster" is used to describe paroxysmal short, one-sided attacks of headache. These attacks can occur many times during the day, sometimes lasting for weeks and then suddenly disappear for a period of time.
Cluster headaches can be similar to migraines and be just as intense. In fact, patients with severe headaches sometimes even have suicidal ideas. Without proper diagnosis and treatment, headaches can bother for years. Provoking factors may be substances that cause the expansion of cerebral vessels (alcoholic beverages, nitroglycerin, etc.).
According to the International Headache Society (IHS), there are two types of cluster headaches: episodic and chronic (about 10%).
Episodic cluster headaches - in patients with episodic cluster pains, exacerbations lasting from one day to several months alternate with periods of remission varying in duration (from a month to a year).
Chronic cluster pain - characterized by the absence of remission for one year. Often episodic KB smoothly turn into chronic and vice versa.
Cluster pains are more common in men than in women (in a ratio of 7/1).
Cluster pains can occur at any age, but usually, they begin at the age of 20 to 40.
The exact causes of cluster headaches are not fully understood. Nevertheless, excessive activity of the hypothalamus and triggers of the "trigeminal-vegetative reflex" was detected. The manifestation of this reflex complex is sweating in the forehead, tearfulness, redness of the eyes, stuffiness in the nose and throat on the side of the headache.
Hypothalamus. Many researchers believe that during a cluster headache, an area of the brain called the hypothalamus is activated. The hypothalamus is responsible for controlling such bodily functions as hunger and thirst, sleep and wakefulness, and sexual instincts. It also acts on the autonomic nervous system like a light switch (turning it on and off). During a cluster headache, the hypothalamus triggers certain processes that lead to headaches and vegetative manifestations.
Headaches are the vegetative nervous system.The autonomic nervous system performs adaptive and protective functions. It helps the body to be prepared for stress, fear and pain. It also returns the body to its original state. During cluster pains, vegetative manifestations are on the side of pain. But this is not a normal reaction of the autonomic nervous system. Medical scientists continue to investigate the reasons that the hypothalamus activates vegetatics.
Trigeminal nerve.The trigeminal nerve is responsible for sensitivity (sense of touch, pain, thermoreception), and movement of the muscles of the face, mouth and front of the head. This nerve is divided into three main branches. The upper part of the nerve is the orbital. It provides sensitivity in the eye, in the forehead, scalp and the front of the nose. During an attack of cluster headache, a person has pain in the face and head and vegetative disorders in the area of innervation of the orbital branch of the trigeminal nerve.
Substances that provoke headaches.Some substances that have the ability to dilate blood vessels can provoke cluster pain during exacerbation. For example, drinking alcoholic beverages (wine, beer, strong alcoholic beverages) or smoking can cause an attack of headaches. Nitroglycerin and histamine can also trigger an attack. But these substances do not cause seizures during remission.
Typical manifestations of a cluster headache attack:
The intensity of the pain is very pronounced - the pain can be acute, burning, pulsating or constant.
Most headaches occur only on one side of the head. Pain can be localized in the following areas: inside and around the eye, in half of the head or face.
Seizures, as a rule, occur on the same side. The frequency of seizures can reach up to 8 times a day and the average duration of an attack is from 15 minutes to 3 hours.
Most cluster headache attacks last from 15 minutes to three hours. Taking medications shortens the duration of pain attacks.
Periodicity - Although typical cluster headache attacks occur without a prodrome, nevertheless, it is noted that they occur more often at the same time of day and have a certain seasonality. Some patients feel anxious before an attack of pain.
If you have a headache, you need to consult a doctor in order to make an accurate diagnosis. A doctor's consultation is also necessary in cases where there have been changes against the background of the prescribed treatment.
The main questions of interest to the doctor:
- Is this the first time a headache has appeared?
- If the pain has happened repeatedly, what has changed in the nature of the pain in the localization or additional symptoms have appeared?
The doctor will conduct a physical examination and check the neurological status. If necessary, the doctor will prescribe an examination (blood tests, CT, MRI). Based on the examination data, the doctor will be able to diagnose and prescribe treatment.
Methods for the complete cure of cluster headaches do not yet exist. But if you do not engage in treatment, cluster headaches significantly worsen the quality of life. In most cases, seizures are controlled by taking medications and by excluding provoking factors. But in some cases, medications are ineffective, and it is necessary to resort to minimally invasive methods of treatment (blockades or peripheral nerve stimulation).
Due to the severe intensity of pain, doctors adhere to active treatment tactics. The main treatment strategy is a combination of preventive therapy and abortive.
Treatment depends on the type (episodic or chronic) and sensitivity to certain drugs.
As soon as the pain begins, it can become very intense within a few minutes and, therefore, it is necessary to take measures to quickly minimize the pain.
Abortive drugs should be fast-acting and they should be prescribed immediately after the onset of a painful attack. They help to shorten the duration and intensity of the attack (abort the attack). Drugs can be prescribed in the form of a spray, injection or tablet under the tongue. The following drugs are most often used:
Oxygen - Inhaling pure oxygen through a mask helps relieve headaches, especially if the attack occurs at night. In addition, oxygen causes narrowing of blood vessels in the brain.
Lidocaine - This local anesthetic is used in the form of a spray or drops. It is introduced in the position of the head thrown back and turned in the direction opposite to the painful side. Lidocaine is injected into the nostril on the side of the headache.
Fast - acting opioids - help block the perception of pain (for example, stadol in the form of a spray or fentanyl under the tongue). The use of opiates is severely limited due to possible rapid addiction.
Ergotamines - help relieve pain by narrowing the vessels of the brain. Ergotamines are contraindicated during pregnancy and lactation.
Triptans (5-HT1 receptor agonists) are sometimes also prescribed to relieve pain (they, like ergotamines, constrict blood vessels). But their application should be individual. They should not be prescribed in the presence of coronary heart disease or other heart diseases.
Conventional NSAIDs (indomethacin, ibuprofen) ointment (Zotrix) are also used to relieve seizures.
If abortive drugs are prescribed directly during an attack, then the task of preventive drug therapy is to prevent the appearance of pain attacks and shorten exacerbations.
Verapamil is a drug from the group of calcium channel antagonists (used in cardiology for the treatment of hypertension angina pectoris). It turned out that this drug is very effective for the prevention of cluster pain and is the drug of choice.
Steroids - in tablets can be used for a short time in order to shorten the period of exacerbation of cluster pain. Steroids should be used no more than once a year to avoid serious side effects. In addition, the effect of steroids is not stable.
Lithium preparations are sometimes used in preventive treatment. But they have a lot of side effects and require careful monitoring of the function of the hematopoietic organs and urinary system.
Anticonvulsants. Initially , they were used to treat epilepsy . But drugs such as Neurontin and Topamax are also used to treat cluster headaches.