Attention to the treatment of headache

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About the author:Wei Shepeng, male, born in December 1970, doctor of medicine, deputy chief physician, director of Department of neurosurger


About the author:

Wei Shepeng, male, born in December 1970, doctor of medicine, deputy chief physician, director of Department of neurosurgery.

July 1995 graduated from Shandong Medical University, bachelor degree; graduated from Capital Medical University in July 2000 Tiantan Department of Neurosurgery, received a master's degree in science; Fudan University in July 2004 graduated from the Huashan Hospital Department of Neurosurgery, received a doctorate in science. Zhao Jizong has studied Chinese Academy of Sciences Academician, Professor Zhou Fanmin Huashan Hospital Department of Neurosurgery, a complete system has undergone six years of micro Department of neurosurgery to witness the essence of China training, the two major north-south Department of Neurosurgery center, has been committed to exploring the advantages of Tiantan and Huashan in fusion.

In the Department of Neurosurgery clinical practice for more than 20 years, the specific situation is good at treatment guidelines and patients from the UpToDate clinical evidence-based medicine database of the latest combination to provide the most suitable for their own treatment programs for patients.

Specializes in the treatment of headache, dizziness, epilepsy, brain glioma and brain metastasis of minimally invasive surgical treatment, as well as sleep health and long-term care of brain health.

Recent epidemiological studies found that headache medicine is one of the most common complaint. According to the latest guidelines, headache can be divided into two categories: primary and secondary. The former refers to the specific cause of headache unknown, also known as benign headache; the latter is the cause of finger pain due to obvious structural or systemic abnormalities.

All primary headache close to 90% was finally classified in a few subtypes: This includes migraine, tension headache and cluster headache and chronic daily headache.

In a population based study, tension headache was the most common type of headache. The annual incidence of tension headache was 65%, but most of these patients did not go to the hospital.

Migraine is the most common headache diagnosis clinicians can admissions to the. Study from Brazil found that migraine is one of the most popular primary headache, accounting for about 45% of the patients with headache as the only complaint.

Cluster headache often leads to serious loss of labor, most of these patients would come to the hospital. However, this type of headache is not common, the general population, the incidence of less than 1%.

Clinical manifestation and diagnosis of 1 headache

The history is an important diagnostic tool for evaluation of headache, the initial judge patient's headache is the primary or secondary potential causes of headache? If it is a primary headache, which may be a subtype of primary headache.

The following features (SNOOP) indicates that the patient headache is a potentially severe acute or subacute secondary headache manifestations:

• - (Systemic); systemic symptoms, disease or condition (such as fever, weight loss, pregnancy, impaired immune function).

• - (Neurologic); nervous system symptoms or abnormal signs (such as confusion, alertness impaired, papilledema, focal neurological symptoms or signs, pseudomeningitis or seizures)

• - headache (Onset) recently appeared (especially in patients aged over 40 years) or a sudden (such as a bolt from the blue)

• - (other); other relevant features (such as head trauma, illicit drug use or drug abuse, sleep wake up by pain and shortness of breath after severe headache, cough, or force or sexual life can aggravate headache)

• - (Previous); previous history of headache headache showed progressive or seizure frequency, severity or clinical features appeared to change

Any of the above findings is subject to further examination, including head MRI or CT.

The patient demographics, comorbidities and headache characteristics difference, can help determine the appropriate diagnosis and treatment.

The lightning headache (Thunderclap headache) may be a precursor of subarachnoid hemorrhage and other potential malignant etiology

The characteristics of lack of history - similar to a headache headache that is another serious disease.

The chronic daily headache is a syndrome, including many primary and secondary headaches.

The older patients are more likely to have the risk of secondary headache (such as giant cell arteritis, acute herpes zoster and postherpetic neuralgia and brain tumors) and some types of primary headache (sleep, headache, cough, headache and migraine accompaniment).

- any more than 20 weeks of pregnancy in pregnant women with preeclampsia headache must be excluded.

- accompanied by fever headache may be caused by intracranial and systemic or local infection and other factors caused

In addition, the headache is often a sequelae of mild traumatic brain injury.

2 headache treatment

2.1 treatment of primary headache

The treatment of intractable intractable migraine can be treated by microsurgical decompression and the effective rate is 90%.

2.2 treatment of secondary headache

The tumor is headache - recently, progressive, accompanied by vomiting, deep in the morning, diffuse, hard after aggravating headache. After the resection of the tumor, the intracranial pressure was relieved, and the headache disappeared. The surgical technique can reduce the mortality of operation in 3% cases, so the safety is improved greatly.

The hydrocephalus headache -- a headache slow onset, patients with cognitive impairment or dementia, walking instability such as the duck, many patients with mental changes. Three ventriculostomy, ventriculoperitoneal shunt or ventricle shunt after new can effectively relieve headache.

Such sudden headache occurred, such as lightning, headache - Spider blood. Accompanied by nausea and vomiting. Head CT can be clearly diagnosed, giving oxygen, 30 degree elevation of the bed, metoclopramide 20mg intravenous injection, the maintenance of the film can effectively alleviate the headache.

The trigeminal neuralgia - known as the king of pain. Can be caused by tumor compression, such as cholesteatoma. However, most of them are caused by compression of the trigeminal nerve by the anterior inferior cerebellar artery or superior petrosal vein. It is a good way to cure trigeminal neuralgia by inserting the nylon spacer into the trigeminal nerve and the blood vessel under the posterior straight incision.

The occipital neuralgia mostly occipital nerve vascular compression caused local inflammation after. Local closure or microvascular decompression can cure this headache.

The headache after traumatic brain injury according to the location and nature of the headache, pain drug and neurotrophic drugs combined with the nerve combing local treatment of surgical treatment when necessary.

- after cerebral hemorrhage headache -- such a headache suddenly appeared, accompanied by vomiting spray. It is usually accompanied by obvious focal neurological deficits, such as hemiplegia. Minimally invasive surgery, the soft channel is placed in the hematoma cavity, urokinase local perfusion therapy can be very good to alleviate headache, drainage hematoma.

Chronic subdural hematoma - headache - such a mean age of 64 years, with trauma history a slight headache, often accompanied by deep, hidden, walking instability, hemiplegia, mental impairment and personality change. Under local anesthesia forehead drilling, hematoma drainage surgery can cure such a one-time headache.

The cervical headache - the essence of cervicogenic headache is from the neck joint referred pain. The upper part of the three cervical spinal nerves and their branches are the main structures of the peripheral nerves involved in pain. Local anesthetic block neck structure and its nerve branch can effectively determine the diagnosis after the effective relief of headache. Dissection of the carotid artery or vertebral artery is an important reason for the identification of acute cervical headache. We recommend physiotherapy as initial treatment. For patients with C2-3 - or C3-4 - facet joints, and the pain has been confirmed by a diagnostic block, radiofrequency ablation of the third occipital nerve often relieves this type of headache. For those who do not wish to receive radiofrequency therapy, we recommend the use of intra-articular corticosteroids.

The meningitis headache -- such headache accompanied by fever, anorexia, lethargy and stiff neck. Cerebrospinal fluid routine test and culture can often be diagnosed. The use of intracerebroventricular or intrathecal dexamethasone can relieve fever and headache, intracerebroventricular or intrathecal injection of vancomycin, imipenem or can quickly cure the disease meningitis and ventriculitis.

Divided into acute and chronic headache headache headache - after radiotherapy. The former occurs during radiotherapy, and the latter occurs for months or years after radiotherapy. Corticosteroids can be used to alleviate this kind of headache.

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