Headache

Author: Cai Shutao (Editor) / Country:
Publisher:
Publish Date: 2005-04-01
Features: When diagnosing tension-type headache, it is also necessary to pay attention to whether the following causative or exacerbating factors are present, such as temporomandibular joint dysfunction, psychosocial stress, anxiety, depression, delusion, muscle tension (occupational postural, prolonged muscle contraction, etc.), excessive medication for tension-type or coexisting migraine, or if the original tension-type headache has worsened or coexists due to new headache classifications (5th to 11th) of diseases. Tension-type headache is not synonymous with contractive headache. Modern research, including electromyography monitoring, has found that both episodic and chronic tension-type headaches can be divided into two subtypes with and without muscle contraction: ① Tension-type headache with cranial peripheral muscle disorders, also known as muscle contraction headache, with at least one of the following positive findings for diagnosis: tenderness or pressure pain in the cranial peripheral muscles detected by palpation or a pressure-type algometer, or elevated electromyographic activity levels in the cranial peripheral muscles at rest or during physiological tests. ② Tension-type headache without cranial peripheral muscle disorders, where both of the above tests are normal, is referred to as tension-type headache without cranial peripheral muscle disorders, equivalent to cryptogenic headache, simple headache, or psychogenic headache, and cannot be called muscle contraction headache. Although the above tests have not yet established objective and uniform quantitative normal values, the judgment of positivity is based on the examiner's experience, but it is not more subjective than other sensory disturbances in neurologic examinations. Combining electromyography and using a blind method for the observer can improve objectivity. Using such subtyping diagnostic criteria helps avoid confusion in the diagnosis of tension-type headache and muscle contraction headache. (III) Cluster Headache and Chronic Paroxysmal Headache These are two headache disorders with unknown etiology and pathogenesis. They are grouped together because they share the following common features: ① Both headaches are unilateral; ② Severe pain intensity; ③ Same pain location; ④ Accompanied by autonomic symptoms; ⑤ Similar attack phase and course. However, there are also differences sufficient to distinguish them into two subtypes, such as gender differences, attack frequency and duration, diurnal variation (cluster headache is often worse at night), and different responses to medication (indomethacin is highly effective in treating and preventing chronic paroxysmal unilateral headache). Therefore, the following different diagnostic criteria are established. 1. Cluster Headache According to the new headache classification, it is uniformly named cluster headache. The diagnostic criteria are: ① At least five attacks; ② Severe unilateral orbital, supraorbital, and/or temporal pain lasting 15 to 180 minutes without treatment; ③ At least one of the following signs on the same side as the headache, such as conjunctival injection, tearing, nasal congestion, rhinorrhea, ptosis, eyelid edema, forehead and facial sweating, and miosis; ④ Attack frequency ranging from once every other day to several times a day, often with fixed attack times. Attacks can last from weeks to months, with completely normal intervals between attacks; ⑤ Exclusion of neurologic organic lesions. Cluster headache typically begins in people aged 20 to 40, with men being 5 to 6 times more affected than women. Those who meet the above headache attack characteristics can be diagnosed. If the attacks meet the diagnostic criteria but the course is insufficient to determine, it is called atypical cluster headache. If there are two or more cluster attacks without treatment, with a cluster period from 1 week to 1 year and an interval of more than 2 weeks between attacks, it is called episodic cluster headache (about 10% of patients). Most patients have intermittent recurrences, with no headaches during remission, which can last for months or years. Headaches may occur in the same season spontaneously. They can also be triggered by alcohol, histamine, or nitroglycerin. The attack cycle, frequency, and severity can vary in the same patient, and it can also transition from episodic to chronic. 2. Chronic Paroxysmal Unilateral Headache The diagnostic criteria are: ① At least 50 typical headache attacks; ② Severe, unilateral orbital, supraorbital, and/or temporal pain attacks lasting 2 to 45 minutes each; ③ Attack frequency of more than 5 times per day for most of the time; ④ At least one of the following signs on the same side as the pain, such as conjunctival injection, tearing, nasal congestion, rhinorrhea, ptosis, or eyelid edema; ⑤ Effective treatment with indomethacin (150 mg or less per day); ⑥ Meeting the same diagnostic requirements as migraine, excluding intracranial organic diseases. This type of headache often begins in adults, with women being significantly more affected. Nausea and vomiting are rare during attacks. Most attacks last 5 to 20 minutes, with a frequency as high as 30 attacks per 24 hours. Although the attacks are typical but not enough in number, or the number of attacks is sufficient but does not meet the diagnostic criteria for cluster headache or chronic paroxysmal unilateral headache, it is called cluster-like headache. In summary, cluster headache and its subtypes, chronic paroxysmal unilateral headache, migraine without aura, and episodic tension-type headache each have diagnostic criteria but are easily confused, can coexist, and should be carefully differentiated. (IV) Headache Without Structural Lesions The above three major types of headache disorders have not been found to have structural (or organic) etiologies. Clinically, some other headache disorders without structural lesions can also be seen. 1. Primary Stimulant Headache Pain is localized to the head, completely or mainly in the area supplied by the trigeminal nerve branches (orbit, temporal, top). The nature of the pain is single or