Headache (cephalgia): causes, diagnosis and treatment

Causes

Why does my head hurt? Common causes of headaches are:

• neck muscle spasm;
• compression of the vessels of the head and neck;
• compression of the membranes of the brain;
• brain nutritional disorders: insufficient blood supply, narrowing of blood vessels supplying the brain;
• smoking, poisoning with alcohol, drugs, medications;
• stress, sleep disturbance;
• due to neck and head injuries;
• birth injuries;
• anomalies in the development of blood vessels in the neck and head.

Headache on the right side - diagnostic methods

It is important to determine the exact cause of the headache on the right side. This is impossible at home, so it is better to consult a doctor at the first alarming symptoms. The Clinical Institute of the Brain has developed general and individual programs for diagnosing headaches on the right side of the head, as a result of which it is possible to differentiate between strokes, neoplasms, infectious and chronic diseases, as well as analyze herbal disorders.

If the right side of the head hurts, the following examination methods may be required:

• X-ray of the cervical spine;
• Dopplerography - ultrasound diagnostics of the vessels of the head, which will allow you to assess the degree of blood supply to the nerve tissues;
• encephalography - studies of the electrical potential of individual areas of the brain;
• Magnetic resonance and computed tomography are one of the most informative methods for detecting tumors, cysts, areas of necrosis and other abnormalities in brain tissue;
• laboratory blood tests to determine infectious diseases.

Based on the diagnostic results, treatment is prescribed. The course is selected separately for each patient and will be most effective if the exact cause of pain and disorders caused by the underlying disease are determined. If painful sensations in the area of ​​the right side of the head, neck, forehead occur once and do not recur, a full examination is not necessary. It is enough to monitor your health on your own and consult a doctor if the attack recurs.

Primary headaches

1.What is facial pain and classification of prosopalgia?

Facial pain

(“prosopalgia” from the Greek prosopon - face and algos - pain) - refers to a number of symptoms that cause diagnostic difficulties. The surface of the face and its internal structures have many nerve endings and nodes, and pain in them can be associated with the face itself or other organs and parts of the body.

Since the face contains organs related to several body systems, several medical specialists can study and treat facial pain (ENT, ophthalmologist, neurologist, surgeon, dentist). Facial pain can be part of some syndromes, the symptom complex of which affects not only the facial areas. Facial pain can be unilateral or symmetrical.

According to its genesis, facial pain can be classified into the following groups:

• neuralgic pain (somatalgia);
• pain caused by vascular disorders, for example, migraine (sympathalgia);
• muscle pain;
• soreness of the facial bones;
• skin pain;
• osteochondrotic pain;
• pain of inflammatory origin;
• traumatic and post-traumatic pain.

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Secondary

Secondary headaches can be a sign of other diseases. Most often it is caused by the following diseases:

Causes of pain in the face and head

Headaches that radiate to the face can have different origins. In some cases it is primary (migraine, cluster pain, tension headache), in others it is one of the symptoms of diseases of the nervous system, musculoskeletal system, heart and blood vessels. It is important to take into account the exact localization of painful sensations, their nature and intensity, and the conditions of occurrence.

Trigeminal neuralgia

The trigeminal nerve is a paired nerve and represents the fifth pair of cranial nerves. In the temporal region it is divided into 3 main branches: the ophthalmic, maxillary and mandibular nerves. They provide facial skin sensitivity, motor activity of the facial and masticatory muscles. When the trigeminal nerve becomes inflamed or damaged, an acute headache begins, which spreads along the nerve fibers. It is so intense that during the period of exacerbation of trigeminal neuralgia, patients cannot touch their face, eat food, turn or tilt their head.

The cause of neuralgia is inflammation of the nerve or its mechanical damage. There are also several factors that can contribute to the development of acute pain:

• viral respiratory diseases, as well as herpes virus infection;
• neoplasms in the cerebellopontine region of the brain;
• dental diseases, including stomatitis, periodontitis and others;
• acute purulent inflammation of the paranasal sinuses (sinusitis);
• atherosclerosis is a disease in which arterial blood flow deteriorates and the supply of oxygen to brain tissue decreases;
• bruises, injuries in the facial area, which are accompanied by damage to nerve fibers.

Headache with trigeminal neuralgia can spread to any part of the face. It is sharp, throbbing, and can be confused with pain caused by dental problems. In some patients, the disease is chronic and worsens at regular intervals. More often this happens in the winter and in the off-season - inflammatory reactions are caused by a sharp drop in temperature and the effect of a viral infection. During an attack, additional symptoms are also felt: increased lacrimation in response to bright lighting, cold weather and decreased sensitivity of the facial skin, involuntary contractions of the facial and masticatory muscles.

In most cases, treatment of trigeminal neuralgia is carried out with medication. The doctor prescribes antibiotics, antiviral and anti-inflammatory drugs. To make you feel better, you will need painkillers. Some patients require surgery to destroy the trigeminal nerve root or remove pathological formations that exert mechanical pressure on the nerve. Physiotherapy is also useful as treatment and rehabilitation.

Cluster pain

Main article: Cluster headaches

Cluster headaches are the least common type. They are characterized by a very high degree of intensity and do not have an exact cause. An attack consists of a series of pain sensations in the area of ​​​​the projection of the brain onto the human skull. It is so acute that the person cannot continue to carry out daily tasks during this time, and conventional over-the-counter analgesics are ineffective.

Cluster headaches have several features:

• first appears in adulthood, most often from 20 to 30 years;
• has no warning symptoms, begins abruptly, at any time of the day;
• extends only to one half of the head;
• accompanied by deterioration of vision, constriction of the pupil, increased heart rate, redness of the skin;
• the period lasts from several days to several months - during this time the patient experiences on average 1-3 headache attacks per day, often at the same time.

Cluster pain is more common in women . There is no hereditary predisposition, since the disease in most cases is found in only one family member. After the end of the exacerbation period, a long-term remission is observed. It can last up to 3 years, during which the pain does not bother the patient. A seasonal course of the disease is also possible if it appears only at certain times of the year.

Migraine

Main article: Chronic migraine

Migraine is one of the types of primary headaches. It is often one-sided and affects only one half of the head. Painful sensations can be of varying degrees of intensity, but most often acute. The exact cause of migraine is unknown. It often develops in response to factors such as changes in weather and atmospheric pressure, stress and emotional tension, intense physical activity, disruption of the daily routine, as well as smoking and frequent alcohol consumption, poor diet, and hormonal changes.

Migraine is a one-sided headache. There are several theories of its origin - doctors explain its appearance by vascular, nervous, and hormonal disorders. Migraine can occur in different ways, but the classic form includes several stages:

1. The initial stage is prodromal. It begins a few days before a headache attack. During this period, a person’s mood often changes, irritability and fatigue appear, concentration and performance deteriorate. This symptom complex does not occur in all patients, but its appearance accurately indicates the onset of migraine.
2. Aura (Main article: Migraine with aura) is the period several hours before an acute headache. It is typical for migraine, but also does not necessarily occur. Its cause is considered to be spasmodic contraction of brain vessels and deterioration of its blood supply. The aura is manifested by increased sensitivity to sunlight, the appearance of bright circles and dark spots before the eyes, as well as hearing impairment and severe fatigue.
3. The immediate attack of headache lasts several hours, but in some patients it may not stop for up to several days. It is acute, one-sided, and intensifies in the presence of external stimuli (bright light, loud sounds). Painful sensations are concentrated in one half of the head and can spread to the face and neck. Symptoms such as lacrimation, nausea and vomiting, and dizziness are also typical.
4. Resolution stage – lasts 1–2 days. Some patients feel better immediately after the headache ends, but resolution may be slow. Symptoms include weakness, decreased alertness, and increased sensitivity to bright lights and loud noises.

According to statistics, migraines are more common in middle-aged women. To treat it, a set of medications is prescribed that help reduce pain and shorten its duration. If attacks occur frequently and do not stop for 3–5 days or more, hospital treatment may be necessary. The procedures are aimed at preventing complications: dehydration, cerebral edema, seizures, heart attack and stroke.

Somatogenic facial pain

Pain in the face and head can be somatogenic (secondary), that is, associated with diseases of other organs and systems. They are less intense than cluster pain, migraine and facial neuralgia, but also affect performance and can cause complications. Common causes of pain in the face are dental diseases, inflammation of the paranasal sinuses, and ophthalmological problems.

1. Toothache – often spreads to the scalp, skin, muscles and nerves of the face. It is often associated with inflammatory processes and dental caries. Symptoms such as pain in the jaw joints, pain when chewing, or eating cold or hot food and drinks also occur. To make you feel better, consultation with a dentist, medication, and, if necessary, surgery are recommended.
2. Joint pain is another type of somatogenic pain. They are often triggered by arthritis or arthrosis of the temporomandibular joint, its deformation or injury. In addition, soreness may be a sign of a malocclusion, tooth loss, or discomfort when wearing dentures.
3. Inflammation of the paranasal sinuses is a group of dangerous diseases. The sinuses (sinuses) are cavities formed by the bones of the skull. Normally, they are empty, filled with air and necessary for proper breathing. Their inflammation is accompanied by the appearance of aseptic or purulent contents, an increase in body temperature, a sharp deterioration in health and nasal congestion. The most common type of sinusitis is sinusitis. It develops as a result of hypothermia, the proliferation of a viral, bacterial or fungal infection, head injuries and bruises.
4. Eye diseases also cause headaches. When diagnosing pain, glaucoma may be detected - increased intraocular pressure. This is a dangerous condition that requires immediate treatment. Increased pressure causes compression of blood vessels and nerves, and over time can lead to poor vision and even complete blindness.

If a patient complains of pain in the face and head, a comprehensive examination is prescribed. The scheme will include general diagnostics, as well as consultations with specialized specialists: ophthalmologist, otolaryngologist, dentist and others.

Other reasons

Soreness is a symptom of a number of disorders that do not necessarily indicate dangerous diseases. Headaches can occur periodically in a healthy person, and then go away on their own or after taking painkillers. Doctors identify a number of reasons that can cause deterioration in health:

• stress, nervous tension;
• sleep disturbances caused by insomnia, moving to regions with a different time zone, irregular schedules, or working at night;
• poor nutrition, an abundance of fatty foods, flour products, spices and sweets in the diet;
• intense physical activity;
• sudden changes in weather, temperature or atmospheric pressure;
• hormonal changes.

Doctors recommend calling for a full examination if headaches continue for several days or more. Also dangerous are acute pains that affect performance and are accompanied by additional symptoms: nausea, vomiting, impaired coordination of movement, and memory impairment.

When you can't put off visiting a doctor

1. For an acute headache that suddenly arose and resembles “a blow to the head.” This may be a symptom of subarachnoid hemorrhage. Call an ambulance immediately.
2. The pain intensifies when lying down and goes away half an hour after getting out of bed. This is a sign of impaired outflow of cerebrospinal fluid, increased intracranial pressure, and a tumor.
3. If the headache appears regularly, is intense, is associated with changes in body position and changes with movement.

3.Treats for facial pain

When your face hurts, you should not self-medicate until you see a doctor. Even taking painkillers should be postponed, although most often after an examination the doctor prescribes something for the symptomatic treatment of pain. The fact is that the picture and nature of pain are an important diagnostic criterion, so a blurry picture of facial pain will complicate the examination and making a correct diagnosis.

If during the diagnosis it is possible to determine the cause of facial pain, then treatment of the causative disease is prescribed, and, as a rule, the pain goes away when a therapeutic effect is achieved. This does not exclude the use of painkillers at the beginning of treatment, since prosopalgia can be quite painful and lead to disturbances in sleep and performance.

Treatment of atypical pain that does not have a specific cause includes the drugs carbamazepine, finlepsin, mazetol

and others used for trigeminal neuralgia.
In addition, a psychological examination is indicated, identifying the triggers for pain, and psychocorrection sessions. Physiotherapy can also be a good addition

• magnetic and laser therapy;
• electrophoresis with analgin and lidase;
• electrosleep;
• treatment with diadynamic currents;
• hydrocarbon treatment.

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Treatment

Now that we have figured out the difference between a lipoma and an atheroma, let’s move on to the next question: is it necessary to remove the lipoma or remove the atheroma? Let's start with the fact that conservative treatment of lipoma, as well as treatment of atheroma, is absolutely futile. Moreover, aggressive influence on these formations using various “folk” remedies can cause suppuration of atheroma, as well as malignancy (malignancy) of lipoma.

Tactical approaches to the treatment of lipoma are as follows: if the lipoma is small (2-3 cm), does not grow and does not cause any inconvenience (does not rub against clothes, is not a cosmetic defect, etc.), then it does not need to be removed. In case of growth (especially rapid growth), it is better to go for surgery. If the lipoma grows, then sooner or later you will still have to remove it, but it is better to do this while it is small in order to avoid large incisions and traumatic intervention. Any removed lipoma should be sent for histological (under a microscope) examination.

As for atheroma, it is recommended to remove it in any case, because practice shows that sooner or later they fester, and during surgery against the background of inflammation it is not always possible to completely remove the atheroma capsule, which is fraught with relapse (reappearance of the formation). In addition, when suppuration occurs, the wound is almost never sutured; it heals by secondary intention, which often leads to the formation of a rough scar. If, after removing the atheroma, it turns out that the formation does not have a capsule and does not contain atheromatous masses, it should be sent for histological examination to exclude dermatosarcoma, which is sometimes similar in appearance to atheroma.