1. In addition to the skull, arachnoid membrane, pia mater, choroidal plexus, and brain tissue, most head and face structures are pain-sensitive tissues.

2. Possible mechanisms of headache: ① Dilation, contraction, and spasm of intracranial blood vessels; ② Inflammation, traction, and displacement of painful tissues; ③ Continuous muscle contraction and tension; ④ Damage/inflammation of pain transmission pathways; ⑤ Eyes, ears, nose, and throat, etc. Inflammation of organs and spread of tumor diseases; ⑥ Mental factors

Pay attention to the differential diagnosis of primary headache and secondary headache:

The possibility of organic disease must be highly suspected when the following conditions exist: ① Severe headache for the first time; ② There is a history of headache in the past but the nature of this headache is different from before; ③ Subacute disease, the headache is persistent and lasts for several days or more. Does not relieve and worsens within weeks or months; ④ Headache accompanied by fever and vomiting, which cannot be explained by systemic diseases; ⑤ Headache accompanied by transient changes in consciousness/speech; ⑥ Headache accompanied by neurological signs (such as papilledema) , subvitreous hemorrhage, neck stiffness, pathological signs)

internal cause

external factors

Features

Classification

Migraine without aura

Migraine headache with typical aura

chronic migraine

1. Cluster headache/histamine headache: more common in men; headache occurs suddenly, without aura, almost at the same time every day ("alarm clock type headache", common in sleeping); located in one Sharp, explosive (rather than pulsating) pain in the periorbital, retrobulbar, and temporal regions; lasting from 15 minutes to 3 hours; attacks are often accompanied by ipsilateral facial autonomic nervous system symptoms (such as conjunctival congestion, tearing, Runny nose, Horner syndrome) but rarely nausea and vomiting; episodes can last weeks to months (clusters)

2. Tension-type headache (TTH)/muscle contraction headache: more common in women aged 20 to 40 years old; it is the most common chronic headache in clinical practice; there is no precursor manifestation/aura, the location is not fixed, and it is often persistent bilateral Dull side pain, non-pulsating but with a tight feeling, pressure, and heaviness around the head; may be accompanied by dizziness, vertigo, tinnitus, insomnia, anxiety, and depression, but rarely nausea and vomiting, photophobia/phonophobia, and pale complexion , the headache is not aggravated by physical activity; physical examination can reveal muscle tenderness/tenderness points in the painful area, and stiffness in the neck and shoulder muscles; daily life/work is mostly unaffected during the headache; some patients may also have migraine symptoms

3. Medication overuse headache (MOH)/drug-induced headache: Most people have a history of chronic headaches and have long-term use of acute medications to treat headaches; primary headaches are the most common in migraine patients; headaches can occur almost every day, but the original Change in headache characteristics with other side effects of the drug; headache resolves/returns to original headache pattern within 2 months of drug discontinuation

4. Low-cranial pressure headache: The headache is more common in the bilateral occipital/frontal area (rarely unilateral), and presents as mild to moderate dull/pulsating pain; the headache is obviously related to the posture (occurs when standing/ Aggravated, reduced/disappeared when lying down) and appears within 15 to 30 minutes after changing positions; may be accompanied by posterior neck pain/stiffness, nausea and vomiting, photophobia, tinnitus, and vertigo; the optic nerve, trigeminal nerve, and facial nerve may still appear Performance of compression; cerebrospinal fluid pressure <70mmH2O; including postdural/lumbar puncture headache, cerebrospinal fluid leakage headache, and spontaneous hypotensive headache

5.Hunt syndrome/painful ophthalmoplegia: paroxysmal retrobulbar/periorbital intractable pain, accompanied by oculomotor/trochlear/abducent nerve palsy; MRI/biopsy shows cavernous sinus/superior orbital fissure/intraorbital granulomatosis Lesions; may resolve spontaneously after a few weeks but are prone to relapse; glucocorticoids are effective

6. Symptomatic migraine: secondary to certain diseases, but without obvious migraine attack process; often with focal neurological deficit/irritation symptoms, and positive findings on imaging

non-pharmacological treatment

medical treatement