In the article we will consider the classification of headache and its main clinical manifestations.
Among the most common pain syndromes observed in clinical practice, the main place is occupied by cephalalgia. A headache can be considered any pain and discomfort that is localized in the head, although some clinicians are limited to an area localized upward from the eyebrows to the back of the head. Cephalgia can be observed in more than 45 different pathologies. Therefore, the diagnosis and therapy of this pathological phenomenon is an interdisciplinary, general medical problem that deserves the attention of doctors of all speci alties.
What types of headaches are indicated in the ICD-10, we will describe below.
Pathogenesis
The pathogenesis of this symptom is not well understood. Cephalgia may be associated with irritation of the sensitive structures of this area from pressure, tension, displacement, inflammation and stretching. Along with vessels andnerves, some areas of the dura mater, venous sinuses with their tributaries, arteries at the base of the brain, large vessels, as well as sensory nerves passing through the skull, also have pain sensitivity. The brain tissue itself, soft membranes and small vessels do not have such sensitivity.
Headache classification is of interest to many.
Main reasons
Cephalgia may occur due to the following phenomena:
- development of spasm;
- traction or dilatation of arteries;
- displacement or traction of the sinuses;
- compression, inflammation or traction of indicated cranial nerves;
- spasms, inflammation or injuries of the tendons and muscles of the head and neck;
- irritation of the meninges and increased intracranial pressure.
The duration and severity of a headache attack, as well as its localization, can provide the necessary information for a correct diagnosis.
Classification
Let's give a classification of headache according to the mechanism of occurrence:
- migraine;
- tension headache;
- various types of cephalgia not associated with organic lesions;
- cluster pain and chronic paroxysmal hemicrania;
- pain due to head injuries;
- pain associated with vascular disorders;
- pain due to non-vascular disorders within the skull;
- pain associated with the use or withdrawal of certain chemicals;
- pain onbackground of infectious diseases;
- cephalgia associated with metabolic disorders;
- cephalgia or facial pain due to abnormalities of the skull, eyes, neck, nose, mouth, teeth, or other cranial or facial structures;
- neuropathy, cranial neuralgia and deafferentation pain;
- Unclassifiable cephalalgia.
The most common types in this classification of headache are two types: migraine - 39% and tension pain - 53%, as well as post-traumatic cephalgia.
Migraine
This pathological condition is characterized by the occurrence of a paroxysmal recurrent headache of a throbbing nature, usually on the one hand. It occurs in 2-7% of the population, most often in women from 10 to 35 years old.
In the pathogenesis of migraine (ICD-10 code code G43), hereditary impairment of vasomotor regulation of intra- and extracranial arteries is of great importance. During the attack, 4 stages of vasomotor disorders follow each other:
- spasm of retinal and intracerebral vessels;
- dilatation of extracerebral vessels;
- edema of the vascular walls;
- reverse development of these changes.
During the first phase, an aura may occur, during the second phase, pain in the head. In this case, there may be a violation of the metabolism of serotonin, as well as other biological substances (histamine, tyramine, prostaglandins, glutamate, etc.), and neurophysiological changes are considered a trigger for an attack.
According to the international classification of headpain, migraine is divided into 2 types: migraine with aura and without aura. The precursors of this condition may be syndromes of childhood: abdominal migraine accompanied by abdominal pain, paroxysmal dizziness, vomiting attacks, a tendency to motion sickness, alternating cuts of the limbs.
Simple migraine
Simple migraine (without aura) - unilateral throbbing cephalalgia. Most often, it does not cover the entire side of the head, but the parieto-occipital or fronto-temporal region. Sometimes it is bilateral or there is an alternation of the sides of the development of pain. The intensity of cephalalgia is moderate or pronounced, at the end of the attack the pain becomes dull. During an attack, there is general hyperesthesia, intolerance to strong sounds, light. For most people, the attack is accompanied by vomiting and nausea.
From 4 to 72 hours - this is, in this case, the duration of the headache.
Migraine with aura is also highlighted in the classification.
Migraine with aura
Neurological focal symptom preceding headache that occurs immediately after the symptom has ended or after a short interval. Most often, a visual aura occurs, which is manifested by blurred vision, atrial scotoma, zigzag lines of the visual field. It lasts up to 20 minutes, after which an attack of cephalalgia occurs. In second place in frequency is the aura in the form of paresthesia. Initially, it occurs in the finger of the hand, then it rises along the arm and can spread to the face, mouth. To the rareaura varieties include hemiparesis, ophthalmoparesis, motor aphasia. Migraine with aura in the form of a neurological disorder used to be called associated migraine. Very rarely, usually in older men, there is no headache after the aura, and then this phenomenon is called local ischemia.
We continue to consider the classification of headaches.
Tension Pain
This type of headache is the most common. It affects about 6% of the population. Its etiology is associated with autonomic dysfunction, hereditary factors, psychological characteristics (anxiety), depression, chronic stress (physical, psycho-emotional).
Tension headache in the classification takes the lead. ICD-10 code - G44.
In the pathogenesis of such pain, violations of the "gate control system" by Wall and Melzak (noci-anti-nociceptive system), biochemical, vascular, neurogenic factors are considered. Tension pain is a complex of pathological conditions ranging from minor episodic pain to daily bouts lasting all day. Allocate chronic and episodic tension cephalgia. A conditional boundary is established between these states: 180 or more days a year - in the chronic form and less than this - in the episodic form. The main factors here are sensitization of the posterior horn of the spinal cord, if the pain is chronic, and myofascial disorders in the pericranial muscles,which can be confirmed using the EMG method, however, such violations are not considered obligatory.
A type of tension pain can be psychogenic pain that is not accompanied by myofascial changes (tension pain without dysfunction of the pericranial muscles).
This pathological condition is perceived by patients as a squeezing of the head, a feeling of heaviness. Tension pain is localized most often in the forehead, calvaria, eyes, and in some cases may radiate to the temples, neck, shoulders. Such a headache is often accompanied by psycho-vegetative disorders: loss of appetite, difficulty in breathing, nausea, sleep disturbances, a feeling of "lump in the throat", increased fatigue (mental and physical), attention disorder.
Episodic tension pain is usually paroxysmal and can occur at different times of the day. The duration of the attack is from 30 minutes to 7 days. In this case, the patient constantly feels pain.
Unlike a migraine, the strength of such a headache is mild or moderate, the sensations are pressing (not pulsating), the location is bilateral, it does not increase with physical exertion. The pain of episodic tension is not accompanied by nausea, phonophobia, and at the time of an attack it practically does not impair a person’s ability to work.
In the classification of headaches in neurology, chronic pain is distinguished.
Chronic tension pain is similar to episodic in nature, but occurs dailyor more frequent attacks.
The absence of pathognomonic symptoms of tension pain, which distinguishes it from migraine, makes it difficult to diagnose. Almost half of the patients are diagnosed with symptomatic cephalgia associated with organic pathologies of the brain.
Tension headache can coexist with migraines. In about 10-50% of cases, chronic or episodic tension pain is noted in the interictal period. Often they are joined by a third form - abuza, which is associated with the abuse of medicinal substances that eliminate cephalalgia.
Cluster cephalgia is indicated in the international classification of headache.
Cluster cephalgia
This pain is also called bundle pain, Harris ciliary migraine neuralgia, Horton histamine cephalgia, etc. This type of pain combines several separated forms: ciliary neuralgia, migraine and pterygopalatine neuralgia. In the international classification, three forms of cluster pain are distinguished depending on the frequency of their occurrence: with indefinite frequency, chronic and episodic. Together with them, paroxysmal chronic hemicrania is also considered.
Not everyone knows what types of headaches are.
Cluster cephalgia (according to ICD-10 R51) is quite rare, men suffer from it several times more often than women, the onset of the disease is noted in 20-50 years. The etiopathogenesis of this type of headache is not known, however, scientists suggest that it is based on a violation of certain vascular mechanisms.
Beamcephalgia is characterized by attacks of sharp, excruciating one-sided pain in the head, repeated daily for a long period of time, followed by the same long pause. The intensity and duration of pain varies during the cluster period from mild and short to severe and prolonged sensations. Pain occurs quickly, without precursors, and is observed in the eye area, temples, in the periorbital zone, irradiation to the neck, ear, and arm is possible. The nature of such pain is boring, burning, and the strength is so great that it can even awaken sleeping patients. Initially, attacks develop at night, at the same time. During them, psychomotor agitation and pronounced vegetative disorders, redness and tearing of the eyes, swelling of the eyelids, nasal congestion are observed.
What other types of headaches are there?
Chronic paroxysmal hemicrania
This headache is a rare type of paroxysmal unilateral cephalgia, which is localized in the oculo-frontal-temporal region and has a pronounced intensity and boring character. Attacks last up to 30 minutes, are repeated many times a day and are accompanied by autonomic disorders of the eyes and nose. What distinguishes them from cluster chronic cephalalgia is that such pains predominate in women.
Neuralgia
Is another type of headache that affects people regardless of gender. The duration of the attacks - from a couple of seconds to several minutes, they are repeated withcertain intervals and are characterized by varying degrees of intensity (from moderate to strong). Causes neuralgia irritation of one of the nerves.
Injury related headache
In neurology, there is a tendency to cause chronic cephalgia with traumatic brain injuries. In the international classification, different types of headache are distinguished, namely, two types of post-traumatic cephalalgia: acute and chronic. And for each type, there are two more subspecies, taking into account the severity of the injury:
- significant, with neurological symptoms,
- minor, none.
Acute post-traumatic pain occurs at the time of injury or after a two-week period. The luminous gap requires examination to exclude subdural hematomas and other complications of trauma.
Chronic post-traumatic pain is characterized by the same symptoms, but lasts quite a long time. In the development of post-traumatic pain in the head, brain damage, a disorder of its integrative activity, psycho-vegetative dysfunction, psychological characteristics of the patient, psychogenic factors, and rental attitudes matter. Such a headache is the result of an interaction of psychosocial and organic factors that become important in mild injuries, while organic changes in severe ones.
Secondary headaches
They are caused by a whole host of different factors. So, such a pain in the head arises from-for:
- head and neck injuries;
- various infections;
- individual drug response;
- alcohol and drug use;
- concussion;
- brain tumors.
The article discusses the classification of headaches.
