Headache

HEADACHE, cephalalgia (from the Greek kephale-head and algos-pain), a very frequent symptom of the most diverse diseases of the nervous system and other organs. The best scheme (G. I. Rossolimo) divides all types of H. b. into the following genetic groups: I-mechanical and inflammatory; II-depending on the state of circulation; III-vasomotor; IV-hematogenous; V-reflex and VI-psychic. These groups in turn are subdivided according to etiological factors, from which the localization, character, onset and course of headache depend. I. Mechanical and inflammatory H. b.- 1. Tumors of the brain. H. b. is one of the most characteristic and constant symptoms of this condition, although individual cases without pain have been described in the literature. H. b. in brain tumors occurs due to local irritation of the membranes or increased intracranial pressure, the cause of which lies in the insufficient capacity of the skull that occurs with tumors. Localization of H. b. is varied: sometimes it is local (most often in the forehead and occipital regions), sometimes diffuse. In terms of quality of sensation, H. b. varies: it is described as cutting, shooting, tearing, boring, etc. The intensity is also varied-from the mildest degrees (more often at the beginning of the disease) to the most severe and unbearable. The onset of H. b. is gradual in most cases. The course is prolonged, sometimes with fluctuations. Temporary increase in pain depends on all those causes that further increase blood and intracranial pressure (coughing, sneezing, straining during defecation, excessive alcohol consumption, etc.). In rapidly growing malignant tumors (sarcoma, etc.), all phenomena proceed more violently. Under otherwise equal conditions, the course and intensity of H. b. depend on the natural capacity of the skull and on the nature of the work of the circulatory apparatus, mainly the speed of venous blood outflow. H. b. in tumors is often accompanied by a number of both general cerebral and focal symptoms (see Brain, tumors). H. b. in tumors hardly yields to ordinary therapy, and only removal of the tumor, if possible, can quickly stop it. - 2. Cysts, abscesses and parasites (cysticercus and echinococcus) of the brain. H. b. in these diseases is in many ways similar to the pain observed in tumors. Localization is varied, but most often of a local nature (forehead and occiput). Intensity depends on the method of formation and the more acute or more gradual onset of the disease, but usually the pain is less than in true tumors. The course of H. b. is prolonged or with fluctuations; sometimes the pain has a tendency to regress. This is understandable, since after the process is completed (formation of a cyst, abscess, echinococcal cyst), intracranial pressure can decrease significantly. Complete cessation of H. b. may occur spontaneously or as a result of surgical intervention. - 3. Inflammation of the brain and its membranes. H. b. in encephalitis and especially in meningitis depends partly on increased intracranial pressure, but also on toxic irritation of the roots of the trigeminal nerve. Localization of H. b. can be local (more often forehead and occiput) and diffuse. The intensity of H. b. varies depending on the process (in tuberculous meningitis, pain is sometimes not sharply expressed); subsequently, H. pain has an increasing character, and although remissions and exacerbations are observed, in the end its intensity is very great. The course is quite violent in most cases. Usually H. b. is accompanied by a number of both general cerebral and focal symptoms (see Meningitis, Encephalitis). Treatment should be directed at the underlying condition. - 4. Syphilis. H. b. in this disease can be general or local; usually its intensity is moderate, but in some cases it reaches the highest degrees. The onset of H. pain is slow and subacute, and the course is even, constant, accompanied by extremely characteristic nocturnal exacerbations. The outcome is most often gradual in connection with treatment. Headache can be caused by both local and general cerebral phenomena. Treatment is specific. -5. Lesion of sensory nerves. Localization of H. b. corresponds to the affected nerve (trigeminal, etc.). The character of H. b. is varied: there can be dull, pressing, constricting H. b.; in other cases-acute, cutting, boring, shooting. The intensity of pain is also different-from the mildest to very agonizing and severe. Onset and course-depending on the underlying process. Pain is often accompanied by vasomotor and secretory phenomena. Treatment is causal. II. H. b., depending on the state of circulation.-1. Arteriosclerosis. H. b. in arteriosclerosis usually has a dull, pressing character and has diffuse localization. Their intensity is low. Being a product of circulatory and nutritional disorders, H. b. in arteriosclerosis apparently also depends on the direct irritation of the dura mater by the degenerated vessel walls themselves. The onset of H. b. is usually gradual, the course is prolonged, with fluctuations corresponding to the state of circulation. Accompanying phenomena are almost never observed, or they manifest in the form of mild general and local cerebral symptoms. Treatment is causal (cerebral arteriosclerosis and its treatment; see Arteriosclerosis). -2. Active hyperemia. H. b. in active hyperemia usually has a general diffuse character, although sometimes it is concentrated mainly in the temporal regions. The causes of H. b. lie in the overfilling of the vascular system, which leads to a violation of hydrostatic equilibrium between the cerebrospinal fluid and blood. The intensity of pain is quite significant-the pain has a beating, pulsating character, begins quickly and is accompanied by noise in the ears, flickering before the eyes, dizziness, redness of the face, ears and conjunctiva, frequent pulse, pulsation of the carotid arteries, excitement, etc. The course is irregular, with fluctuations depending on all those causes that increase blood pressure. The outcome is rather rapid. Treatment should be directed at all those factors that contribute to the occurrence of active hyperemia. - 3. Passive hyperemia. H. b. in passive hyperemia depends on venous congestion. Pain is concentrated mainly in the occiput, sometimes in the forehead, and in individual cases has a general character. Pain is pressing, dull, aching, usually of moderate degree, but sometimes very severe. The onset is gradual, subacute, the course is prolonged, with intensification in the morning. Pain is accompanied by pallor of the face, blue circles around the eyes. Treatment is causal-of all those causes that contribute to passive hyperemia of the brain. III. Vasomotor H. b.- 1. Vasodilator hyperemia. H. b. in this form usually has a general, diffuse character, the degree of pain is moderate, the onset is acute, the course is prolonged, in attacks without periodicity. Pain is accompanied by various phenomena from the heart and circulatory system. It ends quite quickly in most cases. - 2. Angioneurosis of the cavities. Headache is usually localized in the occiput and is characterized by heaviness in it and pressure. It begins gradually and proceeds for a long time, with fluctuations, worsening from constipation and disorders in the sexual sphere. It ends slowly. It is caused by constipation, hemorrhoids and diseases of the sexual organs. -3. Meteorological influences sometimes cause general, rather weak H. pains, especially in patients with constitutional diseases of the nervous system (hysteria, neurasthenia). They usually begin subacutely, are characterized by mild attacks, sometimes accompanied by vasomotor and psychic phenomena and end quite quickly. -4. Migraine. In this disease, H. pains and the accompanying phenomena are so characteristic and distinctive that they are выделены in a special nosological unit (see Migraine). IV. Hematogenous H. pains.-1. Anemia, chlorosis. H. b. in these conditions is most often localized in the forehead, in the vertex, in the region of the eyes and in the temporal region and only rarely spreads to the entire head. The cause of H. b. lies in the violation of nutrition of the brain and decreased blood pressure. Pain usually has a dull, pressing character and rarely reaches a severe degree; its onset is gradual, the course is prolonged, with fluctuations, it intensifies with prolonged standing, fatigue and in the morning and decreases with the horizontal position of the body. It is accompanied by pallor of the face, dizziness, slow and weak pulse and tendency to fainting. The outcome is gradual. Treatment is general-of the underlying condition. -2. Poisonings, both acute and chronic, by the most diverse exogenous poisons (opium, belladonna, alcohol, tobacco, quinine, strychnine, caffeine, morphine, chloroform, ether, various metallic poisons, etc.) often cause H. b. H. pain is localized mainly in the frontal region, but in severe cases it can also spread to the entire head. H. b. is usually dull, pressing, but sometimes very acute and intense.

The onset, depending on the method of poisoning, is either acute or slow; the latter occurs with various chronic poisonings (in rubber and aniline factories, when working with mercury and lead, during prolonged treatment with iodine, Copay balsam, etc.). The course depends on the more rapid or slower elimination of the poison from the body. General cerebral phenomena often accompany headaches of a toxic nature. Treatment depends on the poisoning. 3. Autointoxications. Headaches in uremia, diabetes and other autointoxications are caused by the retention of poisonous substances in the blood. A dull, pressing pain is mainly localized in the frontal region. Its onset is usually slow and gradual, and the course is varied, continuing as long as the poison circulates in the blood. Treatment is exclusively causal. 4. Infectious diseases. The character of headaches in most cases is dull, with a preferred localization in the frontal region; in some diseases (typhus and relapsing fever, malaria, etc.) headaches reach exceptional intensity. The course is varied, depending on the course of the main affliction. The termination is gradual. Concomitant symptoms, both from the nervous system and from other organs, are extremely varied depending on the form of infection. Treatment is for the main disease. V. Reflex headaches.-1. Visual anomalies. Anomalies of refraction and accommodation and astigmatism quite often cause reflex headaches, localized in the infraorbital and frontal regions. The pains are dull in nature, intensify from fixation of vision and cease at night. They can end quite quickly with rest for the eyes and the prescription of appropriate glasses.-2. Diseases of the nose, both acute (coryza) and chronic (polyps, hypertrophy of turbinates, etc.), often cause headaches. The pains are dull in nature, with localization in the frontal region. The onset is subacute and gradual, and the course is long, with fluctuations, depending on the course of the process, from which the termination also depends: sometimes rapid, sometimes slower and gradual. Treatment is for the corresponding disease of the nasal cavity.-3. Diseases of the teeth-incisors (localization in the forehead), upper molars (localization in the temple), lower molars (localization behind the mastoid process). The intensity of pain varies greatly-from the mildest to unbearable degrees. The onset is varied; the course is long, often in attacks. The termination depends on the main cause, which is subject to treatment.-4. Diseases of the ear (tympanic region, middle ear and Eustachian tube) often give severe reflex headaches, which are in close dependence on the course and form of the process, from the treatment of which improvement can only be expected.- 5. Diseases of the throat (angina, adenoids, etc.) sometimes give headaches with localization behind the ear and in the temporal region. The intensity of pain varies, as does its onset. The course depends on the course of the process, from the cure of which the time of termination of the headache also depends. A more detailed topography of reflex headaches is established by Head (see Head's zones). VI. Psychic headaches.-1. Clavus hystericus is a special type of headache, usually limited to the vertex along the sagittal line or somewhere on one side, and patients compare this pain with the sensation of a nail driven into the head. In most cases, the pain is acute and burning, but sometimes it can be pressing, dull and aching. The onset is gradual, subacute, the course is long, sometimes in attacks. The termination is rapid. Various other symptoms of hysteria accompany the pains. Treatment is for the main affliction and symptomatic.- 2. Attacks of general hysterical headaches. Besides clavus hystericus, general diffuse headaches are also observed in hysteria, sometimes reaching unbearable degrees. Their onset and course (usually very violent) are often accompanied by general hysterical seizures and other manifestations of general hysteria, which is subject to treatment.- 3. In uncomplicated neurasthenia, headache is mainly localized in the vertex region. Headache begins gradually, in the form of heaviness (casca neurasthenicorum), pressure and aching, especially in the morning. Its course is long and even. The accompanying symptoms are those of neurasthenia, which should be treated first. In some cases, the origin of headache is complex and cannot be classified into one group. An example is alcohol poisoning, in which headache depends not only on hematogenous intoxication but also to a large extent on circulatory disorders, which is why this headache can be attributed not only to group IV but also to group VI. Other cases of headache with unclear etiology are difficult to classify. Here there is probably an endogenous constitutional hereditary predisposition.