Headache worse in an upright position. Vascular headache

   Published: February 10, 2013 Created: February 10, 2013

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Headache

Why does my head hurt?

In our body, all processes are aimed at preserving and continuing life. Outside of our conscious control, complex biophysical and biochemical processes take place that ensure dynamic balance, that is, homeostasis and adequate contact with the external environment. Pain is one of the protective mechanisms. As well as temperature, allergies, vomiting, diarrhea, etc. Being able to read body signals is the wisdom of being healthy.   Headache   - this is a signal, this is a cry for help.

The symptoms, causes and consequences of a headache will help us to understand. neurologistcandidate of Medical Sciences, Leading Specialist of the Insight Medical Family Medicine Clinic Anna Slynko .

- Anna Alekseevna, tell our readers what a headache is - a symptom or illness?

One of the most common neurological symptoms is a headache. About 45% of the adult population has ever suffered from an intense headache. A headache can be among the symptoms of almost the majority of neurological diseases, where it can be a leading symptom, as well as a concomitant or one of the many symptoms. But almost always it is a consequence of various diseases, that is, the disease is primary. Headache is secondary, this is its symptom. Migraine, tension headache and cluster headache are considered by many to be primary headaches, this issue is also debatable, since the nature of these diseases has not been fully studied.

So what is meant by a headache? What hurts?

The brain does not hurt. But they are rich in pain receptors in the lining of the brain, mucous membrane in the sinuses of the skull, blood vessels, venous sinuses, muscles of the scalp of the skull, cranial nerves, and other structures. Signals of irritation of these receptors enter the brain, and we feel a headache. Headache is considered to be any discomfort above the eyebrows and to the cervical-occipital region. Accordingly, all organs located in this zone are responsible for a headache: blood vessels, nerves, ear structures, eyes, sinuses of the skull, temporomandibular joint, etc.

Can a doctor immediately diagnose the cause of a headache and what disease is it characteristic of?

After listening carefully to the patient, the cause of the headache can often be assumed. The head hurts in different ways. Already by the nature of the headache, its location, intensity, duration of the disease, concomitant symptoms, we can presumably tell in the structure of which disease there is a headache. Since the causes of headaches can be very different. From feeling sick, lack of sleep, anxiety, depression to headache with a tumor, inflammation of the brain or its shells, abscess, stroke, diseases of the eyes, ear, teeth, and just with the flu, etc.

What are the most common causes of headache that patients come to you for? What symptoms are there?

Vascular headacheoccurs with excessive stretching of blood vessels with a pulse volume of blood or excessive blood overflow of blood vessels with hypotension, sometimes with an increased tone of arteries, increased blood viscosity. It is characterized by a pulsating, pressing headache, it can decrease with compression of the adducting artery. If the venous outflow is difficult and the intracranial venous system is full, complaints usually occur about bursting, dull pain, often in the back of the head, after sleep, and physical exertion.

More often, vascular headache is characteristic of hypertension, hypotension, heart disease, atherosclerosis, etc.

Neuralgic headache   - This pain is often piercing, tearing, cutting, paroxysmal, “like a current beating” it often gives off to other areas, some movements or areas on the skin, when touched, can provoke an attack. Here, nerves often suffer, there may be trigeminal nerve, occipital, etc.

Headache with an infectious toxic factor.As a rule, a headache spilled, pressing, comes in combination with general infectious symptoms, where there are signs of intoxication, weakness, fever, sensitivity to sound, light, arthralgia, myalgia and other specific symptoms.

Headache with changes in intracranial pressure -this pain at elevated pressure has a bursting, pressing character, depends on the position of the body, may intensify with sneezing, coughing, straining, morning vomiting may occur with subsequent relief. This is always an imbalance in the amount and circulation of cerebrospinal fluid, the volume of tissue inside the skull. This situation occurs with meningitis, hemorrhage, brain tumors, etc. With a hypotensive headache in an upright position, it intensifies, lying down decreases, also increases with every step, shaking of the head. This may be a consequence of trauma, an inflammatory disease of the meninges.

Also exists medicinal headache. It is known that some drugs (nitroglycerin, dipyridamole, alpha-blockers, etc.) cause a headache, and as a result of canceling the constant intake of indomethacin and other anti-inflammatory drugs, codeine, caffeine, etc., a headache may occur.

And what is migraine and what is it fraught with for patients? Who is more prone to migraine?

About 70% of patients are women. Genetic inheritance of migraine has been noted. The disease is based on the characteristics of the response of cerebral vessels to fluctuations in the level of biologically active substances in the body, mainly serotonin, as well as sensitivity to meteorological factors. Onset is usually in adolescence. Frequency on average about 1-2 times a month. With age, the intensity of headaches decreases.

Unilateral headache in 60% of cases. Three phases are distinguished.

1. Stage of Harbingers. There may be visual and sensory disturbances, in 35% of cases the aura (sparkling flashes, dots, etc.) before the pain phase. Migraine without aura is called simple migraine.
2. Pain phase. A pulsating, intense headache is characteristic in the temporo-oculo-frontal region, which can be replaced by a dull and bursting, pain limits the ability to work. However, bilateral localization is also possible. May be: anorexia, nausea, vomiting, mood swings. Hypersensitivity to sounds, light.
3. Post-attack malaise, weakness, a state of "hangover". Headache may intensify after exercise.

A severe headache cannot be tolerated. If the patient suffers from migraine, it is better to begin treatment at the precursor stage. The treatment regimen is selected by the doctor. In any case, it is necessary to consult a specialist - a neurologist, since there may be a completely different pathology behind the migraine mask and against the background of migraine status (an intense migraine attack lasting more than 72 hours), ischemic stroke may develop.

What is the most common type of headache?

The most common type of headache is a tension headache, from which both men and women suffer equally. This is a monotonous, medium-intensity headache, accompanied by a feeling of tightening, constricting, squeezing. More often - the pain is diffuse throughout the head or in the frontoparietal or cervical-occipital region. Exercise does not aggravate a headache. Hippocrates called this headache "a helmet of a neurasthenic." It can be episodic and chronic. A tension headache is often secondary against the background of a primary disease of neurosis, depression, masked depression, in the structure of psychopathy, psychosomatic disorder.

The pathogenesis of tension headache is not fully understood. It can occur as a result of tension in the muscles of the skull, some attribute it to a type of migraine. Of course, the main provoking factor is psycho-emotional, it is not in vain that foreign colleagues include antidepressants and sedatives in the standard of treatment.

Of course, combinations of pathogenetic mechanisms are possible - then the mixed genesis of headache is discussed. In addition, a “typical” headache may be the result of a very serious situation, which manifests itself completely “not typical”. Therefore, a qualified doctor can understand the causes of a headache. Here a diagnostic algorithm is needed. Firstly, to exclude somatic diseases: general clinical laboratory tests, EEG, ultrasound, consultation of a therapist, cardiologist, endocrinologist, etc. Secondly, to exclude diseases of the ENT organs, eyes, dentist consultation. Third, consult a neurologist, if necessary, a neuropsychiatrist. Fourth, MRI ( magnetic resonance imaging) head (CT), TKDG ( transcranial dopplerography) vessels of the head and neck.

What are the factors that trigger a headache?

These factors are more characteristic of migraine and tension headache:

1. violation of the usual daily routine, night wakefulness, inferior sleep;
2. physical and mental overwork;
3. chronic stress, recent stress (in a state of "post-stress relaxation" headache more often occurs;
4. abuse of psychotropic drugs: alcohol, smoking, strong coffee, tea, and others;
5. prolonged use of certain drugs, contraceptives, hypotensive sleeping pills, painkillers, etc .;
6. irregular eating and eating certain foods: foods with a high content of tyramine (cheese, red wine); products containing monosodium glutamate, nitrates (smoked meat, fish); pickled, pickled products.

When should I see a doctor immediately?

First of all, when an intense headache started suddenly. When there is an increase, increase in frequency, a modification of the nature of headaches in a patient suffering from periodic headaches. Also, when a headache is accompanied by a change in consciousness (stunning, drowsiness, agitation, etc.), a sudden rise in blood pressure, fever, convulsive attacks, impaired vision, hearing, taste, speech, face symmetry, numbness or weakness in the arm or leg, face . People after 50 years with the appearance of a headache or a change in its nature also need to see a doctor.

Vascular appearance

It occurs when the tone of the vessels of the brain is impaired. It is characterized by dull, bruising, throbbing pain, accompanied by darkening in the eyes, a feeling of heaviness in the head and a flicker of "goose bumps".

Liquorodynamic view

Typical symptoms of cerebrospinal fluid headaches are confusion, bursting, a feeling of pressure "outside-inside", a sharp increase in intensity when lying down, while walking, when coughing and turning the head.

They are distinguished by the sensation of a “head-hoop”, excessive sensitivity to bright light and loud noises, irritability and tearfulness. Observed with:

Causes of headache while lying down

Often, when visiting a neurologist, patients, when asked in what position the pain intensifies, respond that the head hurts more when I lie down. Based on a combination of headache with other symptoms, the doctor makes an appropriate diagnosis and explains why the headache (cephalgia) worries the patient.

1 What diseases may be indicated by the presence of cephalgia?

Not always people are in a hurry to diagnose the disease due to various reasons. So why when a person is lying down, his headache intensifies?

Before you guess about the disease and make yourself a non-existent diagnosis, headaches should be learned to distinguish. A pulsating type headache is characteristic of vascular diseases. Most often, it is experienced by patients with vegetovascular dystonia, in whom it is bilateral. Unilateral headache is characteristic of migraine. This disease does not go away for a long time and increases with bright light, strong noise and other irritating factors. If a person has a headache worse when lying down and his face swells, then he may have venous cephalalgia.

Other causes of persistent headaches:

• protrusion of the intervertebral discs, scoliosis;
• intracranial hypertension or hypotension;
• a tumor in the base of the skull;
• brain tumors;
• other neurosurgical ailments;
• gynecological diseases;
• neurological ailments;
• diseases of the cardiovascular system;
• lack of vitamins or oxygen;
• fatigue;
• neurosis;
• improper sleeping or working posture;
• too hard or too high a pillow.

In fact, in addition to the above list of reasons for which the headache can be chronic, there are much more provocative factors. Diseases of the kidneys, liver, eyes, ears, smoking, harmful work and other factors can always cause chronic headaches.

2 How liquor behavior affects a person’s condition

When a person visits a treating neurologist or a neurosurgeon, the doctor usually asks when the pain is unbearable: when you lie down or when you are upright. In some cases, the patient reports that with such headaches he is better off lying, then he begins to feel much better. Provided that this condition is caused by cerebrospinal fluid, most likely the patient suffers from intracranial hypotension. If the headache is aggravated in a supine position, then in this case there is a pressure of cerebrospinal fluid on the walls of the skull, i.e. there is intracranial hypertension.

Normally, a uniform distribution of cerebrospinal cerebrospinal fluid is carried out under pressure from 7 to 17 mm RT. Art. (although some experts believe that the maximum value of normal intracranial pressure is not more than 15 mmHg). This provides excellent brain function without headaches. If a person has hypertension, his high blood pressure provokes vascular changes in the brain, resulting in an increase in intracranial pressure and, as a result, a prolonged headache.

With hypotension, a lack of cerebrospinal fluid affects the brain in such a way that this organ performs not only nutritional functioning, but also shock absorbing. In this case, cephalalgia, aggravated by walking or simply by being in an upright position, passes only during rest, when the patient is lying.

The danger of this disease is that the lack of cerebrospinal fluid has an extremely negative effect on the work of the brain and blood vessels of the head, and a fatal outcome may result. This is due to the fact that hypotension severely damages blood vessels and is capable of provoking hemorrhage, dislocation of the structures of the hemispheres and the brain stem. As a result, cerebral edema, impaired brain stem material and hemorrhage lead at best to a stroke, and at worst to a fatal outcome.

Often, a headache is eliminated with conservative therapy aimed at restoring the water-electrolyte balance.

In this case, they often resort to therapy using isoosmolar solutions. If the patient is ill with liquorrhea, most often he needs treatment in a hospital.

3 Why headache and how to treat it from hypertension and from tumors

In the case of hypertension, headache often occurs due to excess fluid in the ventricles of the brain or in the fluid space. So that the patient does not bother with a headache, he is prescribed therapy aimed at the gradual normalization of fluid secretion. If the patient's condition is serious, he is referred for consultation to a neurosurgeon in order to prescribe the operation of this ailment. Then, to remove excess cerebrospinal fluid, which causes not only a headache, but also weakness, shakiness, dizziness, nausea and other signs, an operation is performed to install a shunt.

However, if the outflow of cerebrospinal fluid is too fast, this also leads to multiple poor conditions. In this case, the occurrence of cerebral edema, foci or hemorrhage may occur, which is fraught with serious harm to the patient’s health or even death. If it is impossible to perform a shunt operation, the neurosurgeon performs a cerebrospinal fluid puncture. If the patency of the paths is preserved, the headache can temporarily be eliminated after spinal puncture, in this case the main thing is to start treatment on time and correctly.

Head tumors that can be removed by a cyber knife can also hurt constantly and severely from the tumors at the base of the skull; the symptoms are added to the feeling of a drunken hike, fainting, facial pain and epileptic seizures. Such a neglected condition is most often fatal, therefore it is necessary, if there are even some signs, to immediately seek medical help.

• Episodic or regular headache attacks
• Presses head and eyes or “hits with a sledgehammer” on the back of the head or knocks at the temples
• Sometimes with a headache you feel sick and dizzy?
• Everything begins to enrage, it becomes impossible to work!
• Do you spill your irritability on relatives and colleagues?

Stop enduring it, you can no longer wait, delaying treatment. Read what Elena Malysheva advises and learn how to get rid of these problems.

If you have a headache, seek advice immediately.

You can get a headache questionnaire for free by sending an e-mail to:

Headache is a painful, unpleasant sensation in the area from the level of the orbits to the suboccipital area, one of the most frequent and universal complaints. Its presence often reflects not so much trouble in the head itself as in the body as a whole.

Headaches are primary and secondary.

Primary headaches, which are effectively treated at the Koncha-Zaspa sanatorium, are characterized by the fact that even the most thorough examination does not reveal any organic causes.

Secondary (symptomatic) occur as a result of a variety of diseases of internal organs, injuries, metabolic disorders, poisoning, taking certain medications.

It should be remembered that the substance of the brain does not have pain sensitivity. Pain occurs when the receptors of the dura mater, arteries, veins, muscles, and skin are irritated.

In only 5% of cases, the cause may be serious organic diseases. But it is precisely on their identification that priority attention should be paid.

Diseases that are accompanied by a headache:

A sudden, severe, spilled headache is characteristic of cerebral hemorrhage. It is accompanied by vomiting and sometimes loss of consciousness. Limb paralysis may also occur.

• Cerebrovascular disease   - one of the most common reasons.
• Hypertonic disease.   Pain usually occurs in the back of the head and often occurs in the early morning. There is usually no clear connection between the appearance of a headache and the degree of pressure increase. It usually occurs with a rapid rise in pressure.
• Vascular inflammation (vasculitis).   Persistent headache. In the temporal and frontal areas in older patients, it occurs against the background of general weakness, constantly elevated temperature, weight loss. The pain often intensifies at night, especially if the patient, moving his head along the pillow, affects the painful area.
• Increased intracranial pressure.   Headache can be an early sign of a tumor and an abscess of the brain, intracranial hematoma and other volume formations, as well as dropsy of the brain. The pain is more often spilled, but at first it can occur in the area of \u200b\u200bthe location of the tumor or other formation. Headache occurs periodically, but then becomes constant. May depend on body position. Accompanied by vomiting. Strengthens with coughing, sneezing, tilting the head. Wakes up in the middle of the night.
• Decreased intracranial pressure.   It is less common. The reason is the leakage of cerebrospinal fluid (intracranial fluid) through defects in the tissues of the head. Headache worsens when standing up and is accompanied by nausea, vomiting, dizziness, tinnitus.
• Orgasmic (coital).   A temporarily sudden throbbing headache that occurs in men during intercourse. It usually lasts several minutes, but if it first occurs during intercourse, it persists for several hours, it is necessary to exclude hemorrhage in the brain.
• Nerve compression of the cervical spine.   Inflammation or osteochondrosis of the spine. Occurs in the cervical-occipital region, can spread to the forehead, temple, shoulder, arm. May appear on one or both sides. The side of pain usually does not change. Strengthens with movement of the head, prolonged stay in an uncomfortable position, with the touch of the neck, back of the head.
• Inflammation of the airways of the skull (sinusitis). Sinusitis, frontal sinusitis, ethmoiditis. Pain in the forehead, around the eyes. It is accompanied by fever, nasal congestion, redness of the skin and pain when tapping in the area of \u200b\u200bthe affected sinus. There is almost always purulent discharge from the nose. The pain intensifies in the supine position, after sleep, decreases when standing.
• Inflammation of the joint of the lower jaw.   The pain occurs near the ear, in the muscles when chewing, yawning, wide opening or tightening of the mouth.
• Acute increase in intraocular pressure.   Acute angle-closure glaucoma. The pain is throbbing, in the eye, in the orbit, with redness of the eye, blurred vision, nausea, vomiting.
• Irritation of cold throat receptors.   When the head is cold or swallowing cold food, there is a short-term severe pain near the eyes, nose, and throat.
• Pain after a head injury.   May persist for several months, several years. It is accompanied by a decrease in memory, attention, mental disorders, dizziness, nausea, fatigue, and sleep disturbance. Pain spilled, dull, worse with physical exertion.
• Infectious diseases.   Pain occurs with any infection. It is accompanied by an increase in temperature. There may also be pain in the muscles, joints, general weakness.
• Poisoning, metabolic disorders.   Constant dull pain with nausea, increased sweating, diarrhea, muscle pain.
• Headache while taking medication.   When taking vasodilator drugs, hormones, antibiotics. Headache ricocheted with an overdose of painkillers. A decrease in headache after drug withdrawal is the main symptom of a drug headache.
• Primary headaches   - tension headache and migraine. Cluster headache. Indomethacin-sensitive headache.

Tension headache is the most common variant, which is noted in more than 50-80% of the population. More common in women. The pain is mild or moderate, lasts from several tens of minutes to several days, does not increase with physical activity. The pain is bilateral, in the back of the head, in the forehead, pressing, compressing, without vomiting. It is difficult for patients to describe their feelings. Often - not pain, but a feeling of heaviness or pressure of a helmet, a hoop on the head.

Migraine - occurs in adolescence. Paroxysmal. Unilateral or bilateral headache in the frontal, temporal region, in the orbit. The pain is intense, throbbing, with nausea, vomiting, photophobia, photophobia, desire for peace and isolation.

Cluster headache - occurs at a later age (30-50 years). It is characterized by a cluster occurrence of the pain cycle - 1-3 attacks per day, lasting a minute, for 6-8 weeks. Then the seizures resume after 4-6 months, with a certain periodicity, seasonality. The pain is strictly one-sided, periorbital, extremely intense ("suicidal"). Accompanied by redness of the eyes, nose, lacrimation. The patient is constantly moving, can not find a place for himself.

Indomethacin-sensitive headache is a form of primary headache, with a positive reaction to indomethacin. The pain is usually short-term, repeated several hours a day. It can be unilateral or bilateral, spontaneous or provoked by straining. Some patients may not respond to indomethacin, and other drugs may have a positive effect, so the allocation of this headache group is very arbitrary.

DIAGNOSTICS

Diagnosis of the type of headache is carried out by the method of pupillometry. An indirect sign of a headache is the reaction of the pupils of the eyes. The pupils can expand, narrow, have a different diameter. Researchers are invited to perform a series of test exercises and movements during which pupilometry is performed (video recording of pupils' reactions with high-precision video cameras). The obtained data on the reaction of the pupils are analyzed by a special computer program that determines the type and nature of the headache. This provides an opportunity to individually prescribe the necessary and effective treatment.

Types of Headaches

Stress headaches

Diagnosis of simple and stressful pains is based on a characteristic clinical picture: headache is impregnable in nature with a duration of pain episodes from 30 minutes to 7 days. The pain is compressive, constricting (not pulsating), the intensity is usually moderate (pain worsens performance, but does not lead to cessation of activity). Two-sided localization: frontotemporal, temporal-temporal, “helmet”, “helmet”, “hoop”, “hood”. At the same time, pain does not intensify from everyday physical activity.

Headaches of tension are divided into episodic and chronic. In episodic forms, the number of days with a headache does not exceed 15 per month or 180 days per year. In chronic forms, the number of days with a headache exceeds these figures. Such a division is very arbitrary - for example, it is difficult to classify episodic or chronic headaches, which are observed from 13 to 18 times a month.

In the formation of tension headache, the leading role is played by mental disorders: anxiety, depression, hypochondria, and demonstrative personality traits. However, the leader among them is depression.

The cause of headaches is often a prolonged muscle tension in antiphysiological poses. Often this is associated with professional activities: working at a computer or typewriter, with small parts, driving a car, etc. At the same time, the external eye muscles, scalp aponeurosis muscles, and neck muscles are stressed. An uncomfortable position of the head during sleep can play a role. In this regard, one should not forget about such widespread methods as gymnastics, massage, physiotherapy.

The use of drugs for episodic headache is carried out in short courses or once. So, a headache can be stopped with a single dose of analgesics: aspirin, paracetamol, ibuprofen, combined analgesics (citramone, sedalgin) or tranquilizers, as well as their combination. However, one should remember about the inadmissibility of abuse of analgesics and psychotropic drugs, as this leads to a decrease in their effectiveness, the transition of pain into a chronic form, the formation of a chronic daily abusal headache. The best results are achieved with a single dose of muscle relaxants: midcalm in dosemg (1-2 tablets) in combination with 250 mg (1 capsule) of donalgin; Sirdalud (2-4 mg).

Migraine

This variant of headache is reported in the papyrus of the ancient Egyptians: there are descriptions of migraine seizures, as well as prescriptions for medicines used to treat this disease. Despite this, much remains a mystery in the pathogenesis of migraine. Practitioners and patients with migraines do not have a clear idea of \u200b\u200bwhether it is treatable. What modern medicines most effectively relieve a painful migraine attack? Do all patients with migraine need treatment and how?

Migraine is the second most common type of primary headache after tension headache.

The criteria for the diagnosis of migraine were determined by the International Society for the Study of Headache in 1988:

• Paroxysmal headache lasting from 4 to 72 hours.
• A headache has at least two of the following characteristics: predominantly one-sided localization, alternating sides, less often bilateral, pulsating in nature, moderate or significant headache intensity (disrupts daily activities), increased physical exertion.
• The presence of at least one accompanying symptom: nausea, vomiting, phonophobia, photophobia.

Migraine is a hereditary disease, the course of which is influenced by a number of external and internal factors. The process of forming migraine attacks is extremely complex, and many of its mechanisms are not fully understood. Modern researchers believe that cerebral mechanisms are leading in the onset of an attack.

Liquorodynamic type of headache

As you know, cerebrospinal fluid produced by the vascular plexuses of the brain circulates in the system of the ventricles of the brain, cisterns and spaces of the brain and goes further along the outflow paths into the venous system.

Any pathological processes that interfere with the circulation of cerebrospinal fluid or cerebrospinal fluid, entail a change in intracranial pressure (i.e., its increase or decrease).

With an increase in intracranial pressure, the headache is bursting in nature, patients experience a feeling of pressure "from inside to outside" (as if "the brains were crawling out"). Such pain is aggravated by straining, coughing, sneezing. Often the forerunner of severe persistent headaches of this type is a brain tumor.

Treatment is carried out with the help of diuretics and drugs that lower blood pressure.

With a decrease in intracranial pressure, the pain is pulsating in nature, combined with weakness and apathy.

Vascular type of headache

This type is associated with various options for changing the state of arteries and veins of the brain and skull. So, the first variant of pain - arteriohypotonic - is caused by a decrease in the tone of these arteries, the second - on the contrary, by spasm, and the third - by venous insufficiency.

In the first case, due to a decrease in the tone of the craniocerebral arteries, they are excessively overstretched by blood. Therefore, the pain is pulsating in nature, however, in far-reaching cases, the throbbing pain is replaced by a dull, bursting pain.

In the second case, with an arteriospastic type of headache, the headache is a dull, breaking one, perceived as a feeling of compression and may be accompanied by lightheadedness, nausea, dizziness, "flies" in front of the eyes.

Pain with venous insufficiency is caused by increased blood supply to the venous vessels and difficulty in venous outflow. Patients experience heaviness in the head and a feeling of blunt bursting. Most often, these sensations are limited to the occipital region. A headache of venous insufficiency occurs or worsens when lying down or when working with a low bowed head. One of the characteristic features of such a headache is its morning manifestation - it occurs early in the morning “as soon as I opened my eyes”, “a heavy head, as if it had been plowing all night”.

Treatment of the vascular type of pain is carried out with xanthine preparations (aminophylline), ergotamine, antispasmodics, vinpocetine, calcium antagonists (nifedipine).

Headache

This term comes from the English word "abuse" - abuse. The terms also are used in the literature. “Drug headache”, “analgesic-dependent headache”, “withdrawal headache”, “abuse headache”   et al. Abuse headache is the third most common occurrence, following migraine and tension headache.

Abuse pain develops in patients with primary headache, more often migraine - 3/4 of patients or tension headache - 1/4. Frequent administration of analgesics (daily or every other day) leads to chronic episodic pain and a modification of its nature. Patients noted a constant background headache of low intensity and paroxysmal intensification of pain in the head.

The characteristic of pain is mixed: patients experience both a pulsating migraine pain and a constricting, compressive, more typical tension for a headache. Pain may be accompanied by nausea, vomiting, phono- and photophobia. The effectiveness of constantly taken analgesics decreases over time, which leads to an increase in dosages, and their cancellation causes an increase in pain in half of the patients. A “vicious circle” is forming:

pain - analgesic - pain

Most often, the causes leading to drug abuse are the psychological characteristics of patients. A high level of anxiety and depression, the illusion of high self-control of pain with an analgesic pill, leads to the formation of an incorrect strategy for overcoming pain and leads to drug abuse. It is believed that taking medication daily or every other day after three months can lead to the formation of an abusal headache.

The most important step in the treatment of abusal headache is the abolition of analgesics.

Headache while lying down aggravated

In the event of a sudden severe headache, subarachnoid hemorrhage should always be suspected (emergency).

A patient with a recent, gradually increasing headache that occurs in the morning or during exertion should be referred for an additional examination.

For complaints of headache, blood pressure should be measured.

It should be remembered that in older people, headache may be due to temporal arteritis or chronic subdural hematoma.

The irritation of the meninges:

- acute and chronic meningitis.

Dystonia of intracranial blood vessels:

- volumetric processes (tumor, hematoma, abscess);

- increase in intracranial pressure (ICP) (blockade of cerebrospinal fluid pathways, venous thrombosis, intracranial hypertension, malignant arterial hypertension);

- decrease in ICP (after lumbar puncture, less often spontaneously).

Dilation of intracranial vessels and metabolic disorders:

- generalized infectious disease;

- violation of cerebral circulation of an ischemic nature;

- headache after trauma or convulsions;

- the use of drugs and foods that dilate venous vessels;

- a significant increase in blood pressure;

- headache during physical exertion, sexual intercourse;

- hypoxia and hypercapnia;

- anemia or polycythemia;

- headache caused by analgesics.

- Ordinary (simple) migraine (“temporal artery migraine”).

- Beam headache.

Headache of tension:

- primary (psychogenic mechanisms);

- secondary (neck damage, “whiplash” injuries, malocclusion, bruxism1, incorrect organization of the workplace).

- trigeminal neuralgia;

- glossopharyngeal neuralgia;

- atypical neuralgia of the facial nerve.

- damage to the ears, eyes, paranasal sinuses, oral cavity and bones.

Daily headache

A daily headache can be due to various concomitant causes. There are many types of headaches, and identifying the causes of their headaches can be as difficult as treating them. In addition, prolonged use of analgesics can paradoxically lead to the development of a headache.

Examination and Diagnostics

Of great importance are the data of history. It is necessary to pay special attention to the following points.

Patient age at first headache attack

If a headache occurs after 35 years, a thorough examination of the patient is necessary (migraine and tension headache usually develop at a younger age).

Duration and frequency of headache attacks

Prolonged or intermittently recurring headache often has a vascular origin or is caused by muscle tension.

An acute headache of various kinds can be caused by a serious illness (for example, subarachnoid hemorrhage).

Gradually (over days / weeks), an increasing headache can be a sign of a brain tumor.

Migraine attacks rarely develop more than 2 times a week. Daily attacks for migraines are uncharacteristic.

Headache Features

Vascular headache is usually pulsating.

Tension headache - constricting, constricting, like a hoop.

Headache in the morning (including early) hours is characteristic of migraine or increased intracranial pressure.

Migraine headache, usually one-sided; bundle headache is always one-sided.

A tension headache usually evenly covers the region of the forehead or neck (sometimes it is localized only on the “crown” of the head).

Pain in the temporal region can be caused by various causes (for example, pathology of the mandibular joint). It is necessary to remember the possibility of developing temporal arteritis in the elderly.

Classical migraines are often preceded by various prodromal symptoms. Typical manifestations include photopsies, scotomas, transient visual impairment (figures with blurry contours), visual field defects, sometimes paresthesias, or short-term speech disorders.

- If the prodromal symptoms persist after a headache occurs, the diagnosis of migraine is uncertain.

- Diplopia is not typical for migraine, its occurrence is considered as an indication for further examination.

Nausea and vomiting are characteristic of migraines, but if they are present, differential diagnosis is necessary, for example, with ischemic cerebrovascular accidents, hemorrhages and increased ICP.

Somatic and neurological status

Although a general examination of a patient suffering from a headache usually does not find any deviations, it remains an important stage for diagnosis.

It is necessary to measure blood pressure.

It should be remembered that an ophthalmic examination is necessary (swelling of the optic nerve disks and the absence of venous pulsation of blood vessels indicate an increase in ICP).

Measurement of intraocular pressure is necessary at least in cases where the pain is one-sided and localized in the eye.

Additional research methods

The diagnosis of migraine and tension headache is usually based on anamnesis, in such cases there is no need for further studies.

Ultrasound of the maxillary and frontal sinuses is necessary if there are signs of an infectious disease.

To detect temporal arteritis, ESR must be determined in patients older than 50 years.

CT and MRI are the primary research methods for suspecting a volumetric process.

If subarachnoid hemorrhage is suspected, the primary research method is CT.

Sometimes there are no abnormalities in CT, but a cerebrospinal fluid examination confirms the diagnosis.

If meningitis is suspected, a cerebrospinal fluid test is necessary.

Based on the history and physical examination data, a selective analysis is carried out: a general blood test, determination of fasting glucose concentration, serum concentration of sodium and potassium ions, creatinine, TSH and T3, as well as others

enzymes and hormones in serum.

Indications for expert advice or special research methods

Acute severe headache.

A recent severe or continuously increasing headache.

Constant headache, worse lying down.

Headache appearing in the morning.

Headache provoked by cough, physical exertion.

Headache in patients older than 50 years.

Weight loss.

Objective Examination Data

Fever and a violation of the general condition (in order to exclude meningitis).

Edema of the optic disc.

Soreness of the temporal arteries on palpation or an increase in ESR (temporal artery biopsy).

Recently developed gait disturbance.

Focal neurological symptoms, including visual impairment.

Migraine headache, always developing on one side or first occurring after 40 years.

Headache that is not treatable.

A general practitioner can treat beam headache, provided that the diagnosis of trigeminal neuralgia is excluded.

Chronic paroxysmal hemicrania (resembles a bundle headache and manifests itself in the form of short frequent seizures in women).

Situations in which consultation may be necessary

Patients with chronic pain syndrome that cannot be treated (in this case, trial treatment with antidepressants is necessary).

If you suspect a connection between the occurrence of a headache and a neck lesion.

Why does a headache occur at night

Headache is a symptom that everyone knows. Most people face headaches during the day, working hours. However, there are such groups of people who are bothered by a heaviness in their head at night. This condition is worse because a headache at night disturbs sleep.

What is a headache?

Such an ailment is not a separate disease, but a symptom that can accompany various pathological conditions. This symptom has a mostly subjective characteristic - each person feels discomfort in his head in his own way and describes it with different concepts.

Headache can sometimes be the only symptom of a latent disease. As for night headaches, their reason lies in various conditions.

Causes of night pain in the head

Oxygen deficiency

The most elementary cause of discomfort in the middle of the night is a lack of oxygen. The brain reacts sharply to oxygen starvation. If other organs can maintain their function in conditions of oxygen reduction up to an hour, the brain is not able to survive without it for more than five minutes. In response to hypoxia, the brain reacts with a headache.

Lack of oxygen may be due to:

1. Being in a stuffy room without the influx of fresh air.
2. Diseases of the upper respiratory tract, accompanied by difficulty in nasal breathing.
3. Anomalies in the development of the nasal passages, which also impede free nasal breathing.

Mental strain

Often a headache during sleep is associated with intense mental work during the day. The need to strain the brain throughout the working day leads to the fact that during the night's sleep, the brain continues to work and does not get proper rest. This leads to discomfort in the head at night and a feeling of tiredness after waking up.

Hypotension - Low Blood Pressure

The average normal blood pressure in an adult is 120/80 mm Hg. Art. For some people, the normal pressure at which they feel comfortable is lower numbers - this is due to heredity and physique.

For most people, blood pressure is below 100/60 mm Hg. Art. leads to unpleasant sensations in the head. They are especially pronounced at night. This is due to the fact that in a horizontal position the blood flows from the brain, and if the pressure is low, this process is more pronounced.

Due to a lack of blood supply, night headaches develop. After awakening, dizziness, a sensation of flies in front of the eyes can join her.

Why hypotension may occur:

1. Prolonged fasting.
2. Blood glucose deficiency.
3. Acute or chronic bleeding.
4. Long stay in a forced horizontal position.

On our website there was a detailed article about headaches in hypotensive patients. You can familiarize yourself with it.

Hypertension - high blood pressure

The opposite situation is observed in those whose blood pressure exceeds 130/80 mm RT. Art. Again, in hypertensive patients, such pressure is comfortable - pathology may not occur. But for those whose comfortable pressure fits into standard numbers, changing it upwards becomes the reason why the head hurts at night.

High blood pressure on the walls of blood vessels causes their reflex spasm. At the same time, receptors located both in the vessel wall and in the brain substance are irritated - a headache occurs. The rise in pressure is usually observed in the evening: overfatigue, emotional fatigue accumulate. During sleep, vessels begin to respond - this condition develops.

Why the pressure rises:

1. Emotional and physical overwork.
2. Acute stressful situation.
3. Overheating.
4. Diseases characterized by high blood pressure.

Circulatory disorders - heart attack and stroke

The development of discomfort in the head at night can be a consequence of the emerging cerebrovascular accident - a stroke. The pathological process in stroke is acute spasm or obstruction of the cerebral vessels. As a result, an ischemic zone is formed.

The cells of the brain substance in this zone are in a state of acute hypoxia - as a result, discomfort develops.

Sometimes a headache at night may appear due to acute heart attack. The mechanism of pain here is associated with severe myocardial ischemia, pain in the region of the heart. With a sensitive parasympathetic nervous system, sensation can spread to other organs, in particular, to the head.

Pain in the pathology of the spine

There are frequent cases of night discomfort in the head in people suffering from diseases of the spine, especially the neck and back. The direct cause of the appearance of pathology in this case is excessive muscle tension.

Back pain causes a person to take a forced position, sometimes different from physiological. This leads to tension in the muscles of the back and neck - there is a so-called tension headache. It appears in the evening and at night, when the tense muscles begin to relax.

Psychological problems

Perhaps this is one of the main reasons for the appearance of night discomfort in the head. Negative stresses, melancholy, depressive states are almost always accompanied by the appearance of unpleasant sensations at night. Of course, it can occur during the day. But at night such a person is left alone with his experiences, it scrolls all in his head - a combination of this with sleep disturbance leads to the appearance of a pronounced headache.

Metabolic Disorder - Diabetes

Another organic cause of unpleasant pain at night is diabetes. The condition in this case is due to several factors:

1. Glucose deficiency with an overdose of insulin.
2. Night hunger also leads to a decrease in glucose levels - brain cells are very sensitive to this.
3. In diabetes, a pathology of the peripheral nerves develops - this also leads to the appearance of a headache.
4. The late stage of diabetes is characterized by pathology of the organ of vision - retinopathy, glaucoma. These conditions are always accompanied by a headache at night.

Infectious diseases

There are infections, the main symptom of which is a headache. It can occur at any time of the day, including at night. The appearance of discomfort with an infectious disease may be due to the following:

1. As a symptom of intoxication with severe flu or adenovirus infection.
2. As a result of dehydration with intestinal infections.
3. As a direct lesion of brain structures during meningococcal infection, tick-borne encephalitis, meningitis and encephalitis of another infectious etiology.

Migraine

This is a particular cause of headache. Migraine attacks are prone to occur in the evening and can last throughout the day. The pathogenesis is based on a persistent spasm of the cerebral vessels.

Diagnostics

The diagnosis of nighttime headache depends on its characteristics. If necessary, additional research methods are used.

Discomfort in the head with fatigue, emotional and mental stress, hypoxia has the following characteristics:

1. It develops gradually, reaches a peak in the evening and night hours.
2. It is dull, monotonous.
3. Moderate intensity.
4. It is accompanied by a feeling of fatigue, weakness.

Discomfort with low blood pressure also develops gradually, accompanied by general weakness and dizziness, loss of consciousness is possible.

Discomfort with high blood pressure often occurs suddenly, a person wakes up in the middle of the night due to pain and a feeling of pulsation in his head. If the pressure reaches very high numbers, the headache becomes more intense, the appearance of nosebleeds.

Pain with strokes and heart attacks occurs suddenly, a person wakes up from a sharp headache. This sensation is accompanied by visual impairment, flickering flies in front of the eyes, signs of paresis and paralysis.

Headache with pathology of the spine is formed throughout the day, and by evening and night it becomes as intense as possible. It is characterized by a feeling of heaviness in the head, the inability to turn it or tilt it.

Pain in diabetes occurs suddenly - just as a hypoglycemic state occurs. It is accompanied by severe weakness, dizziness, trembling hands and sweating.

Discomfort in the head with infectious diseases is characterized by the following symptoms:

1. Abrupt, sudden occurrence.
2. Combined with a rise in body temperature.
3. Headache with flu is combined with photophobia, redness of the eyes.
4. In infections that cause meningitis, the headache will be pronounced, combined with nausea and vomiting, photophobia, hearing impairment. Meningeal symptoms are observed.

Migraine pain occurs in one half of the head, accompanied by visual impairment and lacrimation on this side. It can reach high intensity.

In addition to clinical data, instrumental research methods are used to diagnose some types of pathology:

1. Doppler ultrasound of the vessels of the head and neck;
2. Electromyography - a study of the electrical activity of the muscles of the back and neck;
3. Electrocardiography;
4. With a headache caused by an infection, a diagnostic spinal puncture is performed.

Pain treatment

Treatment methods are largely dependent on the cause of the discomfort. In most cases, pain medication alone is not enough.

Hypoxia Pain Management

This condition is most easily stopped. It is enough to ensure a constant flow of fresh air and prescribe painkillers:

These measures are enough to eliminate the pain caused by hypoxia.

Treatment of pain with psycho-emotional and physical stress

In these cases, the headache can go away on its own - after a good rest. To reduce the intensity of sensations, you can use the following drugs:

1. Analgesics - Nurofen, Pentalgin;
2. Soothing - valerian, motherwort, combined preparations (Persen, Novo-passit, Afobazol).

Treatment of pain with fluctuations in blood pressure

Hypotonic headache is treated with drugs that can increase blood pressure:

If hypotension develops due to starvation, a full meal can even eliminate discomfort without pain medication.

Hypertensive headache will pass after lowering blood pressure with special drugs. Only a specialist is engaged in their selection and appointment. You can alleviate the condition yourself by taking a cool bath, relaxation, a full sleep.

Head treatment for spinal diseases

Here, the treatment should be comprehensive, aimed not only at eliminating the headache directly, but also at the discomfort in the spine. If the back pathology remains untreated, the head will not go away after any pain medication.

Gymnastics for the back, massage, acupuncture, physiotherapy methods will be useful. A good effect is swimming and water aerobics.

Treatment of pain with circulatory disorders

Stroke and heart attack - indications for immediate hospitalization in the intensive care unit. Headache in such conditions should not be treated independently.

Infectious Disease Treatment

Headache with infectious diseases will completely disappear only after elimination of the pathogen. During etiotropic therapy, discomfort can be stopped with any pain medication - Diclofenac, Ibuprofen, Pentalgin.

Migraine treatment

Migraine pain is treated with a special group of drugs - sumatriptans. At the moment, in pharmacies there are many trade names for this substance - Amigrenin, Sumumigren, Nomigren. In addition to taking these drugs to stop a migraine attack, it is necessary to create complete rest, a dark environment. Hot compresses are applied to the forehead to relax spasmodic vessels.

Headache Prevention

Preventive measures for headache are as follows:

1. Full motor activity.
2. Adequate stay in the fresh air.
3. Airing the room before going to bed.
4. Blood pressure control.
5. Timely treatment of infectious diseases and diseases of the nasopharynx.
6. Proper nutrition.
7. Treatment of pathology of the spine.

Conclusion

Headaches at night have many causes. Often, in order to eliminate this sensation, one must first act on the original cause.

Headache in a horizontal position

Diagnosis of headaches

Identification of the causes of headache or its diagnosis are important in relation to treatment tactics. After all, it is precisely on the causative factor, or at least on one of the links of the development mechanism, that therapy should be directed. Finding the primary or secondary headache is the first task of doctors. Primary headache occurs in pathological processes developing in the brain itself. A secondary type is formed as a response to distant foci of pathology.

Specialists of the Kiev "Doctor Ignatiev Clinic" are trying to determine the cause of the pain of a distant type. Their competence includes pathologies of the spine, and it is they who often cause the symptom complex, accompanied by a headache. Therefore, it is possible that one of the sides of the body that needs to be subjected to a detailed diagnosis may be the spine and its individual sections. Clinical vertebrologists consult every day after an appointment.

Headache mechanisms

To correctly diagnose, it is important to understand the mechanism of the syndrome:

• Vascular mechanism - may have the nature of a vasomotor reaction when a headache occurs in response to a violation of vascular tone. The venous type is a consequence of an increase in blood supply to the veins. Ischemic-hypoxic type of pain is more often associated with deposits of cholesterol plaques inside the vessel wall during atherosclerosis or with arterial hypertension.
• The neuralgic mechanism - gives a reflected type of headache, for example, when squeezing nerve roots by protruding the disk between the vertebral bodies during protrusion or a hernia in the cervical region.
• The mechanism of muscle tension - in this case, the so-called tension headache appears. It occurs during compression of nerve fibers or supply vessels with spasmodic muscles.
• Liquorodynamic mechanism - associated with deviations in intracranial pressure. Liquor is one of the body’s body fluids located in the ventricles of the brain and in the spinal canal; along with blood and lymph, it plays an important role in the metabolic processes of nerve tissue.
• Psychalgic mechanism - headache occurs as a result of psycho-emotional overstrain.

Thus, having understood the mechanism of headache formation, it is already possible, without a doubt, to establish a preliminary diagnosis.

Symptoms of various types of cephalgia (headache)

In diagnosis, recognition of the characteristic symptoms of a particular type of headache is of great importance. So, vascular pain is detected in the form of pulsating cephalgia. Unilateral pain indicates the presence of migraine, and a bilateral nature indicates the phenomenon of vegetovascular dystonia. Venous cephalalgia increases in the supine position and is accompanied by swelling of the face and eyelids.

A headache of tension has a compressive type, the patient's condition is relieved by kneading the cervical-collar zone and with rhythmic movements of the shoulders. Intracranial hypertension gives a bursting headache, which intensifies in a horizontal position. On the contrary, a decrease in pain in the supine position indicates a decreased cerebrospinal fluid pressure.

Diagnosis and treatment in Kiev

Neuralgic cephalalgia usually has a paroxysmal character and has the appearance of shooting short-term pain. In this case, the sources of pain are determined that correspond to the places where the trigeminal nerve branches exit.

Diagnostic techniques such as computed tomography and magnetic resonance imaging confirm the diagnosis, but they usually give comprehensive results for more obvious causes of cephalgia, such as brain tumors, hematomas, and other volume formations.

Doctors of the "Clinic of Dr. Ignatieff" advised not to neglect the manifestations of cephalalgia. Pathology is best treated at the very beginning of its development, so timely therapy is the most important condition for a full recovery.

Lying headache

A headache in the supine position is the result of many different pathological conditions, ranging from banal overwork and ending with a malignant brain tumor.

Depending on the characteristic symptoms and causes, doctors distinguish several genetic types of headaches, the determination of which is of primary importance for its drug therapy.

Vascular appearance

It occurs when the tone of the vessels of the brain is impaired. It is characterized by dull, bruising, throbbing pain, accompanied by darkening in the eyes, a feeling of heaviness in the head and flickering # 171; goosebumps # 187 ;.

Vascular pain increases significantly with the head down and lying down. The group of vascular headaches includes:

• arterial hypertension pain;
• with migraine and atherosclerosis of the brain vessels;
• in acute cerebrovascular accident (stroke);
• premenstrual and menstrual headaches;
• hypotension pains and seasonal headaches.

Liquorodynamic view

It is formed due to equilibrium failures between the outflow of cerebrospinal fluid and secretion, as a result of which the intracranial pressure either decreases or jumps.

Typical symptoms of cerebrospinal fluid headaches: confusion, bursting, feeling of pressure # 171; outside-from the inside # 187 ;, a sharp increase in intensity when lying down, while walking, when coughing and turning the head.

Diseases that provoke cerebrospinal fluid headaches:

• brain abscess, benign and malignant brain neoplasms;
• cerebral edema due to inflammation or trauma.

Headaches of muscle tension

They arise against the background of painful pathological impulses during localization processes, as well as a result of a high tone of the nervous system.

They are distinguished by sensation # 171; of a head-clutch hoop # 187;, by excessive sensitivity to bright light and loud noises, irritability and tearfulness. Observed with:

• hormonal changes, neurosis, stress;
• infectious toxic diseases;
• organic lesions of the sinuses and eyes.

Cephalgia is a phenomenon familiar to everyone. Most people experience this unpleasant symptom in the daytime. However, there are groups of people who are disturbed by such discomfort at night, thereby disturbing sleep.

This is not a separate ailment, but a symptom that can accompany various pathological conditions. This phenomenon is mainly subjective in nature, since each person describes such discomfort in the head region in his own way.

Cephalgia can sometimes be the only symptom of a latent disease. As for night headaches, their cause lies in various conditions.

Occurrence factors

Oxygen deficiency

The appearance of discomfort in the head at night often provokes a lack of oxygen. The brain reacts sharply to hypoxia. If other organs can maintain their function in conditions of decreasing oxygen levels up to an hour, then the brain can survive without it for no more than five minutes. In response to hypoxia, the central organ of the nervous system reacts with a headache.

Lack of oxygen may be due to:

Mental overwork

Cephalgia that occurs during sleep is often associated with excessive mental activity. The need to strain the brain throughout the working day leads to the fact that during the night's sleep, the main organ of the central nervous system continues to work and does not get proper rest. A similar phenomenon provokes the occurrence of unpleasant sensations in the head at night and fatigue.

Hypotension

Normal blood pressure in an adult is 120/80 mm Hg. Art. For some individuals, lower values \u200b\u200bare a comfortable pressure. Often this is due to heredity, as well as to the features of the physique.

For most people, blood pressure is below 100/60 mm Hg. Art. leads to the appearance of unpleasant sensations in the head, intensifying at night. This is due to the fact that in a horizontal position the blood flows from the brain, and if the pressure is low, this process is more pronounced.

Due to circulatory disorders, cephalgia develops. After awakening, dizziness, as well as flashing flies before the eyes, can join this symptom.

The causes of hypotension are:

• prolonged fasting;
• lack of glucose in the blood;
• acute or chronic bleeding;
• prolonged horizontal position.

On our site there was a detailed article about, you can familiarize yourself with it.

Hypertension

The opposite situation is observed in those whose blood pressure exceeds 130/80 mm RT. Art. For hypertensive patients, this blood pressure is comfortable. However, for those whose normal pressure fits into standard numbers, changing it upwards causes cephalgia to occur at night.

High blood pressure causes reflex vasospasm. At the same time, receptors located both in the walls of tubular formations and in the substance of the brain are irritated. An increase in blood pressure is usually observed in the evening due to overwork and emotional fatigue. During sleep, vessels begin to respond, which leads to the development of a pathological condition.

The factors that trigger hypertension include the following:

• emotional and physical overwork;
• acute stress reactions;
• overheating of the body;
• diseases characterized by high blood pressure.

Details about we considered earlier.

Cerebrovascular accident

The development of a night headache may be the result of a deterioration in the blood circulation of the central organ of the central nervous system, in particular a stroke. The pathological process consists in acute spasm or vascular obstruction of the central organ of the nervous system, resulting in the formation of an ischemic zone.

The gray matter cells of the brain in this area are in a state of hypoxia, which leads to the development of cephalgia.

Sometimes a headache can provoke an acute heart attack. The discomfort mechanism is associated with myocardial ischemia, as well as pain in the region of the heart. With a sensitive parasympathetic nervous system, unpleasant sensations spread to other organs, in particular to the head.

Pathology of the spine

There are frequent cases of the development of cephalgia at night in people suffering from diseases of the spine, especially the neck and back. The immediate cause of the development of pathology in this case is excessive muscle tension.

Back pain causes a person to take a forced position, sometimes different from physiological. This leads to spasm of the muscles of the back and neck, resulting in the so-called. As a rule, such an ailment makes itself felt at night, when spasmodic muscles begin to relax.

Psychological problems

Stress, melancholy, depressive conditions are almost always accompanied by unpleasant sensations in the head at night. A similar phenomenon can occur during the day, however, it is at night that a person is left alone with his experiences, scrolls it all in his head, which leads to the development of pronounced cephalgia.

Metabolic disorders

Another cause of discomfort in the head during sleep is diabetes. The condition in this case is due to several factors, including the following:

• insulin overdose;
• night hunger;
• damage to the peripheral nerves;
• pathology of the organs of vision: retinopathy, glaucoma.

Infectious diseases

The main symptom of such ailments is a headache. It can occur at any time of the day, including at night. The appearance of discomfort is due to the following reasons:

• intoxication in severe influenza or adenovirus infection;
• dehydration of the body with intestinal infections;
• meningococcal infection, tick-borne encephalitis, meningitis, etc.

Migraine

Attacks of migraine headache most often occur in the evening and can last throughout the day. The basis of pathogenesis is a persistent spasm of the vessels of the central organ of the central nervous system.

Diagnostics

An accurate diagnosis depends on the nature of the disease. If necessary, additional methods for detecting an ailment are used.

Headache caused by fatigue, emotional and mental stress, as well as hypoxia, has the following characteristics:

• develops gradually, reaches a peak in the evening and night;
• accompanied by a feeling of weakness;
• is dull, monotonous;
• has moderate intensity.

Discomfort in the head area with low blood pressure also develops gradually, accompanied by general weakness and dizziness, loss of consciousness is possible.

Cephalgia, provoked by hypertension, most often occurs suddenly. A person wakes up in the middle of the night because of pain and a feeling of throbbing in his head. With a fairly high blood pressure, cephalgia becomes more intense. In some cases, nosebleeds may occur.

Unpleasant sensations in the head area caused by a stroke or heart attack occur suddenly and are sharp. This condition is accompanied by visual impairment, flickering flies in front of the eyes, paresis and paralysis.

Headache with pathologies of the spine appears during the day and worsens in the evening. The condition is characterized by the appearance of a feeling of heaviness in the head, the inability to turn it or tilt it.

Cephalgia provoked by diabetes develops as suddenly as a hypoglycemic state. This phenomenon is accompanied by weakness, loss of a sense of balance, trembling hands and excessive sweating.

Discomfort in the head area with infectious diseases occurs suddenly and is characterized by the following symptoms:

• fever;
• photophobia, redness of the eyes (with flu);
• pronounced pain, accompanied by nausea and vomiting, hypersensitivity to bright light, hearing impairment; meningeal symptoms are often observed (with infections that cause meningitis).

Migraine headache is one-sided, accompanied by visual impairment and lacrimation in the affected area. Such sensations can reach high intensity.

In addition to clinical data, instrumental research methods are used to diagnose certain types of pathology, including:

• doppler ultrasound of the vessels of the head and neck;
• electromyography (registration of electrical activity of the muscles of the back and neck);
• electrocardiography;
• diagnostic spinal puncture (with headache caused by infection).

Treatment

Therapeutic measures largely depend on the cause of the discomfort in the head area. In most cases, pain medication alone is not enough.

With hypoxia

This condition is most easily stopped. To do this, it is necessary to ensure a constant flow of fresh air and take painkillers:

• Nurofen
• "Moment";
• Pentalgin.

With psychoemotional and physical stress

In this case, the discomfort can go away on its own after a good rest. To reduce the intensity of discomfort, it is recommended to use the following drugs:

• analgesics (Nurofen, Pentalgin);
• sedatives (tincture of valerian or motherwort);
• combined medicines (Persen, Novo-Passit, Afobazol).

When blood pressure jumps

Hypotonic cephalgia is treated by taking the following drugs that increase blood pressure:

If hypotension has developed due to prolonged starvation, a full meal helps to eliminate discomfort in the head, even without the use of medications.

Hypertensive cephalgia occurs after a decrease in blood pressure with special drugs. Only a specialist is engaged in their selection and appointment. It is possible to alleviate the condition on your own by taking a cool bath, relaxing, and fully sleeping.

With pathologies of the spine

Here, treatment should be comprehensive, aimed not only at eliminating cephalgia directly, but also at pain in the spine. If the pathology remains untreated, it will not be possible to completely get rid of unpleasant sensations.

The methods of treatment of diseases of the spine include back gymnastics, massage, acupuncture, physiotherapeutic procedures. With this ailment, swimming and water aerobics have a good effect.

For infections

It is possible to get rid of a headache with such diseases only after eliminating the pathogen. During etiotropic therapy, discomfort can be stopped with any pain medication: Diclofenac, Ibuprofen, Pentalgin.

In case of circulatory disorders

Stroke and heart attack - indications for emergency hospitalization in the intensive care unit. Headache in these conditions cannot be treated on its own.

With migraine

Migraine cephalgia is removed by a special group of drugs - sumatriptans. The pharmaceutical market has many trade names for this substance: Amigrenin, Sumumigren, Nomigren, etc. In addition, to stop a migraine attack, it is necessary to create complete silence and a dark environment. Hot compresses are applied to the forehead to relax spasmodic vessels.

Prevention

Preventive measures for cephalgia that occurs at night are as follows:

Conclusion

There may be many factors causing headaches at night. To make the correct diagnosis and prescribe the necessary treatment, you need to see a doctor who will help find out the root cause.

Bursting headaches can be caused by various factors. This symptom should not be ignored, especially if it is permanent, as headaches can indicate serious health problems.

Basically, patients complain of pressing paroxysmal headaches that are felt throughout the head, noting the most powerful impulses of a bursting headache in the temples, frontal areas, in the back of the head and neck.

Pain arises suddenly, most intensively manifests itself at night and in the morning, subsides a little in the daytime and evening.

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Causes

The occurrence of bursting headaches can be due to various conditions and diseases, the main of which include:

• VVD (vegetative-vascular dystonia);
• increased intracranial pressure (intracranial pressure);
• infectious diseases;
• sudden changes in blood pressure;
• neoplasms in the head;
• stress and depression;
• hormonal disruptions;
• excessive use of salt, liquid, alcoholic beverages.

Vegetative-vascular dystonia	Headaches in vegetative-vascular dystonia are the result of malfunctions in the functioning of the central and autonomic nervous systems. The strength of headaches during VVD is slightly inferior to toothaches. If the patient is followed by severe, sharp pains, then this is probably not VVD. The pain is permanent and may be accompanied by nausea, dizziness, loss of consciousness, puts pressure on the ears. As a rule, it begins immediately after waking up, within 3-5 minutes and can pursue throughout the day, without changing the intensity. When tilted, it can intensify, pulsate. The perception of reality is difficult, everything becomes as if in a fog. For the night period, such pains are not characteristic, but if you wake up, they can occur and do not stop until the next bedtime. Headaches with VVD occur on the one hand, or affect the entire head. Separate areas may be affected: pain appears in the parietal region, temples, affects the forehead, nape. Sometimes it is combined with congestion and pulsation in the ear, a feeling of swelling and tension in the forehead, eyes, and temples.
Increased intracranial pressure	Intracranial pressure may increase due to various reasons: congenital pathologies and complications during pregnancy; infectious diseases (bronchitis, gastroenteritis, otitis media, malaria, etc.), including those affecting the nervous system (meningitis, encephalitis); taking certain medications (tetracycline-based antibiotics, corticosteroids, biseptol, oral contraceptives); endocrine disorders; neoplasms in the head; cerebral edema due to injuries, operations,. With ICP, the headache does not have a specific location. An increase in intensity is noted with bending, coughing (read about), sneezing, and turning the head. The pain intensifies in the morning, which is associated with an increase in blood flow to the head in the supine position and increased production of cerebrospinal fluid.
Infection	The course of infectious diseases is almost always accompanied by severe headaches. The reason for this is the intoxication of the body due to the production of toxins by microorganisms. It is accompanied by fever, chills, body aches. Along with common colds and flu, headaches can be a sign of meningitis. On the site you can find out what to do with. In this case, it is growing in nature, in some cases it starts abruptly. May be combined with nausea and photophobia.
Brain tumors	With brain tumors, the pains are dull, bursting. At first, they can be rare, however, as the tumor grows, seizures become more frequent. Headache can be felt both throughout the head and in one half (where the tumor is located). With an increase in tumor size, ICP increases, so pain is felt in the forehead and neck. Nausea, vomiting, weakness, photophobia, mild fever, mental disorders, drowsiness, lack of appetite, and seizures are also observed. Increased activity provokes an increase in pain.
Blood pressure	During a pressure jump, the load on the heart and blood vessels increases. Infectious diseases (sinusitis, tonsillitis), hormonal drugs, changes in weather conditions can provoke this condition. Often, such jumps occur during the restoration of blood vessels after a stroke or after childbirth. More often hypotension suffers from attacks. They have a jump in pressure accompanied by dizziness and a fainting state. People with high blood pressure have constricting sensations, combined with nausea, which can last several days.
Hormonal disorders	A change in the hormonal background can be caused by many reasons. The situation most familiar to all women is a change in the concentration of hormones in the blood at the end of the menstrual cycle. Therefore, some women with PMS have headaches. This can be caused by an increased level of progesterone or a violation of the water-salt balance due to fluid retention due to an increased level of estrogen. Women who are prone to edema may develop small swelling of the brain tissue. Most often, pains are localized in the parietal and occipital part and are accompanied by a slight increase in pressure.
Excessive intake of salt, alcohol, liquid	Studies have confirmed that increased salt intake leads to headaches. A diet high in sodium (8 g / day) increased by 1/3 the incidence of headaches in the control group. With excessive use of fluid, in the case when it is retained in the body, edema can occur, which also leads to headaches. Alcohol can cause dehydration, it kills nerve cells, affects the liver, which cannot produce glucose in the right amount, upsets the metabolism - all this leads to the fact that after heavy intake of alcoholic drinks, the head often hurts.
Stress, depression	During nerve stress, depression, headaches often occur. In this case, there are several difficulties at once - the specialist is not always able to establish the root cause, as the patient speaks of the accompanying symptoms: fatigue, nausea, but not his psychological state. In addition, it is difficult to get rid of such headaches, since it turns out to be a vicious circle - a person does not rest because his head hurts and his head hurts due to stress due to the lack of proper rest.

Symptoms

The most common signs accompanying a headache include:

• feeling of pressure, heaviness in the head;
• inability to concentrate;
• aggression, nervousness;
• fast fatiguability;
• accelerated heartbeat;
• excessive sweating;
• pressure surges;
• dizziness, nausea, vomiting;
• sensitivity to weather changes;
• rapid pulse during small physical activities, intimate relationships.

In infectious diseases, headaches are accompanied by fever, chills, and pain in the eyes. Meningitis causes severe pain in the head, vomiting, and stiff neck.

With pressure surges, numbness of the fingers of the upper and lower extremities is observed, the pulse quickens, dizziness occurs.

Headaches caused by a violation of venous blood circulation are aggravated when lying down, as well as when forced to work with the head bowed, especially in a room where there is not enough oxygen.

Beam headaches are characterized by sharp and very intense manifestations. They can be chronic or episodic.

Diagnostics

Early diagnosis will help remove the causes of a bursting headache and eliminate the development of dangerous consequences.

As diagnostic methods can be used:

Bursting Headache Treatment

Drug treatment of VVD almost never gives the desired effect. Neither painkillers nor drugs to dilate blood vessels and improve blood supply help relieve pain. In this case, the use of sedatives, including herbs, is relevant.

Be sure to exclude factors that negatively affect the psyche, bring the work and rest regime into normal, abandon bad habits, and monitor mood. Since stress is the main cause of headaches in the case of VVD, it is recommended to consult a psychologist who will help to cope with existing problems and increase stress resistance.

Treatment of increased ICP in complex cases requires surgical intervention. The usual treatment regimen includes medication, massage and exercise therapy.

Medications used include diuretics, potassium-containing drugs, and corticosteroids. In some cases, treatment can be supplemented with traditional medicine: decoctions and tinctures.

Physiotherapeutic procedures include the use of:

• electrophoresis with aminophylline;
• magnet on the collar area;
• massage of the cervical-collar zone and spine;
• acupuncture;
• circular shower.

Mandatory dosed physical activity:

• swimming classes;
• tennis
• race walking.

Treatment for headaches with infections is determined by its intensity and causes. If you suspect a serious illness (meningitis, encephalitis, etc.), you must urgently consult a doctor to make a diagnosis. With colds and SARS, an antipyretic will help relieve a headache.

If a brain tumor occurs, it is important to identify the disease in time. In the early stages, it is possible to remove the neoplasm surgically without consequences.

With pressure surges, drugs are used whose action is aimed at bringing the pressure back to normal.

In the treatment of headaches due to changes in the hormonal background, it is necessary to build on the cause of the failure. It can be pregnancy, overweight, endocrine disorders, stress, physical activity or menopause. Depending on the reasons, a treatment regimen is being developed.

It is necessary to avoid dehydration, monitor the amount of fluid consumed, and also deal with its delay in the body and edema. Limit your intake of high salt foods and do not abuse alcohol.

For stress and depression, it is better to seek the advice of a specialist. It is necessary to avoid mental and physical overwork, try to get positive emotions. In this case, the doctor should prescribe drug therapy.

Prevention

There are a number of rules under which the probability of developing headaches decreases:

Read what to do when headaches and nausea after smoking.

In you can familiarize yourself with the treatment of shooting pain in the head on the right side.

Specialists what methods of prevention of tension headache.

All information on the site is provided for informational purposes. Before applying any recommendations, be sure to consult your doctor. Self-medication can be dangerous to your health.

Often, when visiting a neurologist, patients, when asked in what position the pain intensifies, respond when I lie. Based on a combination of headache with other symptoms, the doctor makes an appropriate diagnosis and explains why the headache (cephalgia) worries the patient.

Not always people are in a hurry to diagnose the disease due to various reasons. So why when a person is lying down, his headache intensifies?

Before you guess about the disease and make yourself a non-existent diagnosis, headaches should be learned to distinguish. A pulsating type headache is characteristic of vascular diseases. Most often, it is experienced by patients with vegetovascular dystonia, in whom it is bilateral. Unilateral headache is characteristic of migraine. This disease does not go away for a long time and increases with bright light, strong noise and other irritating factors. If a person has a headache worse when lying down and his face swells, then he may have venous cephalalgia.

Other causes of persistent headaches:

• protrusion of the intervertebral discs, scoliosis;
• intracranial hypertension or hypotension;
• a tumor in the base of the skull;
•   brain
• other neurosurgical ailments;
• gynecological diseases;
• neurological ailments;
• diseases of the cardiovascular system;
• lack of vitamins or oxygen;
• fatigue;
• neurosis;
• improper sleeping or working posture;
• too hard or too high a pillow.

In fact, in addition to the above list of reasons for which the headache can be chronic, there are much more provocative factors. Diseases of the kidneys, liver, eyes, ears, smoking, harmful work and other factors can always cause chronic headaches.

When a person visits a treating neurologist or a neurosurgeon, the doctor usually asks when the pain is unbearable: when you lie down or when you are upright. In some cases, the patient reports that with such headaches he is better off lying, then he begins to feel much better. Provided that this condition is caused by cerebrospinal fluid, most likely the patient suffers from intracranial hypotension. If it intensifies in a supine position, then in this case there is a pressure of cerebrospinal fluid on the walls of the cranium, i.e. there is intracranial hypertension.

Normally, a uniform distribution of cerebrospinal cerebrospinal fluid is carried out under pressure from 7 to 17 mm RT. Art. (although some experts believe that the maximum normal value is not more than 15 mm Hg. Art.). This provides excellent brain function without headaches. If a person has hypertension, his high blood pressure provokes vascular changes in the brain, resulting in an increase in intracranial pressure and, as a result, a prolonged headache.

With hypotension, a lack of cerebrospinal fluid affects the brain in such a way that this organ performs not only nutritional functioning, but also shock absorbing. In this case, cephalalgia, aggravated by walking or simply by being in an upright position, passes only during rest, when the patient is lying.

The danger of this disease is that the lack of cerebrospinal fluid has an extremely negative effect on the work of the brain and blood vessels of the head, and a fatal outcome may result. This is due to the fact that hypotension severely damages blood vessels and is capable of provoking hemorrhage, dislocation of the structures of the hemispheres and the brain stem. As a result, the damaged substance of the brain stem and hemorrhage lead at best to a stroke, and at worst to a fatal outcome.

Often, a headache is eliminated with conservative therapy aimed at restoring the water-electrolyte balance.

In this case, they often resort to therapy using isoosmolar solutions. If the patient is ill with liquorrhea, most often he needs treatment in a hospital.

Why does hypertension and tumors hurt my head and how to treat it

In the case of hypertension, headache often occurs due to excess fluid in the ventricles of the brain or in the fluid space. So that the patient does not bother with a headache, he is prescribed therapy aimed at the gradual normalization of fluid secretion. If the patient's condition is serious, he is referred for consultation to a neurosurgeon in order to prescribe the operation of this ailment. Then, to remove excess cerebrospinal fluid, which causes not only a headache, but also weakness, shakiness, dizziness, nausea and other signs, an operation is performed to install a shunt.

However, if the outflow of cerebrospinal fluid is too fast, this also leads to multiple poor conditions. In this case, the occurrence of cerebral edema, foci or hemorrhage may occur, which is fraught with serious harm to the patient’s health or even death. If it is impossible to perform a shunt operation, the neurosurgeon performs a cerebrospinal fluid puncture. If the patency of the paths is preserved, the headache can temporarily be eliminated after spinal puncture, in this case the main thing is to start treatment on time and correctly.