In the article, we will consider the classification of headache and its main clinical manifestations.
Among the most common pain syndromes observed in clinical practice, the main place is cephalgia. Headache can be considered any pain and discomfort that is localized in the head, although some clinicians are limited to the area localized upward from the eyebrows to the back of the head. Cephalgia can occur with more than 45 different pathologies. Therefore, the diagnosis and treatment of this pathological phenomenon is an interdisciplinary, general medical problem, which deserves the attention of doctors of all specialties.
What types of headaches in the ICD-10 are indicated below.
Pathogenesis
The pathogenesis of this symptom is not well understood. Cephalgia may be associated with irritation of the sensitive structures of this area from pressure, tension, displacement, inflammation and sprain. Along with the vessels and nerves, some areas of the dura mater, venous sinuses with their inflows, arteries at the base of the brain, large vessels, and also sensitive nerves passing through the skull have pain sensitivity. The brain tissue itself, soft membranes and small vessels do not have such sensitivity.
The classification of headaches is of interest to many.
Main reasons
Cephalgia may occur in connection with the following phenomena:
- development of spasm;
- traction or dilatation of arteries;
- displacement or traction of the sinuses;
- compression, inflammation or traction of these cranial nerves;
- cramping, inflammation, or injury to the tendons and muscles of the head and neck;
- irritation of the meninges and increased intracranial pressure.
The duration and severity of a headache attack, as well as its localization, can provide the necessary information for a correct diagnosis.
Classification
We give a classification of headaches according to the mechanism of occurrence:
- migraine;
- headache from tension;
- various types of cephalgia not associated with organic lesions;
- cluster pain and chronic paroxysmal hemicrania ;
- pain due to head injuries;
- pain associated with vascular disorders;
- pain due to non-vascular disorders inside the skull;
- pain associated with the use of certain chemicals or refusal of them;
- pain against a background of infectious diseases;
- cephalgia associated with metabolic disorders;
- cephalalgia or facial pain caused by pathologies of the skull, eyes, neck, nose, mouth, teeth or other cranial or facial structures;
- neuropathies, cranial neuralgia and deafferent pain;
- unclassified cephalgia.
Two varieties are considered the most common types in this classification of headache: migraine - 39% and tension pain - 53%, as well as post-traumatic cephalgia.
Migraine
This pathological condition is characterized by the occurrence of a paroxysmal recurring headache of a pulsating nature, as a rule, on the one hand. It occurs in 2-7% of the population, most often in women from 10 to 35 years.
In the pathogenesis of migraine (ICD-10 code G43 code), hereditary dysfunction of the vasomotor regulation of intra- and extracranial arteries is of great importance. In the course of an attack, 4 stages of vasomotor disorders replace each other:
- spasm of retinal and intracerebral vessels;
- dilatation of extracerebral vessels;
- swelling of the vascular walls;
- reverse development of these changes.
In the period of the first phase, an aura may occur, in the period of the second - pain in the head. In this case, metabolic disorders of serotonin, as well as other biological substances (histamine, tyramine, prostaglandins, glutamate, etc.) may occur, and neurophysiological changes are considered a trigger factor for an attack.
According to the international classification of headaches, migraine is divided into 2 types: migraine with aura and without aura. The predecessors of this condition can be childhood syndromes: abdominal migraine, accompanied by abdominal pain, paroxysmal dizziness, vomiting, tendency to motion sickness, alternating cuts of limbs.
Simple migraine
Simple migraine (without aura) is a one-sided pulsating cephalalgia. Most often, it does not cover the entire side of the head, but the parieto-occipital or frontotemporal region. Sometimes it is bilateral or there is an alternation of sides in the development of pain. The intensity of cephalgia is moderate or pronounced, at the end of the attack the pain becomes dull. During the attack, general hyperesthesia, intolerance to strong sounds, light is noted. In most people, the attack is accompanied by vomiting and nausea.
From 4 to 72 hours - this is, in this case, the duration of the headache.
Migraine with aura is also highlighted in the classification.
Migraine with aura
A neurological focal symptom preceding a headache that occurs immediately after the end of this symptom or after a short period. Most often, a visual aura arises, which is manifested by blurred vision, ciliated scotoma, zigzag lines of the field of view. It lasts up to 20 minutes, after which an attack of cephalgia occurs. In second place in frequency is an aura in the form of paresthesia. First appears in the finger of the hand, then rises along the hand and can spread to the face, mouth. Rare varieties of aura include hemiparesis, ophthalmoparesis, motor aphasia. Migraine with an aura in the form of a neurological disorder was previously called associated. Very rarely, usually in older men, a headache does not occur after an aura, and then this phenomenon is called local ischemia.
We continue to consider the classification of headaches.
Pain of tension
This type of headache is the most common. It affects about 6% of the population. Its etiology is associated with autonomic dysfunction, hereditary factors, psychological characteristics (anxiety), depressive states, chronic stress (physical, psycho-emotional).
Headache tension in the classification takes a leading place. The code for ICD-10 is G44.
In the pathogenesis of such pain, violations of the "gate control system" Wall and Melzak (noci-anti-nociceptive system), biochemical, vascular, neurogenic factors are considered. Pain of tension is a complex of pathological conditions from minor episodic pain to daily attacks lasting all day. Chronic and episodic cephalalgia of stress is distinguished. A conditional boundary is established between these states: 180 or more days per year — in the chronic form and less than that — in the episodic form. The main factors here are sensitization of the horn of the spinal cord, if the pain is chronic, and myofascial disorders in the pericranial muscles, which can be confirmed using the EMG method, but such violations are not considered obligate.
A kind of tension pain can be psychogenic pain, which is not accompanied by myofascial changes (tension pain without impaired pericranial muscle function).
This pathological condition is perceived by patients as a squeezing of the head, a feeling of heaviness. The pain of tension is localized most often in the forehead, cranial vault, eyes, and in some cases can radiate to the temples, neck, shoulders. Such a headache is often accompanied by psycho-vegetative disorders: loss of appetite, difficulty in breathing, nausea, sleep disturbances, sensation of a “coma in the throat”, increased fatigue (mental and physical), and impaired attention.
Occasional pain of tension, as a rule, has a paroxysmal course and can occur at different times of the day. The duration of the attack is from 30 minutes to 7 days. In this case, the patient constantly feels pain.
Unlike migraine, the strength of such a headache is mild or moderate, the sensations are oppressive (not pulsating), the location is bilateral, it does not increase with physical exertion. The pain of tension of an episodic form is not accompanied by nausea, phonophobia, and at the time of the attack practically does not violate a person's working capacity.
In the classification of headaches in neurology, chronic pain is distinguished.
Chronic pain of tension is similar episodic in nature, but manifests itself daily or more frequent attacks.
The absence of pathognomonic symptoms of tension pain, which distinguishes it from migraine, complicates its diagnosis. Almost half of the patients are diagnosed with symptomatic cephalgia associated with organic brain pathologies.
Stress headache can occur together with migraine. In approximately 10-50% of cases in the interictal period, chronic or episodic pain of tension is noted. Often they are joined by a third form - abusal, which is associated with the abuse of medications that eliminate cephalgia.
In the international classification of headaches, cluster cephalgia is indicated.
Cluster Cephalgia
Such pain is also called bundle pain, Harris ciliary migraine neuralgia, Horton histamine cephalgia, etc. This type of pain combines several divided forms: ciliary neuralgia, migraine and pterygopalatine neuralgia. In the international classification, three forms of cluster pain are distinguished depending on the frequency of their occurrence: with an indefinite frequency, chronic and episodic. Together with them, paroxysmal chronic hemicrania is also considered.
What types of headaches are, not everyone knows.
Cluster cephalgia (according to ICD-10 R51) is quite rare, men suffer from it several times more often than women, the onset of the disease is noted in 20-50 years. The etiopathogenesis of this type of headache is not known, but scientists suggest that it is based on the violation of certain vascular mechanisms.
Beam cephalalgia is characterized by bouts of sharp, excruciating, unilateral pain in the head, recurring daily for a long period of time, after which there is a similarly long pause. The intensity and duration of pain varies during the cluster period from lungs and short to pronounced and prolonged sensations. The pain occurs quickly, without precursors, and is observed in the eyes, temples, in the periorbital zone, radiation to the neck, ear, and arm is possible. The nature of such pain is boring, burning, and the strength is so great that it can even awaken sleeping patients. Initially, seizures develop at night, at the same time. During them, psychomotor agitation and pronounced autonomic disturbances, redness and lacrimation of the eyes, swelling of the eyelids, nasal congestion are observed.
What other types of headaches are there?
Chronic paroxysmal hemicrania
This headache is a rare variety of paroxysmal unilateral cephalgia, which is localized in the eye-frontotemporal region and has a pronounced intensity and a boring character. Attacks last up to 30 minutes, are repeated many times a day and are accompanied by vegetative disorders of the eyes and nose. From cluster chronic cephalgia they are distinguished by the fact that such pains prevail in women.
Neuralgia
It is another type of headache that people suffer from regardless of gender. The duration of seizures is from a couple of seconds to several minutes, they are repeated at certain intervals and are characterized by different degrees of intensity (from moderate to strong). Causes neuralgia irritation of one of the nerves.
Headache due to trauma
In neurology, there is a tendency to cause chronic cephalgia with past craniocerebral injuries. In the international classification, different types of headaches are distinguished, namely two types of post-traumatic cephalalgia: acute and chronic. And with each species, two more subspecies, taking into account the severity of the injury:
- significant, with neurological symptoms,
- insignificant, without those.
Acute post-traumatic pain occurs at the time of injury or after a two-week period. The light gap requires examination to exclude subdural hematomas and other complications of injury.
Chronic post-traumatic pain is characterized by the same symptoms, but it lasts for a rather long time. In the development of post-traumatic pain in the head, brain damage, a disorder of its integrative activity, psycho-vegetative dysfunction, psychological characteristics of the patient, psychogenic factors, rental attitudes are important. Such a headache is the result of the interaction of psychosocial and organic factors, which acquire significance in light injuries, while organic changes in severe ones.
Secondary headaches
The whole mass of various factors causes them. So, such a pain in the head occurs due to:
- injuries in the head and neck;
- various infections;
- individual reaction to drugs;
- alcohol and drug use;
- concussion;
- brain tumors.
The article discusses the classification of headaches.