Guide to headaches

Anton Loboda, anesthetist resuscitator specializing in getting rid of pain told her all about the pain and answered a number of questions. Published his guide through the pain.



About medical specialty: pain management ("working with pain")

It should say that in medicine I went exactly to rid people of pain, the anesthesiologist-resuscitator was for the same reasons and now going in separately evolving specialty – specialist in pain management (pain management) all for the same reason.

Why a specialist in pain? And so all the spices know. The problem is that the specialist that comes with pain, will look, and if its not it finds one, it sends further down the list. For example: a person has chest pain, he goes to the cardiologist, he referred to the pulmonologist, he is a neurologist and this may continue or chronic pain or independent of its passage. Moreover, the patient remained without a diagnosis, respectively, without recommendations for the prevention and, if necessary, the treatment of pain when they return.

Specialist in pain assesses pain, find the source and then if necessary sends to the spice already with the diagnosis while trying to numb the pain and give advice on pain relief.

What is the pain

The pain is different. Is the concept of acute pain, it is instant and intense. There is a concept of chronic pain, and often there is no longer a substrate for the pain, everything has healed and gone, but the pain is there and then the pain is not intense, and more exhausting.

In General, pain is the body's response to the stimulus with the subjective emotional color. It really is verified evolutionary mechanism that is protective: damaged — do not load,. Another question: mechanisms of damage and the various different structures are damaged and the pain from these structures is perceived differently. And sometimes all is already healed, but the pain is still there.

Pain scale

I must say that I (like most) was a fan of a visual analogue scale, which quickly reflects a very subtle and subjective substance as pain.



Visual analogue scale of pain.

Comes to you people with 10 of 10 points on the visual analog scale, and leaves with a 2 out of 10. A very clear result: unbearable pain remained low background pain.

After local injection therapy it is possible to understand got there or not there, whether the source of pain and/or makes how (if at all makes) in its contribution to prick the structure.

Headache and myths about her

About the headache you can talk endlessly, it is individual from the beginning of its formation to the trigger points of which it arises. Head really hurts special this feature the patient is usually unable to articulate. Hurts something, somehow, somewhere, as if. While I will describe three types of pain, the most frequent, and then I will add extravagant occasions.

Immediately dispel a few well-established myths:

Myth: a headache is a sign of high pressure. However, only the case in attack of the flow (the figures above 180/120 mm Hg.St). In terms of migraines so do the high blood pressure is the prevention of attacks or relief.

First, by itself, the pain partly stimulates the sympathoadrenal system, which gives an increase in blood pressure. Second, psychologically dissipate the pressure increase. Thirdly, there is the concept of error of measurement of pressure: improper technique of pressure measurement, the blood pressure monitor is acting up, not prepared for the measurement.

Especially the last moment when a couple of times out of the office a man comes to me after 3 cups of double espresso, 2 cigarettes, a sleepless night and bring it to me with some kind of super important meetings. And here he is in a panic requires a pill, I give him the pill, not only from the pressure, and soothing and asking for 10 minutes in a darkened room to lie down and count your breaths. And, lo and behold, pressure is normal.

There was a study within the sports medicine, where runners, weightlifters and swimmers measured pressure during exercise. Unprepared people would say that a person hypertensive crisis and he needs the pills, but they did not die and the pressure they have at the end of the load returned to normal. The mechanism of pressure increase during stress and exercise — about the same. And the head of the way, from increase pressure they ached.

Myth: no-Spa will relieve headaches. This is not so. If Pepto helps, the placebo effect with the same headaches tension has not been canceled. When they can make almost anything and it will work, just probably because you very much want to work.

There are 4 main types of headaches:



 

Further more about them: how to identify and treat.

Headache a busy type

You have to be honest and say that it is not known what specifically hurts: studies conducted since the mid-1980s. at First thought that the muscular hypertonicity of the occipital region and neck gives pain checked out – no, muscle is normal. However, decided to retain the term "headache busy" or "tension headache". What have you learned: the pain is clearly associated with stress. Accordingly, the problem is not only outside but inside, or rather somewhere in the region gippokampa.



Green doctor said the usual pain when entezopatii.

Often talks about enthesopathy, especially in the area of skull base is an interesting thing. Entity is the region of attachment of the muscle to the periosteum. These points are innervated by very intensively (that is, they have a lot of nerve endings), and accordingly minimal trauma to this area causes pain.

The analogue of the inflammatory process after trauma, can be maintained for quite a long time due to the fact that we are people active and Willy-nilly head stir and turn the power on the already injured area. I often see in practice: heavy patients or severe headaches I injections of painkillers in the attachment area of the nuchal muscles and all is well.

Diagnosis of headaches a busy type.

In the United States like tension-type headaches and migraines (a migraine is a separate subject, I will consider it in more detail below) have a system of criteria.

For tension headaches must be present 2 of the following criteria:

• The pain is pressing or compressing, not throbbing;
  
  
• Occipital–parietal / occipital–frontal localization;
  
  
• Bilateral (two-sided) medium or low intensity (visual analogue scale of pain is usually from 1 to 5 points);
  
  
• Is not increased during physical activity.
  
  

It is worth noting that this pain does not prevent to live, and often when you communicate with such a patient, you begin to tell him something, to show every possible way to divert the pain disappears, but appears at the termination of a distraction. This once again confirms that there is something in the brain because it develops and supports.

A tension headache is also divided into paroxysmal (acute) and chronic. The attack lasts from 30 minutes to 7 days. Chronic: not less than 15 days per month for at least 6 months in a row. It is worth noting that this pain can wear a background character and is subjective people don't even perceive as a headache, but it's still a headache.

Headache treatment busy like:

First line:

• NSAIDs (nonsteroidal anti-inflammatory drugs) like aspirin, ibuprofen (Nurofen), Ketoprofen (Ketonal), indomethacin etc, or selective blockers of COX–2 and coxibs (celecoxib, enterococci);
  
  
• Antipyretics/analgesics such as metamizol (dipyrone) or paracetamol (usual dose 1 gram).
  
  

I prefer to initially prescribe paracetamol, it is well helps in the dose of 1 gram. Ketorol very good painkiller, but he never prescribed and otherwise kept a distance from him because of gastrotoxicity: may cause ulcers of the stomach and duodenum.

Paracetamol is the safest at the moment the drug is 1 gram 4 times a day is considered a safe dose. Instead of ibuprofen, I would recommend coxib, those on the stomach to a lesser degree, but on the kidneys are also, however, can be too long may be taken with protection of the stomach (taken after meals, diet + blockers proton pump), — judging by the patients who take it for life.

In General, the NSAIDs would soon come to naught, when will generic celecoxib. (the original expensive: 400-1200 rubles per pack).

Second line: more strong painkillers in combinations paracetamol/codeine, paracetamol/tramadol.

Third line: add antidepressants, for chronic tension headaches. In our country very strange and very wrong attitude to antidepressants. Only recently returned from Austria with learning in the school of pain management, where a German specialist in pain management said that 100% of patients undergo a psychiatric examination in the framework of the monitoring of depression.

The pain itself a vile thing, except masochists, no one particularly likes, but here it is a long time, if ever gets into your life. Whether the pain provokes and supports depression, whether originally a hidden depression provokes and maintains pain. The connection is proven, it is and it is necessary to do something. In this context, the purpose of antidepressants is justified and necessary.

The objective of antidepressants is to reduce the number of attacks in combination therapy (I always emphasize it because one pill you don't take a comprehensive pain), ideally to zero. I explain: we don't treat antidepressant depression as such, we remove the depressive component of chronic pain. Often patients refuse to take antidepressants, they say what they told me, I'm not depressed.

Have to explain that depression is a serious disease that has a different manifestation. One man marching with depression out the window a couple of years of the disease, and someone with mild depression myself marinating over the years, not even thinking that the daily negativity that allegedly dumped on him — the manifestation of this very mild depression, if it is without pain.

And if the pain, the life of the common man and the life of a person with chronic pain, but rather a man who was not in pain and then she arose and chronicals is two different lives. For example, often ask the patient about his past to the pain and he talks about himself as about another person: "I've travelled / worked / liked to do (insert missing), but now can not because of pain." And here is one of the origins of the depressive component.



A life without pain.



Life with pain.

 

Ideally, of course, necessary examination of the psychiatrist, with the aim to professionally confirm the depressive component and how it is expressed that patients with chronic pain is close to 100%.

It should be noted that under unsystematic continuous administration of drugs may develop medication-induced headache. That is, the pain associated not with the original problem of headaches, and immediate pain relief means. This usually develops after 3 months of system acceptance and is very difficult to distinguish tension-type headache or migraine from medication induced headaches.

It the rule is simple: no more than two preparations per day not more than two times a week.

Pills are nice, but you have to understand that headaches are not the cause but the consequence. So I recommend to change the way of life:

• Regular physical activity/sports (if not engaged in a gym, simply walk at least 2 hours a day. Don't stand on the escalator, and go. Don't wait for the Elevator, and go up the stairs. Good weather? Walk a couple of subway stations and so on);
  
  
• Quitting Smoking and large amounts of coffee;
  
  
• Normal life: sleep (too much sleep is bad, too little bad, 6-9 hours is the norm), regular meals (usually fractional 4-5 times a day in small portions, hunger is a very serious instigator of the stress) and so on.
  
  
• Different meditation techniques, cognitive behavioral techniques, consultation with a psychiatrist and therapist to identify and change the relationship to stress and increase stress resistance. It is important not only what we experience pain, it is important how we perceive and how we are able to control it, not it us.
  
  

Also the cause of the pain can be a calcium deficiency. Sometimes the patient comes in, you look the spit of the lower muscles, and there are tense and painful on both sides. This often happens when calcium-deficient tetany.

All around the polls say, I need to drink calcium, but few know that calcium is not absorbed from the intestines if there is a deficiency of vitamin D. Accordingly, on the background of deficiency of calcium formed persistent muscle hypertonicity, which not only gives a headache, and pain in many parts of the body.

Along with muscle pain cramping of the limbs/face, a feeling of a lump in the goal that you can't swallow, or choking when swallowing (as a result of spasm of the esophagus) is the main symptoms. Painkillers and muscle-relaxing pills in this case will not help or will help, but not for long and not to the end. You need to restore the vitamin D.

Migraine: what is it, types how to treat

Ancient disease. History will say that the name was born because of the perverted Greek words hemkrania ("pain on one side of the head") into Latin in the form hemigranea and then in the French migrane.

For people suffering from migraines for the record, at the moment, the migraine is not treated. It is a hereditary or acquired thing that is characterized by dysfunction of the brain. No, this does not mean that there is a tumor or some other pathology. This means that unlike other people your brain a bit to respond abnormally to some precipitating headache factors.

This suggests a simple conclusion: find the triggers and avoid them, take control. This is one of those diseases (as in many chronic diseases), where the doctor has a very small effect. We as doctors give you the tools and you have to work with the disease yourself, you will not do it.

What is the cause of migraine? As in tension-type headache is unknown. Previously I thought that the problem in the blood flow and vasospasm or their extension. Checked the blood flow on the attack – everything is fine. Now the concept is not vascular, and neuroendo–vascular. Initially for some unknown reasons, there is neurogenic processes that lead to sterile inflammation in the brain with secondary changes in cerebral blood flow.

I highlighted the word "change" because it is not a violation, it is a variant of dysfunction. Everything works, but it works a bit wrong. The light is not flashing, it is lit but not so bright as before, and then again erupted.

Genetics work here for 70%. A huge negative factor: if a person is neurotic, excessive susceptibility and mental instability, cognitive povedencheskie disorders acute reaction to stress, panic attacks and other anxiety-hypochondriac people, so to speak.

Here he writes for the diagnosis of "migraine" international society of headaches:

First: there must be at least 5 headaches lasting from 4 to 72 hours, also these headaches must have two signs of the following:

• — Unilateral (one-sided) localization;
  
  
• The pulsating nature of the pain;
  
  
• The pain from medium intensity to very strong (usually from 5 to 9-10 on the pain scale)
  
  

During the headache also must be at least one of these signs:

• — nausea or vomiting;
  
  
• — photophobia or phonophobia (dislike/fear of light or loud noises);
  
  

And in the end, all the above should have no overlap with other diseases existing at the time of inspection of the patient.

Officially diagnosed variants of migraine:

1. migraine without aura (common migraine);

2. possible migraine without aura;

3. migraine with aura (classic migraine);

4. possible migraine with aura;

5. chronic migraine;

6. chronic migraine associated with the excessive consumption of painkillers;

7. childhood periodic syndromes that may be precursors to or associated with migraine;

8. migrainous disorder not fulfilling the conditions of the criteria.

A few words about migraine with aura and the aura. "Aura" refers to sensory, motor and visual phenomena, time (20 to 60 minutes). Are individually are in combination. The most frequent: a visual phenomenon, the type of scotoma is the loss of the area of view with zigzag boundaries, which eventually shifted to the periphery.

Here's a variation of scotoma:



Migraine treatment

It's complicated and individually, as and when the pain tension. The difference is that it is dysfunctional sore and, accordingly, there are drugs that treat pain (abortive drugs), and there are those who spend the prevention of its development (preventive).

Usually if there is vomiting, then start with her: give antiemetics (anti-nausea), then just give NSAIDs, but high in effectiveness dose, then if that doesn't help, then connect triptan.

For prevention are very different drugs and antiepileptic drugs and antidepressants, and drugs to reduce pressure such as beta blockers, and calcium channel blockers, but not to reduce pressure and to prevent migraine headaches. To recommend the medicine stupid, because everything is very individual: someone one helps, the other is not and Vice versa. The most important thing to understand are the provocateurs of migraine development and to minimize contact with them, or always ready to take the abortive medications.

It is important to keep a diary of headaches: when a headache as, in the background, took, helped/not helped, and how? Step by step in yourself to understand and understand what is right and what is wrong, what should and should not be for you personally. The doctor here only puts beacons and specifies a path, but to go through it, everyone should.

Just want to say one important thing with migraines: it is not necessary to wait for the development of pain. Once you realize that it starts here or came here immediately to drink painkillers. The sooner you start, the better the effect.



It is not necessary to wait for the development of pain — the sooner you take the remedy, the better.

Cluster headaches

Cluster headaches pronounced headaches usually behind the eye, above the eye or temple, lasting from 15 to 180 minutes from 1 times to 8 a day. Always 10 out of 10 on the pain scale. Usually happens with them tearing, redness of the conjunctiva, runny nose, drooping of the upper eyelid or swelling, all on the same side of the pain.

The mechanism of development are not fully known. Expect a genetic factor and the development of nonspecific inflammation in the cavernous sinus and upper eye Vienna and the development of pain has something to do trigeminalna c-hypothalamic path. Also there are trigger factors that contribute to: alcohol, nitroglycerine, relaxation/tension, histamine, high altitudes and the flashing light.

Under the form distinguish episodic and chronic. Cameo is an Association of cluster pain during periods, that is, respectively, 2 cluster period from 7 days to one year, separated by 1 month without pain. Chronic is painless when period less than a month.

It is necessary to tell also about neuroimaging, such pains are secondary, and find MRI structural brain damage. So all patients with cluster pain I recommend doing a brain MRI.

Treatment of cluster headaches.

Very good at helping the oxygen, 10-12 liters per minute. It often happens that giving to breathe, and after 15 minutes it goes away. If does not help, add triptan, a sedative for example. Triptan good, but they are not commonly used and still there are contraindications cardiovascular diseases, pregnancy. There are abortive therapy is not aimed at preventing attacks, but rather on reducing the frequency of attacks. I read about the drugs lithium and verapamil.

Also assists in avoidance of triggers — anything that causes pain. No provocation, no headache.

Singanna facial and headache

It also applies rhinogenous headache. This is about you, forever smugaua nose allergies, about you sinusitis with inflamed sinuses. Yes, headaches accompany sinusitis, and not just accompany, and are sometimes the first sign. Especially, slack, sluggish.

Often people don't even know what the problem is, I just have a headache and all, especially when you bend over to pick something up, tie your shoes and "so direct head hurts!" — tell patients. It's not dull, aching pain in the head, not a throbbing migraine headache, or fall out of the eye in the cluster of pain — this pain that is unbearable. Sometimes you can gently tap (propertycasualty) in the projection of the anticipated sinusitis and get a reasonable response from the patient in response with increased pain.

The types sinogenic facial and headache:

• Frontal (forehead) sinus pain in the forehead, the crown of the head and above/ behind eye.
  
  
• Maxillary sinus pain in upper teeth and painters. Often, these patients give dentists when sure teeth very well.
  
  
• Etmoidit — postorbital pain radiating to the temple.
  
  
• Steroidit — Crown, forehead, postorbital part, even the head.
  
  

Treatment. Of course, it is necessary to treat not so much a headache, as its source. You first need to make the paranasal sinuses or CT scan, to assess whether to prescribe antibiotics. Then the hormones in the nose, regular intense flushing, NSAIDs and look development. With chronic sinusitis, polyps and all sorts of mucocele — a separate issue.

A headache in the hangover

The pain from the hangover — classic pain voltage of + cervicogenic headache. We have natural mechanisms of change in body position during sleep so as not to "talegate" limbs or head. Alcohol these mechanisms turns off and we are in what position fell, and then sleep, sometimes it uncomfortable for the cervical spine and accordingly takes the neck muscles in hypertonus. Wake up without alcohol and anesthesia with combined headaches.

 

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Why is it that even before sleep, before the hangover, drink analgin and then not hurt? Well, most likely initially turn off an inflammatory cascade, which then gives pain. Why not working then? Probably because the cascade engages in the midst of not only muscles but also neural structures, which are the drugs that take, do not apply. Or in addition to tension-type headache develops a migraine attack and as I described above — it is necessary to stop immediately, with the passage of time it is more difficult to handle.published

Author: Anton Loboda

 

Source: www.zozhnik.ru/gid-po-boli-kak-izbavlyatsya-ot-raznyx-bolej/