医学精品课件：11&12.headache (2).ppt

1、Headache重庆医科大学附属第一医院神经内科重庆医科大学附属第一医院神经内科王恬竹王恬竹1Introduction A headache or cephalalgia is pain anywhere in the region of the head or neck.It can be a symptom of a number of different conditions of the head and neck.1.cephalalgia:/,seflld/n.pain in the head,headache cephal-:Latin prefix=head -algia:su

2、ffix=pain 2.region:a part of your body2The brain tissue itself is not sensitive to pain because it lacks pain receptors.Rather,the pain is caused by disturbance of the pain-sensitive structures around the brain.1.rather:adv.You use rather when you are correcting something that you have just said,esp

3、ecially when you are describing a particular situation after saying what it is not.更确切地说更确切地说 2.disturbance:a medical or psychological problem,when someones body or mind is not working in the normal way3Nine areas of the head and neck have these pain-sensitive structures,which are the cranium(the pe

4、riosteum of the skull),muscles,nerves,arteries and veins,subcutaneous tissues,eyes,ears,sinuses and mucous membranes.1、cranium|krenm|n.(plural craniums or crania)the round part of your skull that contains your brain2、periosteum perstrm n.a dense fibrous membrane covering the surface of bones,骨膜骨膜3、s

5、ubcutaneous|sbkjutens|adj.皮下的皮下的 sub/cutaneous：relating to or existing on or affecting the skin（cutaneum）4、sinus:any of various air-filled cavities especially in the bones of the skull4There are a number of different classification systems for headaches.The most well-recognized is that of the Intern

6、ational Headache Society.Headache is a non-specific symptom,which means that it has many possible causes.Treatment of a headache depends on the underlying etiology or cause,but commonly involves analgesics.1、etiology:the cause of a disease.aetiology2、analgesic nldi:zk:drugs reducing the effect of pa

7、in，painkiller.5ClassificationHeadaches are most thoroughly classified by the International Headache Societys International Classification of Headache Disorders(ICHD),which published the second edition in 2004.This classification is accepted by the WHO.Any volunteer?6ICHD-2The International Classific

8、ation of Headache Disorders(ICHD)is an in-depth hierarchical classification of headaches published by the International Headache Society.1、in-depth:adj.深入的，彻底的深入的，彻底的 e.g.discussion/analysis/interview2、hierarchical harrkkl:adj.classified according to various criteria into successive levels or layers

9、;7It contains explicit(operational)diagnostic criteria for headache disorders.The first version of the classification,ICHD-1,was published in 1988.The current revision,ICHD-2,was published in 2004.1、explicit ksplst:precisely and clearly expressed or readily observable2、operational:fit or ready for u

10、se or service3、criteria:(pl.for criterion)a factor on which you judge or decide something.inclusion,exclusion 8The classification uses numeric codes.The top,one-digit diagnostic level includes 14 headache groups.The first four of these are classified as primary headaches,groups 5-12 as secondary hea

11、daches,cranial neuralgia and central causes of facial pain,and other headaches,cranial neuralgia,central or primary facial pain for the last two groups.1、cranial neuralgia 颅颅神经痛神经痛 2、facial:adj.refer to face9The ICHD-2 classification defines migraine,tension-type headache,cluster headache and other

12、trigeminal autonomic cephalalgia as the main types of primary headaches.1、migraine:a severe recurring vascular headache 2、cluster headache:a painful recurring headache associated with the release of histamine from cells3、trigeminal:the main sensory nerve of the face and motor nerve for the muscles o

13、f mastication autonomic:relating to or controlled by the autonomic nervous system 1011Also,according to the same classification,stabbing headaches and headaches due to cough,exertion and sexual activity(coital cephalalgia)are classified as primary headaches.1.stab:use a knife on;stabbing:a sudden sh

14、arp pain.2.coital:relating to sexual intercourseThe daily-persistent headaches along with the hypnic headache and thunderclap headaches are considered primary headaches as well.3.hypnic:/hipnik/sleep inducing 4.clap:a sudden and loud noise4.Other primary headaches 4.1 Primary stabbing headache 4.2 P

15、rimary cough headache4.3 Primary exertional headache4.4 Primary headache associated with sexual activity 4.4.1 Preorgasmic headache4.4.2 Orgasmic headache 4.5 Hypnic headache 4.6 Primary thunderclap headache4.7 Hemicrania continua4.8 New daily-persistent headache12Secondary headaches are classified

16、based on their etiology and not on their symptoms.According to the ICHD-2 classification,the main types of secondary headaches include those that are due to head or neck trauma such as whiplash injury,intracranial hematoma,post craniotomy or other head or neck injury.1.trauma:any physical damage to

17、the body caused by violence 2.whiplash:/wpl/an injury to the neck(the cervical vertebrae)resulting from rapid acceleration or deceleration;挥鞭伤 3.hemo-:blood;-toma:tumor 4.craniotomy:/,krentmi/a surgical opening through the skull -otomy:a surgical cutting of a specified part or tissue -ectomy:resecti

18、on;gastrectomy 13Headaches caused by cranial or cervical vascular disorders such as ischemic stroke and transient ischemic attack,non-traumatic intracranial hemorrhage,vascular malformations or arteritis are also defined as secondary headaches.This type of headaches may also be caused by cerebral ve

19、nous thrombosis or different intracranial vascular disorders.1.cervical:relating to the cervix;relating to the neck 2.hemorrhage:bleeding 3.mal-:bad or unpleasant;4.artery arteritis 5.thrombosis:the formation of a blood clot in a persons heart or in one of their blood vessels14Other secondary headac

20、hes are those due to intracranial disorders such as low or high pressure of the cerebrospinal fluid pressure,non-infectious inflammatory disease,intracranial neoplasm,epileptic seizure or other types of disorders or diseases that are intracranial but that are not associated with the vasculature of t

21、he central nervous system.1.cerebro-:brain;spinal:relating to spine 2.neoplasm:/nioplzm/tumor 3.epileptic seizure:convulsions accompanied by impaired consciousness；癫痫；癫痫 4.vasculature:脉管系统脉管系统15ICHD-2 classifies headaches that are caused by the ingestion of a certain substance or by its withdrawal a

22、s secondary headaches as well.This type of headache may result from the overuse of some medications or by exposure to some substances.HIV/AIDS,intracranial infections and systemic infections may also cause secondary headaches.1.ingestion:the process of taking food into the body through the mouth 2.e

23、xpose to:uncover 16The ICHD-2 system of classification includes the headaches associated with homeostasis disorders in the category of secondary headaches.This means that headaches caused by dialysis,high blood pressure,hypothyroidism,and even fasting are considered secondary headaches.1.homeostasis

24、:/,hm()stess/内稳态内稳态 2.dialysis:separation of substances in solution by means of their unequal diffusion through semipermeable membranes;透透析析 3.hypo-:under;thyroidism:甲状腺功能甲状腺功能 4.fasting:abstaining from food17Secondary headaches,according to the same classification system,can also be due to the inju

25、ry of any of the facial structures including eyes,ear,nose,sinuses,teeth,jaws,or temporomandibular joint.Headaches caused by psychiatric disorders such as somatization or psychotic disorders are also classified as secondary headaches.1.temporomandibular joint:/,tmpromndbjl/颞下颌关节颞下颌关节 temporo-:颞部的颞部的

26、;mandibular:下颌的下颌的 2.psychiatric:relating to psychiatry 3.somatization:/,somtzein/a tendency to experience and communicate psychological distress in the form of somatic symptoms and to seek medical help for them 4.psychotic disorder:精神障碍精神障碍18The ICHD-2 classification puts cranial neuralgias and oth

27、er types of neuralgia in a different category.According to this system,there are 19 types of neuralgias and headaches due to different central causes of facial pain.Moreover,the ICHD-2 includes a category that contains all the headaches that cannot be classified.19Although the ICHD-2 is the most com

28、plete headache classification and it includes frequency in the diagnostic criteria of some types of headaches(primarily primary headaches),it does not specifically code frequency or severity which are left at the discretion of the examiner.1.at the discretion of somebody:任由他人自行决断任由他人自行决断 20CausesThe

29、re are over 200 types of headaches,and the causes range from harmless to life-threatening.The description of the headache,together with findings on neurological examination,determines the need for any further investigations and the most appropriate treatment.21Primary headaches The most common types

30、 of headache are the primary headache disorders,such as tension-type headache and migraine.They have typical features;migraine,for example,tends to be pulsating in character,affecting one side of the head,associated with nausea,disabling in severity,and usually lasts between 4 hours and 3 days.1.pul

31、sating:/plseiti/expanding and contracting rhythmically as to the beating of the heart 2.in character:in the nature 3.nausea:the state that precedes vomiting22Rarer primary headache disorders are trigeminal neuralgia(a shooting face pain),cluster headache(severe pains that occur together in bouts),an

32、d hemicrania continua(a continuous headache on one side of the head).1.bout:a period of illness 发作发作 2.hemicrania continua:连续性偏侧颅痛连续性偏侧颅痛,not migraine 23Secondary headachesHeadaches may be caused by problems anywhere in the head or neck.Some of these are not harmful,such as cervicogenic headache(pai

33、n arising from the neck muscles).Medication overuse headache may occur in those using excessive painkillers for headaches,paradoxically causing worsening headaches.1.cervicogenic:caused by problems in the neck 2.paradoxical:seemingly contradictory but nonetheless possibly true 24A number of characte

34、ristics make it more likely that the headache is due to potentially dangerous secondary causes;some of these may be life-threatening or cause long-term damage.A number of red flag symptoms therefore means that a headache warrants further investigations,usually by a specialist.1.red flag:a flag that

35、serves as a warning/danger signal 2.warrant:show to be reasonable or provide adequate ground for25The red flag symptoms are a new or different headache in someone over 50 years old,headache that develops within minutes(thunderclap headache),inability to move a limb or abnormalities on neurological e

36、xamination,mental confusion,being woken by headache,headache that worsens with changing posture,headache worsened by exertion or Valsalva manoeuvre(coughing,straining),visual loss or visual abnormalities,jaw claudication(jaw pain on chewing that resolves afterwards),neck stiffness,fever,and headache

37、s in people with HIV,cancer or risk factors for thrombosis.26 Thunderclap headache may be the only symptom of subarachnoid hemorrhage,a form of stroke in which blood accumulates around the brain,often from a ruptured brain aneurysm.Headache with fever may be caused by meningitis,particularly if ther

38、e is meningism(inability to flex the neck forward due to stiffness),and confusion may be indicative of encephalitis(inflammation of the brain,usually due to particular viruses).1.aneurysm:a saclike widening of an artery resulting from weakening of the artery wall 2.meningism:neck stiffness,Kernig si

39、gn,Brudzinski sign 3.confusion:a mental state characterized by a lack of clear and orderly thought and behavior27Headache that is worsened by straining or a change in position may be caused by increased pressure in the skull;this is often worse in the morning and associated with vomiting.Raised intr

40、acranial pressure may be due to brain tumors,idiopathic intracranial hypertension(IIH,more common in younger overweight women)and occasionally cerebral venous sinus thrombosis.1.idiopathic:/,dpk/arising from an unknown cause28Headache together with weakness in part of the body may indicate a stroke(

41、particularly intracranial hemorrhage or subdural hematoma)or brain tumor.Headache in older people,particularly when associated with visual symptoms or jaw claudication,may indicate giant cell arteritis(GCA),in which the blood vessel wall is inflamed and obstructs blood flow.1.subdural:below the dura

42、 mater but above the arachnoid membrane of the meninges 2.obstruct:block passage through29Carbon monoxide poisoning may lead to headaches as well as nausea,vomiting,dizziness,muscle weakness and blurred vision.Angle closure glaucoma(acute raised pressure in the eyeball)may lead to headache,particula

43、rly around the eye,as well as visual abnormalities,nausea,vomiting and a red eye with a dilated pupil.1.dizziness:a feeling that you are about to fall 2.blurred:indistinct or hazy in outline 3.angle closure glaucoma:闭角型青光眼闭角型青光眼 4.pupil:contractile aperture in the iris of the eye30Primary headaches

44、are even more difficult to understand than secondary headaches.Although the pathophysiology of migraines,cluster headaches and tension headaches is still not well understood,there have been different theories over time which attempt to provide an explanation of what exactly happens within the brain

45、when individuals suffer from headaches.31Pathophysiology One of the oldest such theories is referred to as the vascular theory which was developed in the middle of the 20th century.The vascular theory was proposed by Wolff and it described the intracranial vasoconstriction as being responsible for t

46、he aura of the migraine.1.aura:a sensation that precedes the onset of certain disorders32The headache was believed to result from the subsequent rebound of the dilatation of the blood vessels which led to the activation of the perivascular nociceptive nerves.1.rebound:n.a movement back from an impac

47、t 2.peri-:around 3.nociceptive:,nusiseptiv caused by or in response to pain 痛感的痛感的33The developers of this theory took into consideration the changes that occur within the blood vessels outside the cranium when a migraine attack occurs and other data that was available at that time including the eff

48、ect of vasodilators and vasoconstrictors on headaches.34The American College of Emergency Physicians have guidelines on the evaluation and management of adult patients who have a nontraumatic headache of acute onset.While,statistically,headaches are most likely to be primary(non serious and self-lim

49、iting),some specific secondary headache syndromes may demand specific treatment or may be warning signals of more serious disorders.Differentiating between primary and secondary headaches can be difficult.35Diagnosis approachAs it is often difficult for patients to recall the precise details regardi

50、ng each headache,it is often useful for the sufferer to fill-out a headache diary detailing the characteristics of the headache.Electroencephalograms have not been found to be useful in working up this symptom.1.electroencephalogram:EEG.a graphical record of electrical activity of the brain electro-