What kind of examination for headaches. The importance of examination for headaches. Angiography - what is it

The first question that a neurologist faces when a patient comes to him is what kind of pain is he dealing with? - from the secondary or from the primary (in that order). And first of all, it is important to exclude such serious causes of headache development as a tumor process, inflammatory changes, and vascular disorders.

The arsenal of modern medicine has a wide range of various research methods nervous system, evaluation of her work in any place and at any level.

In addition to the instrumental examination, during the examination the neurologist examines facial expressions, eye movements, muscle function, range of motion, muscle strength and tone, and the ability for normal coordination of movements.

The information obtained during the examination helps determine the primary or secondary nature of the headache, confirm the diagnosis, and identify contraindications to the prescription of certain medications.

It should be borne in mind that at the first consultation with a specialist, a lot will depend on the patient. The patient, if possible, needs to formulate his complaints as detailed and accurately as possible and tell the history of the disease, as well as answer some questions.

In particular, it will be important for the doctor to find out the patient’s age when the headache appeared, heredity, the course of the disease (attack-like or non-attack-like headache, etc.), the frequency of attacks and episodes of headache at the beginning of its appearance and in subsequent years, whether there is a connection between the increase in attacks and external circumstances, the time of attacks during the day, the duration of pain attacks, the “pattern” of pain (localization, irradiation, nature painful sensation, intensity).

To make your story more specific, the patient can prepare a written description of the headache on a sheet in advance and take it with him to the doctor. You can make notes about the nature of your pain immediately after a painful attack. This will help the doctor make a more accurate diagnosis. After all, the assessment of a headache directly depends on the psycho-emotional state of a person. And over time and under the influence of external circumstances, the description of pain may differ from reality.

Dopplerography

Dopplerography is one of the main examination methods in neurological practice, through which the functioning of blood vessels is assessed.

Encephalography

An electroencephalogram, or EEG for short, records the activity of a huge number of brain neurons through the intact skin of the skull.

Magnetic resonance imaging of the brain

Magnetic resonance imaging (MRI) provides images of the brain and spine in various planes and with a high degree of resolution.

Blood tests - why take them?

In a comprehensive examination of the patient and identifying the causes of headaches, various blood tests may be prescribed. Headache may be a sign of some infectious diseases. Blood tests can reveal signs of infection and inflammation. In particular, a general blood test shows the number of leukocytes. They protect the body from viruses and infections.

What types of headaches are there? What examination should be done for headaches? What factors influence headaches? What types of headaches are there? Although headaches are one of the most common complaints, they can impair a person's quality of life in the same way that chronic diseases (diabetes, heart failure or asthma) do. Headache is a symptom of more than 40 various diseases, and most often motivates people to take analgesics. It is very important to distinguish between primary and secondary headaches. Primary – independent forms of headaches, such as migraine, cluster pain, tension pain. Secondary – accompany a more serious disease. Headaches can be classified depending on the factors that provoke them: 1. Migraines. 2. Tension or tension headaches. 3. Cluster headaches (chronic paroxysmal hemicrania). 4. Pain caused various lesions– squeezing, cold, severe cough. 5. Headaches after injury. 6. Headaches due to vascular diseases. 7. Headaches as a result of diseases not related to blood vessels. 8. Pain caused by exposure to certain substances or cessation of this exposure. 9. Headaches as a result of metabolic disorders (hypoxia, hypercapnia). 10. Headaches caused by inflammation of the sinuses, mouth, ears or eyes. 11. Neuralgia of the occipital nerve. 12. Pain that cannot be classified. What examination should be done for headaches? Examination in case of complaint headache aimed at searching for diseases that can cause it. The following factors cause suspicion of secondary headaches: - pain in people over 50 years of age; - increased habitual pain; - pains that are not similar to those that were previously; - long and progressive headaches; - increased pain when coughing, sneezing, sexual intercourse, physical activity; - if the pain is accompanied by impaired vision, speech, hearing, reflexes; - if there is weight loss, fluctuations in blood pressure, cough, runny nose, breathing problems. During a physical examination of the patient, the following is carried out: - palpation of the head, search for the consequences of injury (seals, pulsation of the artery); - examination of cranial nerves and fundus; - examination of the oral cavity (toothache); - examination of the temporomandibular joints, correct bite, symmetry and mobility; - check of cervical lymph nodes, arteries, thyroid gland; - checking pain sensitivity of the arms, legs, shoulders; - checking muscle strength in the arms and legs; - examination of internal organs to search for systemic diseases; - studying posture, its symmetry, feeling trigger points on the shoulders and back. Computed tomography and magnetic resonance imaging of the head are carried out in the case of: - disturbances in the patient’s consciousness and behavior during headaches; - for pain that is aggravated by coughing, sneezing, or physical activity; - excessive tension (rigidity) of the neck muscles; - first attacks of pain in people over 50 years of age; - pain of an unusual nature; - increased habitual pain. What factors influence headaches? Headaches can be caused by a variety of factors everyday life. When visiting a doctor, it is important to remember and report what exactly triggered the attack. The causes of headaches can be divided into groups: 1. Hormonal - in many women, headaches are associated with ovulation, menstruation, menopause, and taking hormonal medications. 2. Psychogenic - very often pain appears as a result of stress, returning to work after vacation, depression, and frequent anxiety. 3. Food - alcohol in any form can cause a headache, also “harmful” foods include: cocoa, nuts, eggs, aspartame and nitrites in food. Irregular eating also leads to pain. 4. Factors environment– too bright light, weather changes, working in poor lighting – provoke headaches. 5. Bad dream or excessive sleep also trigger the pain mechanism. 6. Taking some medicines is also a factor (nitroglycerin, histamine, reserpine, ranitidine, hydralazine, estrogen). 7. Other reasons include: head injuries, physical fatigue.

If your head hurts several times a week, this is already a reason to consult a doctor. So, let's look at the main causes of headaches and the specialists you should contact.

The first doctor you should visit is a general practitioner. He will conduct an initial examination and give directions for tests.

Headache due to overwork

It’s as if your head is being squeezed by a hoop. The pain is monotonous and seems to be spread all over the head. With chronic fatigue, your head will hurt more than 15 days a month for several months.

First aid:, breathing exercises, hot bath with aromatic oils and salt. For severe pain, it is recommended to place a wrung-out hot towel on your forehead. Drink freshly brewed green tea and sleep more.

Headache "due to blood vessels"

The pain is intense. My head feels like it's splitting. There is a strong knocking in the temples. I want to lie down and not get out of bed. The face may become puffy. One of the signs of problems with the vascular system is the onset of headaches during sudden weather changes and a few days before menstruation.

First aid: for intense pain - wet compresses. If your face turns red during an attack, use a hot compress; if it turns pale, use a cold compress.

Traditional medicine advises drinking herbal teas based on hawthorn, lemon balm and dried cucumber. Smoking and drinking coffee are strictly not recommended.

Migraine headache

Very difficult to bear. Typically, only one side of the head hurts, but migraines can be accompanied by nausea and vomiting. In acute attacks, loss of consciousness is possible.

The pain may last from several hours to several days. Migraines affect women more often than men; this may be due to hormonal conditions.

First aid: do not waste time on self-medication, rather go to a therapist (and do not be alarmed if he gives a referral to a psychotherapist, this is a feature of the disease).

Tablets, teas and cold compresses are ineffective for migraines. It is important not to aggravate existing pain. Try to create silence. Dim the lights. Take a warm bath with essential oils lavender, lemon, mint.

Headache due to poisoning

Intoxication of the body often leads not only to digestive system disorders, but also to headaches. The pain will continue until the toxins are eliminated from the body.

But, paradoxically, it may also be due to a lack of toxins. Those who use nicotine, alcohol, caffeine and other substances that are not the most beneficial for the body know well that without receiving a “dose”, the body begins to “be capricious”.

First aid: in case of poisoning, consult a doctor. Gastric lavage followed by diet may be required. With headaches that accompany a lack of a particular substance in the body, only time will help if the decision is made not to return to the bad habit. To relieve pain, you can drink green tea and give yourself a head massage.

Which doctors will help with headaches?

For severe and frequent headaches, first consult a physician. Next, be prepared for the fact that you will have to undergo an examination, take tests and visit one of the specialized specialists.

To confirm the diagnosis of primary headache, it is not necessary to detect any changes during examination. This does not mean at all that the headache is “not real” or has no cause. The simple fact is that headaches in most cases are a paroxysmal (occurring periodically for a short time) condition. Therefore, usually when a patient comes to the doctor (outside the attack period), upon examination, nothing except some tension in the pericranial muscles or a slight increase in reflexes can be detected (see the reasons for more details). However, a general and neurological examination is mandatory to exclude secondary, sometimes dangerous reasons headache.

Naturally, each doctor has his own diagnostic techniques that he uses to examine the patient. However, there are a number of parameters that you should definitely pay attention to. As an example, we present the examination protocol adopted at the Center (treatment/Center) for Headache at the Department of Nervous Diseases of the Faculty of Medical Sciences of the Faculty of Medical Sciences named after I.M. Sechenov (head of the department, Professor V.L. Golubev).

• Pulse, blood pressure and, in some cases, respiratory rate and temperature.
• Head size and shape.
• Changes in the eyes, including increased intraocular pressure (typical of glaucoma).
• The condition of the temporomandibular joint - is there pain, are movements difficult, are there any clicks or unpleasant sensations when opening the mouth.
• Scalp, neck, shoulders, spine - pay attention primarily to muscle tension.
• Temples - the condition of the temporal artery (does it protrude, is there any swelling), is there pain or tension in this area.
• Arteries of the neck - the doctor listens to see if there is any noise in them and feels the pulsation.
• Thyroid gland - by feeling it (located on the front surface of the neck), it is determined whether the gland is enlarged.
• Cranial nerves - their function is very important to evaluate in order to exclude organic causes of headaches (i.e. structural, rather than biochemical disorders).
• Sensitivity - sensitivity of the skin (all over the body) to irritants such as cold, pin pricks, vibration.
• Muscles - tone and strength; It is especially important to notice muscle tremors (may be due to hyperthyroidism, Parkinson's disease, multiple sclerosis, anxiety, as well as side effect some drugs).
• The cerebellum is the part of the brain located at the back of the brain. The safety of its functions is assessed, the main of which is coordination of movements. For example, one test is to close your eyes and touch your nose with the index finger of your outstretched hand.
• Reflexes, including pupillary (reaction to light, etc.) and tendon (for example, knee).
• Mental health - signs of depression and anxiety, including anxiety attacks and intrusive thoughts. With post-traumatic headache, there is an inability to concentrate and memory impairment.

In addition to searching for the cause of the headache, a general examination of patients is necessary to diagnose other diseases (bronchial asthma, hypertension, coronary heart disease, etc.). Information about concomitant diseases is important, if only because when choosing a method of treating headaches, you need to take into account what medications the patient is already taking. In addition, some medications may be contraindicated for the listed pathologies.

Which doctor should I consult for headaches? This question is very often asked by those who regularly suffer from unpleasant sensations in the frontal, parietal, temporal or cervical part of the head. To relieve discomfort, most people take painkillers. But, as a rule, they give only a temporary effect. Therefore, if you experience constant pain, you should definitely consult a doctor. So which doctor should you contact for headaches? We will talk about this in this article. We will also tell you about possible reasons discomfort, diagnosis and treatment.

General information

Headache is the most common symptom that occurs not only in adults, but also in children. This medical term includes almost all types of discomfort and pain localized in However, in everyday conditions it is increasingly used to refer to unpleasant sensations in the skull.

Types of pain

Before I tell you about it, I should tell you what types of such unpleasant sensations there are. Currently there are 4 main types. Let's look at them in more detail:

• Muscle tension due to long-term stress or compression of the soft tissues of the head.
• Vascular pain, characterized by noticeable pulsation. They occur when there is a mismatch between the resistance of the vascular walls and an increase in the pulse volume of blood.
• Neuralgic pain, characterized by sharp and cutting sensations. With cephalic neuralgia, so-called trigger zones are formed. After pressing on them, noticeable pain occurs, which can spread to neighboring or distant areas.
• Liquorodynamic pain. It is divided into 2 types, each of which is directly related to the tension of the vascular membranes. Pain caused by intracranial pressure can vary. When elevated, it is bursting, depends on the position of the body and intensifies with straining and coughing. If it is low, the pain intensifies when the patient is standing and decreases when the head is tilted.

Other types

In addition to the mentioned types of headaches, experts also identify 2 additional ones. These include:

• Mixed pain, that is, a combination of some basic types.
• Psychalgia or hypochondriacal, central pain, in which it is not possible to objectify all of the above factors.

Headaches: diseases and causes

Any unpleasant sensations in the skull have their own reasons for their development. To improve your condition, you should find out why such discomfort occurs. Doing this yourself is quite problematic. Therefore, we recommend that you consult a doctor immediately. If you do not have this opportunity, we recommend that you monitor your condition and try to identify the cause yourself.

Muscle tension

This is the most common form. It appears gradually and usually goes away within a few hours or days. With strong emotional stress, discomfort in the skull can occur suddenly.

This pain is bilateral. It is usually localized in both frontal lobes or the fronto-occipital region. Sometimes the discomfort takes on a dull, compressive character and spreads throughout the skull. The patient may experience discomfort when wearing a hat, combing his hair, and also at night.

The reasons for this condition may be: uncomfortable posture, a combination of muscle-tonic factor and emotional chronic stress, incorrect posture, prolonged and frequent stressful situations that are associated with anxiety, anxiety and depression, osteochondrosis.

Tumor

Neoplasms can also cause headaches. Usually they are gradually progressive. Unpleasant sensations can be pulsating, non-pulsating, deep, dull and splitting. In this case, consultation with a neurosurgeon is required.

Most often, pain due to tumors is provoked by changes in head position and physical activity. Due to discomfort in the skull, many people wake up even at night. They often experience severe and sudden vomiting.

If there is constant and severe pain due to a tumor, brain surgery may be performed. However, before this, a thorough examination of the patient is required.

Hemorrhage

This pathological condition can cause a headache of the “sudden impact” type. Very often, such unexpected sensations differ significantly from those that the patient experienced previously.

As a rule, pain with subarachnoid hemorrhage occurs against the background of excessive physical activity or a sharp rise in blood pressure.

Temporal arteritis

Most often, this disease occurs in people over 50 years of age. This disease is characterized by unilateral localization in the temporal region. There is also pain when trying to palpate the temporal artery, which becomes noticeably denser. Temporal arteritis is often accompanied by visual disturbances, fever, and aching muscles and joints.

Increased VD

Headache with high blood pressure is constant and increasing in nature. Such unpleasant sensations have maximum severity and are localized in the frontal region.

Typically, discomfort in the skull occurs at night or in the morning, as well as when coughing and sneezing. The pain may be accompanied by dizziness, nausea and blurred vision. It can also be combined with pregnancy, obesity, oral contraceptives, and systemic lupus erythematosus.

Vertebral artery syndrome

Pain in this disease occurs when the plexuses are irritated. As a rule, this is associated with osteochondrosis of the spine. Most often, with this diagnosis, discomfort is noted in the cervical-occipital region. It is bursting, blunt, shooting and stabbing in nature. It is also possible for discomfort to spread into the eye socket. In this case, ringing and noise in the ears and dizziness occur.

Concussion

A doctor treating a concussion should carefully evaluate the patient immediately after the injury occurs. Pain with this pathology is often accompanied by nausea, dizziness and vomiting.

Acute, abrupt and sudden unpleasant sensations are a serious signal of danger. In some cases, even brain surgery may be required.

Specialist help

Which doctor should I consult for headaches? It depends on the nature of the syndrome. It should immediately be noted that several specialized specialists are involved in the treatment of such a disease.

Survey

Identifying the disease to eliminate persistent headaches is essential. To do this, it is recommended to go through:

• computed tomography;
• magnetic resonance imaging;
• electroencephalography.

• X-ray examination;
• examination of the sinuses and teeth;
• electromyography;
• computer scanning;
• electromyostimulation.

Treatment

Treatment of headaches should be carried out only after determining its causes. As a rule, drug therapy is used for this. In some cases, the patient may undergo surgery.

The following methods of treating headaches are also common: psychotherapy, including relaxation and hypnotherapy, physiotherapy, acupuncture, massage of the temporal and posterior cervical areas, aerobics, relaxation exercises, regular training, etc.