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Headache, acute

Table of contents
Headache, acute
Anamnesis of an acute headache
Physical inspection
Diagnostic testings

Close concepts: cephalalgia, head pain

The concept "headache" characterizes feeling of pain or" discomfort, belonging to anatomical structures of the head and neck. In spite of the fact that bone formations of the head and a parenchyma of a brain are insensitive to pain, actually all other tissues of the head are supplied with the device of painful sensitivity reacting to various irritations. Walls of arteries therefore changes in vessels usually lead to emergence of severe, dull ache are especially sensitive. Painful impulses can be transferred through cranial nerves, especially through trifacial fibers (the V couple). Besides, the glossopharyngeal nerve (the IX couple), a vagus nerve (The X couple), an eleventh cranial nerve (the XI couple) and a hypoglossal nerve (the XII couple) are sensitive to direct painful stimulation. The upper sagittal sine and other sine of a firm meninx are also sensitive to painful incentives, however reaction to pain in them is expressed not so strongly, as in arteries. Pain can arise at stretching of small veins of venous sine of a firm meninx. In addition, the headache can be caused by irritation of the 1, 2 or 3 cervical nerve that is usually shown by feeling of pain in a neck, and also back part of the head.

In the present chapter the acute headache i.e. which arose recently and proceeding rather hard is considered. Consider that pain arose recently if from the moment of its emergence passed no more than a week; it is desirable to measure duration of existence of an acute headache in hours. In spite of the fact that chronic and recurrent headaches are among the most widespread indispositions, this head is devoted to diagnostic approach to a "new" headache; syndromes of a recurrent headache, especially migraine and headaches caused by reduction and a muscle tension are discussed only in connection with differential diagnosis of an acute headache.

Prevalence and reasons of a headache

According to the National review of ambulatory medical care which is carried out in the United States  a headache takes the seventh place among the most frequent reasons of negotiability of patients (18 341923 addresses to doctors of out-patient departments). From total number of patients at whom the headache represented recently appeared symptom at 43,9% of women and 49,3% of men since its emergence there passed less than 1 week.

The headache , of course, represents a symptom, but not the diagnosis. Diagnoses of basic diseases of the patients who came to department of acute management with a headache as the main complaint are provided to the tab.

Final diagnoses of the patients who came to department of acute management with a headache as the main complaint


Number pain -

Number of patients, %

Headache at increase of intracranial



Vascular headache (like migraine)



Posttraumatic headache



Extracranial infections



The headache connected with arterial hypertension



Migraine in combination with increase of intracranial pressure



Subarachnoidal hemorrhage






Other reasons



The diagnosis is not established



In total



On Dhoresh V., Anwar R., Herring of Page A. retrospective assessment of emergency department patiens with complaint of headache.

The highest frequency of developing of a headache in this group was noted as a result of an extracranial infection (39,3%) or injuries (9,3%). Frequency (developing of a headache owing to migraine was twice lower, and the frequency of developing of a headache in connection with arterial hypertension is much lower, than in the supervision provided in the National review of ambulatory medical care. In the similar research conducted by Leight, the headaches resulting from reduction and a muscle tension and migraine met most often and were the cause of receipt in department of acute management of 54% of the patients (from 485) inspected concerning not traumatic headache. At inspection of 124 patients with not traumatic headache," observed in chamber of acute management of university hospital, Dickman and Masten found out that 50% of patients had a headache which could be characterized as "high-quality, caused by muscular tension, having uncertain character or connected with a viral infection or fever", 20% had the headache connected with an upper respiratory tract infection, 10% — with arterial hypertension, 3% — with migraine and 17%. — with other various reasons. Character of a headache at children differs from that at adults; in one of researches it is reported that 15% of children were sent to children's neurologic clinic because the headache at them had the character which is observed at a stroke.

The possible reasons of an acute headache are listed in tab. 2 and are discussed below. Many of them meet infrequently, however demand consideration at differential diagnosis from patients with the headache which developed recently. Some of these reasons deserve a specific mention. Due to the popularity of occupations by physical exercises: at many patients the usual headaches connected with an exercise stress are noted. Here it is necessary to carry cases with arisen from not recognizable earlier intracranial; new growths considerable bleeding during occupations by run. The headaches connected with physical exercises are described also at patients with a pheochromocytoma. Owing to rather long bezbolevy intervals patients with cyclic migraine can show complaints to an acute headache. In these cases headaches develop through the periods averaging 6 weeks, and recurrence arises about 5 times a year.


Table 2. Reasons of an acute headache

Extracranial infections

The children's infectious diseases proceeding with fever


Epidemic parotitis


Infectious mononucleosis



Otitis of an outside or middle ear





Psychogenic   headaches

Headaches owing to tension (reduction) of muscles

The headaches connected with specific psychiatric syndromes

Fear neurosis


Conversion reactions

Posttraumatic  headaches


Brain bruise

Traumatic dizavtonomny headache

Arterial  hypertension

Idiopathic hypertensia


Vascular  head
pains like migraine


Headache of ashes of migraine

Classical migraine

Ordinary migraine

The complicated migraine

Cyclic migraine

Kinds of migraine (for example, a headache at an orgasm)

Intracraneal hemorrhage or similar with
them reasons head

Aneurisms of vessels of a brain

Anomalies of development of arteries and veins


Subarachnoidal hemorrhage

Subdural hemorrhage

Vascular insufficiency (passing ischemia)

Intracranial   infection

Brain abscess



Subdural empyema

The vascular headaches which are not connected with migraine

Caused by drug intake


Peroral contraceptives


The resulting cancellations of drugs

Group of Phenaminum

Ergot drugs


Contact with toxic chemicals





Odioiatriyevy glutamate

Carbon monoxide

Tetrachloride carbon



Headaches at increase, intracranial pressure

Wet brain

Brain tumor

Obstacle to outflow of cerebrospinal fluid
Headaches after a spinal lumbar puncture

Other reasons of a headache

The benign headache arising at an exercise stress
Diseases of eyes and vision disorder
Lack of a refraction, for example, astigmatism, far-sightedness
Inflammation of an iris of the eye
Neuritis or neuralgia of cranial nerves Benign intracranial hypertensia
Pain syndrome at dysfunction of a temporal and maxillary joint
Arteritis of a superficial temporal artery


Mental diseases which can cause a headache include fear neurosis, depressive and conversion reactions. Packard defined a conversion headache as pain at which there is no peripheral painful mechanism and conversion reactions are the prevailing clinical symptom. At these persons in the beginning pain can be connected with local process, and after its treatment to remain as a hysteria symptom.

The headache reason, especially at young women, dysfunction of a temporal and mandibular joint can be. The headache is also often observed at women within the first week after the delivery, especially between the 3rd and 6th day?

 The pseudoneoplasm head a brain, characterized by a headache, a papilledema and doubling in eyes is the rare reason of a headache at young women.

"Gynecomastia   Dizziness"