Why does my head hurt: causes and alarming symptoms

A headache that does not subside after sleep, lasts for several days and does not respond to painkillers is one of the most worrisome. Women are more likely to report it, and an MRI done at the direction of a neurologist shows no reason to panic.

On average, a tension headache attack lasts about 4 hours. There are exceptions to the rule when the symptom persists for several days. As a rule, such disorders are called migraines and have a certain clinical picture. Migraine-like pain usually lasts for a day, sometimes up to 72 hours. They chain a person to bed. Approximately 90% of patients with migraines lose 1-2 days of work ability.

Hidden causes of long-term headaches

Overload of the nervous system is one of the main factors of cephalalgia. It occurs at the chemical, psychological, physical levels. If your head hurts all day, you need to look for a global factor in your lifestyle or psycho-emotional state:

1. Withdrawal syndrome. Associated with abuse of painkillers, quitting smoking or coffee for a long time. After refusing them, a low-intensity aching pain occurs.
2. Depression may be accompanied by headaches due to impaired synthesis of neurotransmitters. Depression is often accompanied by low physical activity and poor appetite, which provokes symptoms from the nervous system.
3. Sleep phase disturbance. Apnea, snoring, and frequent awakenings lead to disruption of the production of neurotransmitters, inflammation and stress, which manifests itself in daytime symptoms - pain and irritability.

If you experience unexpected pain that persists for several days, you need to reconsider your diet. Alcohol leaves a mark on the body for several days in the form of dehydration. Another mechanism is related to tension in the liver capsule, which cleanses toxins. The vagus nerve leaving the skull follows the capsule, and after drinking, tension in the back of the head and temples is associated with its tension and spasm of the meninges. Drinking water helps remove toxins and relieves stress on the liver.

Similarly, symptoms from the head can create food poisoning and allergies. If you have a headache for several days in a row due to a runny nose, you need to be checked for sinusitis. Tension in the neck muscles from coughing also affects the back of the head, skull and lining of the brain, where pain receptors are located. At an early stage, when a person may get the flu, intoxication manifests itself as a headache.

Migraine prevention

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Prescribed when migraines occur more than five days a month or the attacks are very severe.
Take medications daily for six to twelve months, as individually selected by your doctor. A patient’s individual kit for migraine prevention may include antidepressants, blood pressure lowering drugs, two of the currently available antiepileptic drugs, and Botox. This set is strictly individual and is selected for the patient by a neurologist. You can try to treat migraines without pills - eliminate provocateurs, excess weight, smoking, snoring, and accustom yourself to physical activity. Kirill Skorobogatikh is a neurologist, headache specialist.
More than 12 years of experience working with patients suffering from headaches and back pain. Completed an internship at the Jefferson Headache Center in Philadelphia, USA. Member of the International Headache Society (IHS), the International Association for the Study of Pain (IASP), the Russian Headache Society. Participates as an expert in international and Russian clinical studies on the problem of headache. Infographics: Oleg Sdvizhkov

Migraine

Migraines are very intense. The headache lasts for two or three days, and the patient experiences other neurological symptoms such as:

• photophobia;
• dizziness;
• nausea, vomiting).

There are two main types of migraines: with and without aura. Seizures are associated with activation or oversensitivity of receptors on the nerves that innervate the blood vessels of the skull. The onset of symptoms depends on exposure to triggers - these irritating factors can be successfully identified and monitored. Migraines are so severe that they require a combination of medications such as aspirin and paracetamol to relieve symptoms.

The main difference between an attack is that one side of the head hurts. Because the trigeminal nerve has two nodes and three branches to each - on the right and on the left. Pain is associated with irritation of the internal or external carotid artery, and the pathology involves the vagus nerve, which, together with the jugular vein or carotid arteries, is located in the same connective tissue bed. It, like the trigeminal nerve, is responsible for the gag reflex and regulates digestion. This explains the signs of an aura. The patient may feel nauseous and have reactions to odors.

Modern understanding of migraine

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According to surveys, migraine in Russia affects 20% of the working population. According to WHO estimates, migraine is the sixth leading cause of disability. Migraine is an “expensive disease” because it stays with a person all his life.

Today, the causes of migraine are seen in excessive activation of brain receptors, leading to overexcitation of the trigeminal nerve center.

Thus, migraine is a disease of the brain itself, which occurs due to its physiological characteristics. Migraine can be inherited - it is transmitted through the female line in 60% of cases.

Migraines are not associated with increased or decreased blood pressure. Increased blood pressure can be a consequence of a migraine attack, as it is stressful for the body.

Today it is believed that the specific transmitter of pain in migraine is the CGRP protein; its concentration in the trigeminal nerve system increases during migraine attacks.

Modern developments of specific drugs for the prevention of migraine (and until now migraine is treated only symptomatically - by relieving symptoms) are associated precisely with binding or blocking CGRP.

Migraine pain is intense, throbbing, asymmetrical (half the head hurts on the right or left), often with nausea, worsened by light or sound, with severe attacks.
9 historical facts about the treatment of migraines 10,000 years ago, migraines were treated by trepanation to “get the evil spirits out of the head.” The ancient Egyptians tied a clay crocodile to their head, and placed oat grains in its mouth. The ancient Greeks treated migraines with bloodletting. Galen in 200 AD proposed the term “hemicrania” (half head) for headaches similar to the description of migraine, which doctors still use today. Avicenna suggested placing the patient in a quiet and dark place. Thomas Willis suggested in the 17th century that migraines were caused by “dilatation of the blood vessels of the head.” In 1918, migraines were treated with ergotamine, a substance found in ergot. Ergotamine preparations are still used today - in the form of tablets and sprays, and not in the form of a herbal decoction, the exact amount of the active substance in which is impossible to determine at home. In the 1950s, Harold Wolf proposed that migraines begin when blood flow “stretches the vessels in the lining of the brain.”

Tension headache

Tension headaches are diagnosed by exclusion because they have no specific symptoms but are the most common form. Typically, patients do not seek help from a neurologist. The specific pathophysiology of this type of pain is not fully understood, but implies the influence of mental or physical stress.

Many attacks occur against a background of prolonged psychological or physical stress. They are accompanied by a muscle component - a spasm of hyperactive muscles in the face, head and neck. Most often these are the masticatory and temporal muscles, the muscle that lifts the scapula. The main places of localization are the temple, forehead. The pain is severe in nature, reminiscent of a blow.

Migraine attacks women more often

Women are expected to perform many social functions, which keeps them in a constant state of tension. But stress is not the main factor. The key cause of the disease is hormonal changes, and it is the female body that is more often susceptible to them. Hormonal changes occur during:

• menstrual cycle;
• pregnancy;
• postpartum period;
• taking contraceptives
• menopause;
• estrogen or progesterone therapy.

Healing is not possible in all cases. For example, you have to endure menstrual migraines. It occurs in 14% of women along with the first day of the cycle, but does not last long. Such an attack cannot be treated prophylactically, but it is predictable.

For expectant mothers, the situation is especially painful when you suddenly have a headache and cannot take a life-saving pill. If an attack occurs for the first time, you should not go to the pharmacy in search of harmless drugs. Taking any medication carries the risk of negative effects on the fetus.

Sometimes, for the pain to go away, it is enough to massage your temples, the bridge of your nose, and try to fall asleep. But when a migraine becomes a constant companion of pregnancy, and the pain occurs for the fourth time in a week, this is a reason to consult a doctor. He will prescribe treatment suitable for a woman in her situation.

Some pregnant women, on the contrary, are surprised why the previously annoying cephalalgia suddenly disappears. Most likely, their headaches were associated with the use of oral contraceptives or with menstruation. And with the onset of pregnancy, these provoking factors disappear.

Ladies who are in no hurry to give up smoking and alcohol increase their chances of becoming victims of migraine attacks.

If taking contraceptives is accompanied by chronic headaches, it is advisable to think about alternative methods of birth control.

More than half of older women begin to complain less often of painful lumbago in the head after menopause. But this applies only to physiological aging. If the menopause is artificial, resulting from the removal of the reproductive organs, it will either have no effect on the migraine or will worsen it. Those who do not feel improvement during age-related menopause can contact a specialist to prescribe hormone replacement therapy.

Hormonal pain in women

When women have a headache for the third day in the second half of the cycle, menstruation may be approaching. Menstrual migraines are much more severe than usual and develop two or three days after the start of bleeding. They are associated with a natural decrease in estrogen levels in the blood. The female hormone is considered to protect the vascular wall from spasms. Increased levels of irritability cause the release of cortisol, which leads to vasospasm.

Osteopaths view the cause of menstrual attacks differently. Migraine on the first or second day of bleeding is caused by the release of inflammatory molecules, their circulation in the blood. Another reason is the tension of the uterine ligaments, which increases in size, which affects the sacral plexus, sacrum, vertebra and nervous system.

Other hormonal causes include taking hormonal pills for contraception or treatment, especially during the break period when the level of estrogen in the blood decreases. The pain usually intensifies as menopause approaches, when bleeding becomes more frequent due to irregular cycles. During pregnancy, pain is caused by the normal adaptation of the immune system in the first trimester and a decrease in estrogen levels. In the final stages, when the level of physical activity decreases, the baby takes away vitamins and minerals, and women suffer from pregnancy anemia. Low hemoglobin levels are accompanied by dull headaches and weakness. Attacks of nausea and pain in the back of the head sometimes indicate preeclampsia - hypertension of pregnancy. High blood pressure requires consultation with an obstetrician.

New migraine drug on the way

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Unfortunately, when treating migraines, the situation is often aggravated by headaches from medications. Taking ibuprofen or any other simple pain reliever more than 15 days a month for three months or more causes headaches. Triptans should not be taken for more than 10 days a month.

A magnetic electrical stimulator is currently being tested, the purpose of which, according to the researchers, is to reduce pain during migraine attacks.

During 2021, a blocker of the CGRP protein should appear in the West and, perhaps, the first specific preventive medicine for migraine will be obtained, blocking the very mechanism of transmission of migraine pain.

After official release in the USA and Europe, the drug must be approved by the Ministry of Health for use in Russia. The timing of the inclusion of the drug in the list of approved drugs for official use in our country is still unknown.

Meanwhile, the majority of migraine drugs currently prescribed in Russia (Mexidol) have placebo-level effectiveness.

Other causes of long-term headaches

Among other factors, consider the following.

Pain after dental treatment

It is believed that tooth extraction does not cause headaches. But the procedure is accompanied by stress, a reflex clenching of the jaws. Muscle spasms are caused by prolonged and wide opening of the jaws, overexertion or rupture of part of the fibers. If the jaw and temple continue to hurt, then arthritis of the temporomandibular joint may occur. It is extremely rare that the needle gets into the muscle fibers, causing discomfort in the entire jaw and temporal bone.

If you have a headache for the second day after tooth extraction, it means that the trigeminal nerve has been stretched. It also innervates the masticatory muscles, which will be reflexively tense.

Pain when the weather changes

Vegetovascular dystonia is a diagnosis that does not exist in the international classification of diseases. It means poor adaptation of blood vessels to environmental changes. The reason is a change in atmospheric pressure, which forces the arteries to react: pump blood as it grows, or vice versa - reduce pressure. Dystonia is an imbalance between the sympathetic and parasympathetic nervous systems. Baroreceptors are located in the area of ​​the aortic arch and carotid sinus, and the responses are mediated by the vagus nerve. Violation of its function is associated with headaches when the weather changes. Patients feel how on the eve of rain it begins to put pressure on the eyes, there is noise in the ears and a feeling of compression of the skull.

In teenagers, blood pressure can drop dramatically due to excess tension in the arteries during a period of rapid growth, and this leads to headaches.

Cervical osteochondrosis

Pain associated with dysfunction in the cervical spine is also called migraine. One of them is caused by compression of the occipital nerve by the oblique capitis muscle. Such attacks are usually associated with exposure to drafts and cold weather, when the neck first begins to hurt.

People usually notice a headache for a few days after a pop in the vertebrae. The reason for this is imbalances in the muscles that attach to the first three cervical vertebrae. They spasm when breathing incorrectly, after severe stress and prolonged sitting with raised shoulders. For example, at the computer or while driving. Muscle imbalances need to be treated

Myopia and headache

The optic and oculomotor nerves pass through the lining of the skull before passing to the muscles and other structures of the eye. Overexertion of vision causes a spasm similar to what occurs in the neck or other muscles. Therefore, when working, it is recommended to take pauses and exercises to relax the eyes - look into the distance.

“Your head can’t hurt – it’s a bone”

A headache occurs like any other: something irritates a receptor, a signal enters the brain, and we feel pain. The large and branched trigeminal nerve is “responsible” for pain in the head, the nerve endings of which are in the sinuses (sinuses), in the eyes, ears, teeth, and in the meningeal membrane (gray matter on the surface of the brain). It is from the receptors in these areas that a pain signal can come - and then we get a “headache”.

In fact, there are no pain receptors in the brain - which is why sometimes operations on the deep layers of the brain are performed without anesthesia. For example, if it is important during surgery not to affect the speech center, the patient who has undergone craniotomy is woken up and begins to talk to him. At the same time, a person with an open skull does not feel pain from manipulation of the brain.

When should you see a doctor?

People who experience pain year after year and every week are familiar with remedies that help individually: a compress on the forehead or a certain drug. But even in such patients, an attack that lasts for several days in a row is always a cause for concern. You should consult a doctor when you have a headache for two days or more, and the symptom has a number of features:

• manifests itself more strongly than usual, intensifies every day;
• cannot be treated with conventional medications;
• worsens with coughing or movement;
• accompanied by fever, neck stiffness, impaired consciousness and memory;
• complicated by neurological symptoms: blurred vision, slurred speech, weakness, numbness or seizures;
• interferes with sleep, worsens in the morning, leads to sudden awakening in the middle of the night;
• associated with soreness and redness of the eye, sensitivity in the temporal region.

Even mild pain that interferes with daily activities and ability to work requires medical intervention. Cranial injuries are always a reason to be examined, since the force of the blow does not always correspond to the damage. Symptoms may appear the next day or a week later, leading to changes in character years later.

The pain sometimes goes away after sleep, rest in the dark and silence, and a cold compress on the frontal part of the head. With a hangover, drinking fluids, vitamin B6, and sorbents helps. For migraines, Ibuprofen is used, as well as triptans, which reduce the sensitivity of the trigeminal nerve receptors.

Migraine has several phases:

- prodrome - when, within a few hours or days, a person feels an unusual state and symptoms by which he can predict an impending attack (he suddenly craves something sweet, or he yawns after getting enough sleep),

- “aura” - occurs about an hour before the attack: flashes in the eyes, auditory hallucinations, obsessive odors. Numbness of the hands, face, “Alice in Wonderland syndrome” (feeling of changes in body size), polynopsia (when you shift your gaze, outlines of objects remain in your eyes). If the “aura” lasts more than an hour, this is a reason to exclude other neurological diagnoses.

The migraine aura is different in that this stage is dynamic - dots “creep” across the field of vision, numbness can “move” along the arms - this reflects the movement of the electrical signal in the cerebral cortex. (During an attack of epilepsy or stroke, similar phenomena occur, but they are static - since the damage is local);

- the attack itself. The frequency of migraine attacks may vary between patients. There are people who regularly suffer from multi-day attacks. There are patients with very rare and mild migraine attacks - even once every six months.

• postdrome - when, after the headache stops, a person feels overwhelmed, experiencing weakness and drowsiness for up to two days.

Migraine provocateurs - stress, - hunger (skipped meals), - lack or excess sleep (changes in sleep patterns on weekends), - the beginning of the cycle in women (plus or minus two days. In the second or third trimester of pregnancy due to high estrogen and progesterone, attacks often weaken or disappear), - dehydration - some foods - aged cheeses, canned food, spicy, red wine - as part of an individual reaction. Chocolate was previously considered a migraine provocateur; now it is considered a sign of the onset of an attack - the patient may crave sweets before the onset of an attack. The effectiveness of alcohol for migraines has not been studied. It is believed to reduce symptoms, but does not act on the headache itself, but as an anti-anxiety agent, since anxiety-depressive disorders are often found in patients with migraine.

Self-help methods

When you have a headache all day, you need to do a few exercises:

1. Stretch your neck muscles. Grasp the collarbone on the side of pain with your fingers, inhale and, as you exhale, pull the bone down, while tilting your head back and to the side. Repeat 5 times.
2. Wrap a towel around the bottom of your ribs and lie on the floor with your knees bent. Breathe, expanding your ribs to the sides. Try not to arch your lower back or raise your shoulders as you inhale. Continue for 1-2 minutes.
3. Swing your arms back and forth, trying not to raise your shoulders up. Breathe through your nose, turn your torso behind your hand, which goes forward and upward. Continue for 1-2 minutes.

For occipital neuralgia, cervical migraine or pain due to osteochondrosis, it is necessary to relieve the suboccipital muscles:

1. Take two tennis balls, put them in a sock and tie them. Lie on the floor, place a roll of balls under the back of your head. Lie down and relax for 1-2 minutes.
2. Using a ball, massage the place where the muscles attach along the vertebrae at the level of the upper edge of the shoulder blades against the wall.
3. Stand against the wall, pressing your shoulder blades and the back of your head. Tuck your chin back, tensing the long extensor muscles of the neck. Hold the tension for 30 seconds.

For unilateral pain radiating to the eye, cheekbone and temple, you need to relax the jaw muscles. First, massage the muscle that runs from the zygomatic process to the angle of the lower jaw - right or left side. Then relax the external pterygoid muscle, located behind the upper jaw in the mouth.

If you want to stretch your neck during an attack, then you need to massage the inner corner of the shoulder blade at the back, where the levator scapulae muscles are attached. It is this that causes pain that moves from the shoulder girdle to the back of the head.

How to relieve pain attacks at home

What to do if no serious pathologies have been identified, but the pain does not go away for the fourth day? Or even worse - your head started hurting every day? It’s worth giving traditional medicine recipes a chance, making sure there are no allergies to the components or other contraindications. All these methods are aimed at relieving tension and improving blood flow:

• massage the bridge of the nose, and then the entire head for 5-10 minutes;
• lie in a bath at a pleasant temperature with sea salt or lavender;
• make a hot foot bath;
• brew sweet black or herbal tea (with chamomile, mint);
• apply a cabbage leaf, previously mashed until the juice is released, to your temples or forehead;
• drink a quarter glass of blackcurrant juice 3 times a day;
• apply grated garlic to your temples for 15 minutes;
• make a cool compress on your forehead by adding a few drops of mint and lavender essential oils to the water;
• in case of nervous overstrain, drink a glass of warm milk, to which a spoonful of honey with mashed viburnum berries has been added;
• grate the ginger root, dilute it a little with water and keep this paste on the forehead for 15 minutes;
• Apply a cut onion to your temples three times a day for 15 minutes.

Prevention

You can prevent prolonged migraines by tracking triggers - symptoms that irritate the trigeminal nerve. Avoid bright light, overwork, strong odors. Be sure to add physical activity: the neck muscles spasm when mobility in the chest disappears. Sometimes, to prevent pain while working at the computer, it is enough to stand up and load the gluteal muscles: swing your legs back. Dehydration, as one of the causes of vasospasm, can be eliminated by following a drinking regime.