In this article, I wanted to talk about the main types of headache and the headache symptoms of diseases that require neurosurgical treatment. Headaches are divided into three main groups as primary (primary), secondary (secondary) and cranial neuralgias.
(1) PRIMARY HEADACHES
It is a type of headache that is not associated with another underlying disease and the cause of which has not been fully elucidated. Tension, migraine and cluster headaches form this group according to their frequency.
(1a) Tension-type headache
Although the cause has not been fully elucidated, it has been shown that long-term physical activities or physical exertion such as looking at a computer screen or emotional stress are associated with this type of headache, It has been suggested that it occurs as a result of abnormal contraction of the muscles. Tension headache, which is seen in 90% of the society, is more common in women. Usually at the end of the day, the pressure that starts from the back of the head and neck and wraps the head in the form of a band causes pain, which is characterized by a feeling of tightness and is most felt above the eyebrows. Neurological examination of patients with this type of headache is normal. Taking the patient’s history correctly and completely makes the diagnosis and drug treatment is applied.
(1b) Migraine headache
It is a common disease known to mankind since ancient times. It is more common in post-pubertal women. Recent studies have revealed that the reason may be the abnormal function of pain nuclei in the brain stem as a result of a series of complex biological events that occur as a result of overstimulation of the cerebral cortex. Migraine pain, which is usually unilateral, may present symptoms such as visual impairment, nausea, vomiting, sensitivity to sound and light (aura) before the onset of pain in approximately one third of patients. Severe throbbing pain lasting 2 to 48 hours is typical, felt in the front of the head, behind the eyeball, or sometimes in the back of the head. In recent years, surgical techniques such as electrical stimulation (stimulation) and temporal artery ligation have been tried for the definitive treatment of migraine. Currently, different drug combinations are the most commonly used treatment option for the prevention of migraine attacks and during attacks.
(1c) Cluster headache
Contrary to tension and migraine type headaches, the cause of cluster headache, which is more common in young men, is not known exactly. There are findings supporting that it is caused by the abnormal function of the . Pain that starts at the same time of day for weeks and months and lasts for 30-90 minutes is not seen for months and years; therefore they are defined by the word set. Unilateral pain around or behind the eyeball, accompanied by redness, watering, and runny nose is typical. In treatment, drug treatments arranged on a patient basis are applied.
(2) SECONDARY (SECONDARY) HEADACHES
Generally, they can be defined as headaches caused by many other underlying diseases. To sort it out;
(2a) Headaches due to vascular diseases in the head and neck
Sudden onset and very severe headache occurs as a result of the mass effect or bleeding of cerebrovascular bubbles (aneurysm) or tangle (AVM). Vomiting, nausea, and confusion may accompany this very severe headache, which usually occurs during exercise (straining in the toilet, sexual intercourse, sudden excitement and heavy physical work, etc.). Urgent diagnosis of the patient and microsurgical treatment is required. Spontaneous cerebral hemorrhage may also occur in some patients with high blood pressure and taking blood thinners; Treatment is surgery in suitable patients. Stroke, also called stroke, is the sudden blockage of the vessels feeding the brain, and headache may accompany the picture. In appropriate patients, surgery to remove the damaged brain tissue (decompressive surgery) should be performed in order to relieve the brain tissue and reduce the intracranial pressure.
(2b) Headache due to brain tumors
New-onset, drug-resistant, more pronounced in the morning, weakness in the half of the body, sensory deficits and headaches associated with seizure (episode), a possible underlying cause It should definitely be taken into consideration in terms of brain tumor (ureus) and neurological examination and, if necessary, brain imaging (MR and / or tomography) should be performed in these patients. Microsurgical resection (removal of the tumor) is the mainstay of treatment for brain tumors. Radiotherapy and/or chemotherapy can be added to the treatment scheme, depending on the histopathological type and location of the tumor. Currently, immunotherapy, gene therapy, molecular therapies and tumor vaccines are in the experimental stage.
(2c) Headaches associated with infections
Systemic widespread infections, heart valve diseases, weakened immune system due to various reasons, intravenous drug use, neglected middle ear infections, dental caries, open head injuries are the main causes of brain abscesses. In addition, in some cases, the focus of infection may occur under the cerebral cortex; This condition is called subdural empyema. In both clinical presentations, patients should be operated urgently and appropriate antibiotic therapy should be started. In the case of meningitis, also known as the infection of the meninges, and encephalitis, which is defined as a common infection of the brain tissue, only antibiotic treatment is applied.
(2d) Headache due to cerebrospinal fluid accumulation (Hydrocephaly)
The cerebrospinal fluid (CSF), which plays a role in the nutrition, function and protection of the brain tissue, is transparent in color and has a fluid consistency in the brain cavities and around the spinal cord. circulates. CSF ponding, that is, hydrocephalus (water head), may occur due to obstructions in the CSF circulation pathways or inadequacies in its absorption. Widespread and progressive headache occurs due to increased intracranial pressure. In addition to the treatment of the disease (tumor, infection, bleeding) whose treatment causes hydrocephalus, in most cases, shunt surgery is performed to drain excess CSF under the peritoneum with the help of a tube.
(3) HEADACHES ORIGINED BY CRANIAL NEURALGIA
Trapping of nerves originating from the brain stem, which gives the sensation of the head, face and neck region and provides important functions such as mimic, chewing, speaking, swallowing, tumor or It is a type of facial and headache that occurs due to the pressure of vascular formations. Trigeminal neuralgia and glossopharyngeal neuralgia are the main diseases that require surgical treatment in this group.
RECOMMENDATION
SUMMARY OR NEW ONLINE, PAIN REGULATORY RESISTANT, MORE APPROPRIATE IN THE MORNINGS, VOMITING, NAUSEA, WEAKNESS, FEELING DEFECTS, BALANCE DISORDERS AND ILLNESSES THEY MUST BE EVALUATED BY BRAIN Surgeons.
