Why do I get dizzy first, then have a headache, and then feel like vomiting? What should I do?

Migraine

Overview

Migraine is the most important and common vascular headache, presenting pulsating or distending pain consistent with the pulse. Heading down, being exposed to heat, exerting force, coughing, etc. can all make the headache worse. Examination shows that the temporal artery is bulging and the pulsation is enhanced. The headache can be relieved after compression. It often occurs in adolescence, and some patients have a family history. It is often triggered by fatigue, emotional factors, menstruation, etc.

Enter the topic of headache

Cause

The pathogenesis of this disease is complex. In recent years, it is tended to be that after the predisposing factors act on the central nervous system, they are produced through the monoaminergic pathway. Changes in neurotransmitters, followed by activation of platelets, cause the release and depletion of 5-HT and thromboxane A2 (TX A2), which in turn causes contraction and expansion of intracranial and intracranial blood vessels. The dilated vessel wall produces vascular allergy due to the adsorption of 5-HT, and tissue Amine, bradykinin, etc. are involved in causing headaches and neurovascular reactions.

Symptoms

Typical cases (ocular migraine) have eye auras before the headache attack, such as flashes, amaurosis, foggy vision, hemianopia, etc. There may also be facial, Numbness of the tongue and limbs, etc., is related to intracranial vasospasm. About 10-20 minutes later, extracranial blood vessels dilate, and severe pulsating or distending pain occurs on one or both sides, often accompanied by pale complexion, cold limbs, drowsiness, etc., and may include changes in mood and behavior; headache. After the peak, nausea and vomiting last for several hours to one day and then recover. The frequency of attacks varies. Those without the above aura are called "common migraines". It is relatively common and can last for several days in the elderly. A small number of people who develop transient oculomotor nerve paralysis after repeated headache attacks are called "ophthalmoplegic migraine", but the ophthalmoplegia does not recover after a long period of onset.

Examination

After the cause of headache is clarified, further examination is sometimes needed. This is because: ① There may be more than one cause of headache. For example, migraine patients are prone to high blood pressure; brain trauma In addition to neurasthenia, post-headache can also be combined with other types of headaches and even intracranial complications. ② One cause of headache may cause another cause of headache. For example, paranasal sinusitis can induce supraorbital neuralgia, and otitis media can secondary to intracranial abscess. Vigilance should be raised in clinical practice.

1. First of all, we should focus on understanding the characteristics of the headache itself: such as the cause, course, time of occurrence, location, nature, degree, and reasons for aggravation and alleviation of the headache. This can provide some insights into the cause of the headache. Clues or directions for diagnosis. For example, superficial acupuncture-like sharp pain is mostly due to cranial surface neuralgia, pulsating pain or distending pain on one side is due to vascular pain, while tight pain and sleepy pain in the neck, occiput, forehead, etc. are due to muscle contraction. Headache etc. Among them, it is particularly important to clarify whether the headache is episodic (with completely painless intervals) or persistent, because once it is determined to be an episodic headache, if the trigger of the attack is also understood, the scope of exploring the cause can be greatly narrowed. Find out the direction of diagnosis as soon as possible. For example: ① Episodic headaches caused by changes in head and body position: hypotension syndrome, transient ischemic attack, cervical migraine, hypotension, intracranial tumors, especially tumors in the ventricular system, etc. ②Those who have headaches in the morning or at night may have high blood pressure, early increased intracranial pressure, cardiac insufficiency, frontal sinusitis, epilepsy, etc. ③Those related to emotions, fatigue, etc. or the triggers are unknown. ④Short-term sharp pain after catching cold or injury: mostly neuralgia.

2. Secondly, it is necessary to understand the symptoms that accompany headaches, that is, the symptoms of various primary diseases.

3. For those who are not experiencing the disease for the first time: they should also inquire about past diagnosis, treatment and efficacy for reference.

Treatment

1. Actively prevent and treat various primary diseases.

2. Symptomatic treatment:

During an attack, you can use one of the following methods to relieve pain as soon as possible: take 0.1-0.2g of ergotamine and caffeine orally. If it is ineffective, you can take another 0.1g after half an hour. , the total amount per day does not exceed 0.6g. Intramuscular injection of ergometrine 0.2-0.5 mg can be repeated after 1 hour if it is ineffective. Inject 4-5 mg of anisodine intramuscularly or inject 2-6 mg slowly intravenously (put into 40 ml of 50% glucose). 0.5% Novocaine subcutaneously seals around the dilated temporal artery, etc. Ergot preparations should not be used by those with arteriosclerosis, cardiovascular or peripheral vascular disease, and pregnancy.

3. To prevent attacks during the intermittent period, oryzanol (20-30mg), propranolol (10-20mg), anisodine (1-4mg) or phenthiidine (0.5-1mg) can be used three times /d. You can also take ergotamine butolamide (first dose 0.5 mg, gradually increase to 1-2 mg, 2 times/d, no more than 6 months, the contraindications are the same as ergotamine), anisodine (1-4 mg), benzodiazepine Tridine (0.5-1mg), three times/d. Pueraria lobata tablets, Chuanxiong injection, etc. also have certain curative effects.

4. For severe patients with a long course of disease, frequent attacks, ineffective drug treatment, and obvious temporal artery dilation, superficial temporal artery ligation surgery can also be tried as appropriate.

The above is for reference only. Please follow the instructions of your visiting doctor for all diagnosis and treatment.