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頭痛の男
頭痛の男

頭を振ると痛い頭痛の原因と対策

頭痛男性

 

なんらかの身体的疾患から頭痛が現われる時は、突然の激しい痛みである場合が多いものです。手遅れになると生命を落とすことさえあります。主なものとして、くも膜下出血、脳腫瘍、脳出血、髄膜炎など、ほとんどが脳に関係する病気です。頭を振ると痛みが増すような場合、片頭痛が疑われますが、他に吐き気や嘔吐がある場合には危険です。これらの症状があったら、大至急、病院にかかる必要があります。

こちらでは、頭を振ると痛い場合に考えられる頭痛についてご紹介します。

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頭痛の種類

大丈夫な頭痛と怖い頭痛

頭抱男

頭痛は、安易に放置すると生命に関わる様なものとそうでない頭痛があります。前者が器質性頭痛で、後者が機能性頭痛と呼ばれています。前者の代表例としては、くも膜下出血等の脳血管障害や、脳腫瘍、脳膿瘍等があります。また、後者の代表的な頭痛には、片頭痛と緊張型頭痛があります。これらの頭痛は、症状から鑑別が容易な症例もありますが、MRIやCT等によりはじめて診断が出来る頭痛も存在します。

怖い頭痛の見分け方

次に挙げるような「いつもと違う頭痛」の場合には、すぐに医療機関を受診しましょう。

  • 今までにない強い頭痛
  • 突然の激しい頭痛
  • 痛みが急に強くなる
  • 回を重ねるごとに痛みが徐々に強くなる
  • 発熱を伴う頭痛
  • 手足のしびれがある
  • けいれんを伴う
  • 意識がもうろうとなる

頭を振ると痛い頭痛

頭を振ると痛いことが特徴の頭痛を見ていきましょう。

片頭痛

頭の片側がズキンズキンと拍動性に痛むことが多く、吐気や嘔吐を伴い寝込んでしまうなど日常生活や仕事に大きな影響を与えます。頭痛の前に、きらきらした光・点・線が見えたり見えなくなったりしたり、ちくちく感やしびれなどといった前兆が現れるのが特徴です。

痛みのメカニズムは、脳表面の血管拡張と血管周囲の神経由来の炎症と考えられています。治療は頓服薬(消炎鎮痛剤やトリプタン)。月に数回以上みられる重症例では予防薬を用いる場合もあります。

  • 頭を振ると痛みが増す
  • 吐き気がしたり、胃がムカムカする
  • 光が眩しく感じる、音がうるさく感じる
  • 臭いが嫌だと感じる
  • 片側が脈打つように痛む

髄膜炎

後頭部が強く痛んで首すじが硬直し、吐き気や嘔吐、38~39℃の高熱を伴う場合は、くも膜や軟膜の炎症による髄膜炎が疑われます。髄膜炎の頭痛は、体を動かしたり、頭を振ったりすると痛みが強まる点も特徴です。

ウイルスの感染によるウイルス性髄膜炎は、自然に治ることが多いのでさほど心配はありませんが、細菌の感染による細菌性髄膜炎は、治療が遅れると死に至るケースもみられるので、高熱を伴う強い頭痛が起こったときは細菌性髄膜炎を疑って、早急に医師の診察を受けることが大切です。

細菌性髄膜炎
発病は急性発症で、激しい頭痛、悪寒、発熱(38〜40℃)とともにうなじの硬直などの髄膜刺激症状がみられます。発熱では高熱が持続します。また、せん妄などの意識障害、脳神経症状も現れます。乳幼児によく起こり、3カ月未満では大腸菌、B群連鎖球菌、3カ月以降においてはインフルエンザ菌が多いです。成人では肺炎球菌、髄膜炎菌の頻度が高いとされています。
 
ウイルス性髄膜炎
春から夏にかけてはエンテロウイルス、ムンプスなどによるウイルス性髄膜炎が多くみられます。小児によく起こり、通常特別な治療を必要としません。発熱、頭痛をもって急性に発病し、うなじの硬直、髄液でのリンパ球を主体とした細胞増加を認め、一般的に良好な経過をたどります。項部硬直などが認められない場合も。発疹などの随伴症状は、エコーウイルス、手足口病、風疹、麻疹、単純ヘルペス、水痘・帯状疱疹などでみられます。普通、皮膚症状の発症から1週間以内に、頭痛、吐き気などの髄膜刺激症状が現れます。

慢性硬膜下血腫

慢性硬膜下血腫は、頭を打撲してから、3~4週間かけてゆっくりと脳の表面に血液がたまってくる病気です。頭部打撲の程度も、決して強いものではありません。来院した時には、頭をぶつけたことすら忘れている人もいます。通常、高齢で男性に多く見られます。症状は、非常にゆっくり進行します。典型的な症状としては、最初は「頭を振ると痛い」くらいの軽い頭痛を訴えます。その後徐々に、行動が鈍くなったり、物忘れをする様になります。さらに、数週間たつと、半身の麻痺が出てきて、会話が成立しなくなってきます。しかし、結構日常生活は出来ている人も多く、痴呆が進んだなと捉えられているケースもあるようです。基本的な治療法としては外科的治療が推奨されています。

まとめ:頭を振ると痛い頭痛を知ろう

「頭を振ると痛い」ことが特徴の頭痛にはいくつかあります。こちらでおさらいしておきましょう。

  • 片頭痛:光や音、匂いに過敏になる
  • 髄膜炎:うなじの痛み、高熱を伴う
  • 慢性硬膜下血腫:まひや物忘れなどを伴う

頭痛は放置すると生命に関わるものがあります。突然の激しい頭痛、しびれや嘔吐を伴う頭痛は放置しないですぐ病院へ行きましょう。

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