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頭痛の女性
頭痛の女性

偏頭痛(片頭痛)の症状と他の病気との違い

頭痛の女性

偏頭痛は片頭痛と書かれることもあり、両者は同じ意味です(本記事では偏頭痛と表記します)。偏頭痛に悩む人は日本の人口の約8%で、特に女性に多く、10代から20代で発症することの多い若年層に多い頭痛といえます。本記事では、偏頭痛と他の病気との違いについて整理し、病院で診察を受ける際に、より正確な診断の助けとなるような情報をお伝えします。

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偏頭痛の原因は何なのでしょうか

頭痛の男性

偏頭痛は頭部の血管が過度に拡張することが原因と考えられています。頭部の血管において、ストレスなどが引き金となり、神経伝達物質のセロトニンという物質が急激に増加します。増加したセロトニンが、太い血管を収縮させた後に、反動で過度に拡張します。これにより、腫れや炎症を引き起こして頭痛となって現れます。

あるいは、頭部の血管の周囲を取り巻くように存在し、顔面の知覚や咬筋(こうきん)などの動きを司どっている三叉(さんさ)神経が、ストレスなどの刺激により血管を拡張する働きを持つ刺激物質を放出し、血管の過度な拡張及び血管周囲の炎症を起こすことにより、偏頭痛が引き起こされるという説もあります。

次のような症状の場合、偏頭痛と見なされます

偏頭痛は検査でわかる病気ではなく、症状により判定されるものです。そのため、症状についてできるだけ詳しく医師に伝える必要があります。次のような場合は偏頭痛と診断されます。

  1. 頭痛が起こる回数として、月1~2回、多い場合は週1~2回の頻度
  2. 痛みの大きさとしては、1~2時間でマックスとなり、4~72時間続く
  3. ガンガンあるいはズキンズキンという激しい痛みが脈拍とシンクロするような感じでおこる
  4. 頭の片側が痛むことが多いが、両側が痛むこともあります。ひどい場合は頭全体が激しく痛む
  5. 痛みで仕事や勉強が手につかず、体を少し動かすだけでも痛みが強まり、寝込んでしまうほどになることもあります。吐き気や嘔吐を伴う
  6. 光や音に過敏になり、痛みが悪化する
  7. 頭痛の開始前に、眼の前にチカチカとした光のようなものが見え、視野の中心部分が見えづらくなるなどの前兆が出ることがある。あくびや肩凝り、首の後ろ部分に凝りなどが見られる場合もある。

偏頭痛とは異なる病気について

次のような場合、偏頭痛ではなく、病気が原因であると考えられますので、病院で診断を受け、適切な治療を行なう必要があります。

  1. くも膜下出血=脳動脈瘤という血管のこぶが破裂することにより引き起こされる症状で、非常に危険な頭痛です。バットで殴られるような強い痛みというように表現されることもあり、それまでに経験したことがないような痛みが突然起きるのが特徴です。
  2. 脳腫瘍=脳内に発生した腫瘍が原因で起きる頭痛です。脳内の圧力が高くなることが頭痛を引き起こす原因となっています。
  3. 脳出血=血管の動脈硬化が進行している場合に発症しやすい病気です。この頭痛も瞬間的に起こり、頭痛だけでなく手足の麻痺や意識障害を伴うこともあり、非常に危険です。
  4. 髄膜炎=頭痛だけではなく、発熱を伴う症状が出ます。後頭部が張ったような感覚になり、首が曲げられなくなる場合もあります。
  5. 緊張型頭痛=肩凝り、首の凝りから引き起こされる頭痛で、「しめつけられる感じの痛み」や「重苦しい感じの痛み」と表現されます。デスクワークやパソコンでの作業が多くなった現代社会で増えた特徴的な頭痛と言えます。
  6. 副鼻腔炎=鼻づまりによる頭痛で、目の周りや額の辺りが痛むという特徴があります。抗生物質により治療します。
  7. 後頭部神経痛=突然に瞬間的な痛みが起きるのが特徴で、チクチクした痛みを感じたり、髪の毛に触ると痛いという風に感じます。持続的な痛みというより、間を空けて痛みが起こります。通常一週間もすれば改善しますが、水疱が認められる場合はヘルペスウイルスによる帯状疱疹の可能性がありますので、医師による診断が必要です。

偏頭痛の治療法について

偏頭痛の治療においては、薬物療法を中心に行ないます。頭痛の発作時に服用する急性期治療薬(頓挫薬)と発作を起こりにくくする効果の予防薬があり、それぞれについて効果の高い薬が開発され、使用されるようになってきました。急性期治療薬には、医師に処方される「トリプタン系薬剤」や「エルゴタミン製剤」のほか、一般の薬局で購入可能な市販の鎮痛剤などがあります。

また、頭痛の程度に関係なく、吐き気を伴う場合には制吐剤が併用されます。予防に関しては薬だけでなく、日常生活における誘因を避けるように心がけることも大切です。

また、頭痛の治療薬を月に10日間以上飲んでいる場合、「薬物乱用頭痛」と呼ばれる頭痛の状態に陥っている可能性もあります。薬物乱用頭痛に陥らないように、治療薬の適切な選択と服用を医師の診断を受けて行なう必要があります。

まとめ:偏頭痛(片頭痛)の症状と他の病気との違いについて

本記事では、偏頭痛の症状と他の病気との違いについて、わかりやすく整理しました。

  1. 偏頭痛は頭の血管が拡張することにより周囲の神経が刺激され引き起こされる頭痛です。
  2. 後頭部が殴られるような痛みや手足の痺れを伴う危険な症状は、他の病気の可能性が高いので、すぐに医師の診断を受けてください。
  3. 医師と相談し、適切な薬剤の選択、治療を行なってください。

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