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医者

神経内科の代表的な病気である頭痛の種類

医者

神経内科はなかなかなじみのない診療科であるかもしれません。しかし、神経内科の代表的な病気の中には、頭痛も含まれています。他の診療科ではっきりしない診断をされていたり、治療法がなかったりする場合には、神経内科で診てもらった方がいい場合もあります。

そこで、神経内科の代表的な病気である頭痛の種類について知り、頭痛で悩んだ際神経内科で診てもらった方がいいかどうか自分で判断できるようにしましょう。

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神経内科とは?

考える

神経内科は、脳や脊髄、神経、筋肉に関わる病気を診断する内科のことです。身体を動かしたり、感じたり、考えたり、覚えたりすることに異常がある場合には、神経内科に関わる病気が疑われます。神経内科では全身を診ますので、どの部位の病気であるかを見極め、さらに専門的な診療科を紹介することもあります。

頭痛は脳だけでなく、神経や脊髄、筋肉にも影響を及ぼす場合がありますので、神経内科の代表的な病気と言えます。

頭痛の種類

頭痛には、大きく分けて脳腫瘍や脳炎、髄膜炎、くも膜下出血、脳卒中などの脳や頭部の病気の症状として現れる頭痛である症候性頭痛と、他の病気とは関係なく、頭痛の発作を繰り返したり持続したりする慢性頭痛症があります。

①片頭痛

片頭痛とは左右どちらか片方に頭痛が起こることを言います。実際には4割ほどの方が左右どちらも頭痛が起きています。片頭痛には、前兆があるものとないものに分かれます。

片頭痛の前兆は、頭痛より前に起こる症状のことで、視覚性の前兆が多く、きらきらした光やギザギザした光などが見えます。他の前兆の症状として、半身の脱力やしびれ、言語障害なども見られます。前兆はほとんど1時間以内に終わり、その後頭痛が始まります。

片頭痛の発作は、4~72時間続くとされており、脈を打つような頭痛が起こることが特徴です。頭痛の程度は比較的強く、普通に生活できなくなるくらいということもあります。日常で必要な動きをすることで、頭痛がひどくなることもあります。吐き気や嘔吐を伴うことも多いです。頭痛発作が起きている間、普段なら気にならないような強い光や音、香りに敏感になってしまう人も多いです。

片頭痛の治療は大きく分けて2通りあります。早く頭痛を和らげるには、急性期治療が行われます。頭痛の起こる頻度が月に数回程度で、日常生活に支障がなければこの急性期治療が行われます。また、予防療法として、頭痛が起こっていない日にも毎日薬を飲んで頭痛が起こらないようにする治療法もあります。発作の回数が多く、生活への影響が強い場合には、急性期治療と予防療法の両面から治療します。

②緊張型頭痛

緊張型頭痛には、反復発作性と慢性の頭痛があります。さらに、頭部筋群の異常を伴うものと伴わないものに細かく分かれます。頭を押さえつけられるような痛みがあり、頭の両側に痛みが現れます。痛みは、30分から7日続きます。頭痛の強さは比較的軽めであり、頭痛で動けなくなることがあっても、寝込んでしまうほどではありません。

緊張型頭痛は、口や顎の機能に異常が起こることで発症します。また、ストレスや不安、うつ、頭痛に対する薬剤乱用などが原因で起こることもあります。緊張型頭痛が繰り返し起こる場合は、鎮痛剤が効果的です。鎮痛剤の使用が月に数回程度の人は通常、予防薬の必要がありません。筋弛緩作用がある抗不安薬を鎮痛剤と併用するといいということもあります。慢性的に起こる緊張型頭痛には、抗不安薬や抗うつ剤が予防策に用いられています。筋弛緩剤の併用が効果的な場合もあります。

③病気に伴って起こる頭痛

頭痛が起こると、脳に何らかの異常があるのではないかと心配になる方も多いです。頭痛が主な症状となる病気にはさまざまあり、代表的な病気にはくも膜下出血などの脳血管の病気、脳腫瘍や感染症などがあります。頭痛の症状がひどかったり、長引いていたりする場合には、専門医の診察を受けておきましょう。特に、急に起こった頭痛で、これまでになったことがないくらいひどい頭痛の場合は、すぐに診てもらいましょう。命に関わる危険な頭痛が考えられます。

頭痛の始まり方によって、脳血管による頭痛であるかどうかの診断の参考になります。クモ膜下出血による頭痛の特徴は、頭痛が起こってからピークになるまで非常に短時間であるのに対し、片頭痛の場合は少なくとも5分、だいたい20~30分かかりますので、区別ができます。まれに例外もあり、突然頭痛が起こった後、だんだん頭痛の程度が強くなるくも膜下出血もあります。

神経内科―頭痛からパーキンソン病まで (岩波新書)
小長谷 正明
岩波書店
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まとめ:頭痛の程度や始まり方などを観察して診断してもらおう

頭痛の中には脳の病気を伴うものもあることが心配されます。頭痛の痛みの程度や始まり方などが正しい診察の参考になりますので、自分の頭痛についてきちんと説明できるようにしておきましょう。

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