Neurology

Lecture 4aHeadaches

Headaches

• Cephalgia– Headache

• The skull and brain tissue are not capable of – Sensory pain

Headaches: Pathophysiology

• Where does the pain arise from?– Scalp– Dura mater– Blood vessels– Cervical & cranial nerves

• Blood vessels– Dilate

• Become congested • Pain

Classifications of Headaches

• Primary headache • (no organic cause)

1. Migraine2. Tension3. Cluster

Headache Assessment

• Factors that precipitate, provoke, intensify, diminish

• Description• Dx testing

– Not helpful

Migraine

• Description– Primarily a vascular

disturbance– Recurrent– F vs M?

• Female > Male

– Familial tendencies

Migraine: pathophysiology

• H/A is proceeded by in serotonin level

• Vaso constriction • in serotonin level • Vaso dilitation • PAIN• Migraine H/A are caused by

constriction blood vessels in the brain followed by dilation

Migraine: etiology / triggers

• Menstrual cycles• Lights• Meds• MSG• Nitrates• Milk• Chocolate• ETOH• Oral contraceptives

Migraine: Clinical manifestations

• Prodromal phase– Duration

• Hrs – days before H/A

– S&S• Depression• Irritability• Cold• Cravings• Anorexia• (Same)

Migraine:

• Aura Phase– Duration

• < 1 hr

– S&S• Focal neurologic symptom /

sensory manifestation– Lights flashing– Spots – Numbness– Confusion– Weakness– dizzy

Migraine

• Aura phase– Pathophysiology

• Painless vasoconstriction• cerebral blood flow

Migraine: H/A phase

• Headache Phase– Duration

• 4-72 hours

– Pathophysiology• Vasodilatation• serotonin level

Migraine: Headache Phase

• S&S– Unilateral– Throbbing– Severe / incapacitating– Photophobia– N&V– Physical exerting

Migraine: Recovery Phase

• Recovery Phase– Pain

• Subsides

– Tenderness• Neck & scalp

– Exhaustion

Migraine: treatment

• Imitrex (sumatriptan)– Action

• Serotonin agonists• Vasoconstriction• inflammation

Migraine: treatment

• Ergotamine Tartrate– Take early– Action

• Smooth muscle constriction or cerebral blood vessels

• Cafergot– Ergotamine Tartrate + ?

• Caffeine

– severity of the attack

Migraine: treatment

• Inderal– Beta-blocker– Action

• Inhibit dilatation of the blood vessel

– Use• Prevention

– Duration of med• 3-6 months tapper

Migraine: treatment

• Avoid Triggers

Cluster Headaches

• Clinical Manifestations– Unilateral– Come in clusters

• 1-8 day

– Pain localize to the • Eye & orbit

– And radiating to the • Facial & temporal regions

Cluster Headaches: clinical manifestation cont.

• Pain accompanied with – Watering eyes– Nasal congestion

• Duration– 30-90 min

• Female vs Male ?– F < M

Cluster Headaches

• Triggers– Alcohol– Nitrates– Vasodilators– Histamines

Cluster Headaches

• Treatment– O2– Ergotamine Tartrate

Tension Headaches

• Define– Emotional or physical

stress constriction of the muscles in the neck & scalp

Tension Headaches

• Clinical Manifestations– Steady constant pressure– Forehead, temples of back

of neck– Band or weight on head

Tension Headaches

• Associate with– PMS– Stress– Anxiety– Depression

Tension Headaches

• Treatment– Heat– Massage– Analgesics– Antidepressants– Muscle relaxants– Relaxation– Rest