NEUROLOGY

HEADACHES

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HEADACHES
Cephalgia
Headache
The skull and brain tissue are not
capable of
Sensory pain
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HEADACHES: PATHOPHYSIOLOGY
Where does the pain arise from?
Scalp
Dura mater
Blood vessels
Cervical & cranial nerves
Blood vessels
Dilate
Become congested
Pain
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CLASSIFICATIONS OF HEADACHES
Primary headache
(no organic cause)
1. Migraine
2. Tension
3. Cluster
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HEADACHE ASSESSMENT
Factors that precipitate, provoke,
intensify, diminish
Description
Dx testing
Not helpful
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MIGRAINE
Description
Primarily a vascular disturbance
Recurrent
F vs M?
Female > Male
Familial tendencies
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MIGRAINE: PATHOPHYSIOLOGY
H/A is proceeded by h in serotonin level
Vaso constriction
i in serotonin level
Vaso dilitation
PAIN
Migraine H/A are caused by constriction blood
vessels in the brain followed by dilation

anwar wardy w fkk umj
Migraine: etiology / triggers
Menstrual cycles
Lights
Meds
MSG
Nitrates
Milk
Chocolate
ETOH
Oral contraceptives

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MIGRAINE: CLINICAL
MANIFESTATIONS
Prodromal phase
Duration
Hrs days before H/A
S&S
Depression
Irritability
Cold
Cravings
Anorexia
(Same)
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Migraine:
Aura Phase
Duration
< 1 hr
S&S
Focal neurologic symptom /
sensory manifestation
Lights flashing
Spots
Numbness
Confusion
Weakness
dizzy

anwar wardy w fkk umj
Migraine
Aura phase
Pathophysiology
Painless vasoconstriction
i cerebral blood flow



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Migraine: H/A phase
Headache Phase
Duration
4-72 hours
Pathophysiology
Vasodilatation
i serotonin level

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Migraine: Headache Phase
S&S
Unilateral
Throbbing
Severe / incapacitating
Photophobia
N&V
Physical exerting h

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Migraine: Recovery Phase
Recovery Phase
Pain
Subsides
Tenderness
Neck & scalp
Exhaustion
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Migraine: treatment
Imitrex (sumatriptan)
Action
Serotonin agonists
Vasoconstriction
i inflammation


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Migraine: treatment
Ergotamine Tartrate
Take early
Action
Smooth muscle
constriction or cerebral
blood vessels
Cafergot
Ergotamine Tartrate + ?
Caffeine
i severity of the attack

anwar wardy w fkk umj
Migraine: treatment
Inderal
Beta-blocker
Action
Inhibit dilatation of the
blood vessel
Use
Prevention
Duration of med
3-6 months tapper

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Migraine: treatment
Avoid Triggers
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CLUSTER HEADACHES
Clinical Manifestations
Unilateral
Come in clusters
1-8 day
Pain localize to the
Eye & orbit
And radiating to the
Facial & temporal regions

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CLUSTER HEADACHES:
CLINICAL MANIFESTATION CONT.
Pain accompanied with
Watering eyes
Nasal congestion
Duration
30-90 min
Female vs Male ?
F < M

anwar wardy w fkk umj
CLUSTER HEADACHES
Triggers
Alcohol
Nitrates
Vasodilators
Histamines
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CLUSTER HEADACHES
Treatment
O2
Ergotamine Tartrate
anwar wardy w fkk umj
TENSION HEADACHES
Define
Emotional or physical stress
constriction of the muscles in
the neck & scalp

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TENSION HEADACHES
Clinical Manifestations
Steady constant pressure
Forehead, temples of back of
neck
Band or weight on head
anwar wardy w fkk umj
TENSION HEADACHES
Associate with
PMS
Stress
Anxiety
Depression

anwar wardy w fkk umj
TENSION HEADACHES
Treatment
Heat
Massage
Analgesics
Antidepressants
Muscle relaxants
Relaxation
Rest
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