1. Neurology Lecture 4a Headaches

2. Headaches • Cephalgia • Headache • The skull and brain tissue are not capable of • Sensory pain

3. Headaches: Pathophysiology • Where does the pain arise from? • Scalp • Dura mater • Blood vessels • Cervical & cranial nerves • Blood vessels • Dilate • Become congested  • Pain

4. Classifications of Headaches • Primary headache • (no organic cause) • Migraine • Tension • Cluster

5. Headache Assessment • Factors that precipitate, provoke, intensify, diminish • Description • Dx testing • Not helpful

6. Migraine • Description • Primarily a vascular disturbance • Recurrent • F vs M? • Female > Male • Familial tendencies

7. 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

8. Migraine: etiology / triggers • Menstrual cycles • Lights • Meds • MSG • Nitrates • Milk • Chocolate • ETOH • Oral contraceptives

9. Migraine: Clinical manifestations • Prodromal phase • Duration • Hrs – days before H/A • S&S • Depression • Irritability • Cold • Cravings • Anorexia • (Same)

10. Migraine: • Aura Phase • Duration • < 1 hr • S&S • Focal neurologic symptom / sensory manifestation • Lights flashing • Spots • Numbness • Confusion • Weakness • dizzy

11. Migraine • Aura phase • Pathophysiology • Painless vasoconstriction • i cerebral blood flow

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

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

14. Migraine: Recovery Phase • Recovery Phase • Pain • Subsides • Tenderness • Neck & scalp • Exhaustion

15. Migraine: treatment • Imitrex (sumatriptan) • Action • Serotonin agonists • Vasoconstriction • i inflammation

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

17. Migraine: treatment • Inderal • Beta-blocker • Action • Inhibit dilatation of the blood vessel • Use • Prevention • Duration of med • 3-6 months  tapper

18. Migraine: treatment • Avoid Triggers

19. Cluster Headaches • Clinical Manifestations • Unilateral • Come in clusters • 1-8 day • Pain localize to the • Eye & orbit • And radiating to the • Facial & temporal regions

20. Cluster Headaches: clinical manifestation cont. • Pain accompanied with • Watering eyes • Nasal congestion • Duration • 30-90 min • Female vs Male ? • F < M

21. Cluster Headaches • Triggers • Alcohol • Nitrates • Vasodilators • Histamines

22. Cluster Headaches • Treatment • O2 • Ergotamine Tartrate

23. Tension Headaches • Define • Emotional or physical stress  constriction of the muscles in the neck & scalp

24. Tension Headaches • Clinical Manifestations • Steady constant pressure • Forehead, temples of back of neck • Band or weight on head

25. Tension Headaches • Associate with • PMS • Stress • Anxiety • Depression

26. Tension Headaches • Treatment • Heat • Massage • Analgesics • Antidepressants • Muscle relaxants • Relaxation • Rest