1 / 26

Neurology

Neurology. Lecture 4a Headaches. 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 

benard
Télécharger la présentation

Neurology

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  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

More Related