Neurology Lecture 4a Headaches

Headaches Cephalgia 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 Dilate Become congested  Pain

Classifications of Headaches Primary headache (no organic cause) Migraine Tension 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 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

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 S&S < 1 hr Focal neurologic symptom / sensory manifestation Lights flashing Spots Numbness Confusion Weakness dizzy

Migraine Aura phase Pathophysiology Painless vasoconstriction i cerebral blood flow

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

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

Migraine: Recovery Phase Pain Subsides Tenderness Neck & scalp Exhaustion

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

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

Migraine: treatment Inderal Beta-blocker Action Use Duration of med 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