1. PBL-1 NEUROSCIENCE Dr. Abdulrahman AL-Shudifat Neurosurgery Dept. Faculty of Medicine University Of Jordan

2. C ASE (1) A 27 year old female patient Complaining of HEADACHE.Duration.Progression.Nature.Aggravating factors & relieving factors.Associated symptoms

3. P ATHOPHYSIOLOGY Stretching of pain sensitive structures in the cranium or adjacent structures.Dura matter.Periosteum.Vessels BRAIN TISSUE IS NOT SENSITIVE TO PAIN

4. LAYERS…….

5. ARTERIES

6. FACIAL SENSATION

7. R EMEMBER … You look for diagnosis!!!!! Diagnosis will lead to…. MANAGEMENT & PROGNOSIS WHAT DO I NEED FOR DIAGNOSIS????

8. STEPS…...Knowledge.Clinical history.Clinical examination.Investigation.Diagnosis or Differential diagnosis.Management

9. T YPE OF H EADACHE Primary: Migraine, Tension, Cluster Secondary: Space occupying lesions, Infections, Vascular

10. I NTRACRANIAL P RESSURE

12. S TRETCHING PAIN SENSITIVE STRUCTURES

13. S PACE OCCUPYING LESIONS

14. C LINICAL H ISTORY Age Pediatric,Young,Elderly Gender Male,Female Duration Acute,Chronic Relieving factors Analgesia,position,Rest Nature description,diffuse,localized

15. P HYSICAL E XAMINATION General Examination Rule out adjacent structure problem Neurological Examination Rule out focal neurological deficit Secondary causes

16. I NVESTIGATION Lab test Radiological( X-ray, CT,MRI,Angiogram ) Specific neurological Investigations

17. M ANAGEMENT Primary Vs Secondary Treat underlying cause Treat by- Simple analgesia -Life style modification -Other level of analgesia or type specific medications

18. CHOICES…..

19. THANK YOU…..